Readers React: Obamacare tests the limits of our system’s ability to provide care

To the editor: Although I agree with much of your editorial, recognize that the Affordable Care Act represents the largest-ever expansion of Medicaid. (“Campaign 2016: GOP plans to repeal Obamacare won’t bring the change you’re hoping for,” editorial, March 7)

Currently, roughly one-third of Californians have Medi-Cal (our Medicaid program). Recent studies have proved that even the uninsured have better health outcomes than people with Medi-Cal, and low reimbursement rates for Medi-Cal providers are having adverse impacts on our economy.

I disagree with your argument against selling insurance across state lines. With the elimination of the preexisting disease exclusion and the mandate for community rating, more competition and open marketplaces would lower costs.

As companies and unions self-insure and 90% of the purchasers on the Covered California health insurance exchange are subsidized, the rest of us bear the burden with forced narrow networks and increasing premiums.

Howard C. Mandel, MD, Los Angeles

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To the editor: In the United States, healthcare costs about twice per person as in the rest of the developed wold. Plus, our health outcomes in many categories rank much lower than those in countries where care costs far less.

The Times’ simplistic solution is to reorient a system profiting from sickness and injury to one that profits from wellness and prevention. So, we should stop having sick people?

Aside from the disconnect, you can’t change a system if you don’t have one. As former Kaiser Permanente Chairman George Halvorson said: “There is no such thing as a legitimate price for anything in healthcare. Prices are made up depending on who the payer is.”

So we need a system, and we shouldn’t expect massive, monopolistic insurance companies to be the change agents that bring about cost controls and pricing sanity. Single payer (also know as Medicare for all) is our salvation system, and if democracy worked here as it has in other countries, that’s what we’d already have.

Terry De Wolfe, Monterey Park

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