Dear Mr. Trump,
Congratulations on your election. You certainly surprised me and a great many others here on the west coast. Normally I am not one to write to leadership, as it seems that positions are deeply entrenched. You, however, have shown a willingness to modify your positions in response to your constituency. As a repeal/revamp of the Affordable Care Act is at the top of your priority list, I thought I would offer my perspectives.
First, though, I would ask that you make a public effort to mend the rifts caused by one of the most negative campaigns in history. Among your supporters there are those who are openly and angrily racist, white supremacist, homophobic, and transphobic. These people are a small minority of American citizens, but they have felt emboldened by your election to bring their hate into the public sphere. On behalf of my friends who are black, Muslim, gay, and transgender, I ask that you publicly denounce these people and their behavior. For better or worse, the haters mostly gave you their votes, but you do not need their support to govern. Every American has a right to feel safe in this country, and too many have been living in fear since last Tuesday.
With regard to health care, here is my proposal:
- Keep the private insurance companies, at least for now. The federal government is nearly collapsing under its own weight, and the added bureaucracy involved in federal single-payer health insurance may well be untenable. I feel that single-payer insurance would be a positive step but that it is best administered at the state level.
- Change the individual mandate to an individual incentive, e.g. an additional tax deduction for insured taxpayers rather than a tax penalty. People like carrots better than sticks, and the effect would be the same in encouraging healthy people to carry insurance.
- Standardize risk pooling. Create a set of criteria that insurance companies may use to set premiums (e.g. age, tobacco use, local cost of care, chosen coverage/deductibles), and require insurance companies to charge equal premiums for equal plans to everyone. No more special “large group” employer and institution plans with lower premiums and higher benefits. My car insurance is the same whether I work for Google or run my own farm. Health insurance ought to work the same way.
- Standardize costs of care. An MRI has a specific cost in terms of labor, equipment, and overhead, and this is the same regardless of the patient. So an MRI ought to cost, say, $700 for everyone, NOT (as is currently the case) $600 for in-network insurance companies, $900 for out-of-network insurance companies, and $1200 for patients paying out-of-pocket. With cost standardization, we could greatly increase transparency while eliminating the in-network/out-of-network distinction and allowing (as you have suggested) for insurance companies to provide nationwide coverage and compete across state lines.
Thanks, and best of luck in governing our divided nation.
Sincerely,
Mark Luterra
Corvallis, Oregon