Pricey Mr. President-elect:
Your place on common medical health insurance has been admirably clear. You help it. You probably did earlier than you ran for president and continued to take action within the marketing campaign.
In 2000, you wrote, "We will need to have common healthcare." In a Fox Information debate final 12 months, you stated, "We've got to care for the individuals that may't care for themselves." On "60 Minutes," you stated, "Everyone's acquired to be lined."
I'm writing to you now as a result of I'm involved that Republicans in Congress don't share your aim and usually are not providing you with good recommendation on this subject. I'm apprehensive that they aren't appearing in the perfect pursuits of your presidency or the nation. I encourage you to be skeptical of them.
It's fully attainable so that you can signal a conservative well being care invoice that lives as much as your perception in common protection. It's a invoice that you may have a good time as a alternative of Obamacare. However it will be fairly completely different from the payments that congressional Republicans are pushing.
Once they declare that their payments won't take medical health insurance away from thousands and thousands of individuals, they're partaking in magical pondering. They're attempting to idiot the media, voters and also you.
They're specializing in a technique of "repeal and delay," wherein main elements of Obamacare will stay for months or years. In the meanwhile, they are saying, they are going to one way or the other preserve individuals from shedding insurance coverage.
However they don't have a sensible plan, regardless of years of speak. Nor, to be blunt, does your alternative for secretary of well being and human providers, who's a kind of congressional Republicans. And a repeal is prone to undermine insurance coverage markets lengthy earlier than its efficient date.
Mr. President-elect, you're a businessman. You perceive that savvy executives don't merely stay within the current. They give the impression of being to the longer term. They're keen on quoting Wayne Gretzky: "Skate to the place the puck goes, not the place it has been."
Insurance coverage executives can see by means of the magical pondering of politicians. They know functioning insurance coverage market should embrace each wholesome and sick individuals. There are only a few methods to ensure this mixture. With out Obamacare's subsidies to assist individuals purchase protection and its mandate (weak as it's) to require they've protection, markets will break down. The wholesome will go away, the sick will keep and prices will soar.
After a repeal is signed, the uncertainty will give insurers purpose to exit rapidly. As Nicholas Bagley, a number one professional on the College of Michigan, says, "When you're an insurer, you're prone to head for the hills."
The chaos runs a excessive threat of leaving thousands and thousands of individuals with out insurance coverage early in your presidency. A lot of them might be members of the white working class who voted for you. Everybody who loses insurance coverage might be grist for criticism of you.
As you understand, the Republican leaders in Congress have by no means been your largest followers. I feel it's honest to say that they care extra about having the ability to brag that they removed Obamacare than about your political standing. The payments they're contemplating threaten your standing.
However you've gotten options.
The essential first step is to keep away from repealing the insurance coverage enlargement with out concurrently changing it. The brand new Congress involves Washington subsequent week, and its members ought to know the place you stand from the start. It received't work to vow thousands and thousands of individuals medical health insurance on spec.
When you keep away from this entice, you possibly can then push each events towards a distinct model of common well being protection.
"There's a ton of coverage house for compromise," as Bagley says. "There's room for a extremely fascinating dialogue and probably a breakthrough that might rebrand Obamacare and exchange among the parts of it that the majority set Republican tooth on edge." You'll like this, Mr. President-elect: Bagley additionally says you're "the form of politician who might minimize a extremely fascinating deal."
That deal might give states extra flexibility to fulfill the top-line protection objectives. It might rely extra closely on subsidies to deliver wholesome individuals into the market — and in the end scrap the mandate. It might allow insurers to cost younger individuals much less (and older individuals extra). It might create incentives for private accountability, permitting larger costs for individuals who have voluntarily gone with out insurance coverage.
I might be sincere that I don't favor a few of these concepts and fear that they might trigger hardships. However I used to be not elected president, and also you had been. And all of those concepts are inside the realm of significant debate about our well being care system.
On your sake and the nation's, I hope you insist that Congress offers in actuality. Magical pondering isn't good for a presidency.
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