phil gramm worries that hillary clinton plans to push for a single-payer health-care financing system once elected president (<u+201c> where clinton will take obamacare ,<u+201d> op-ed, oct. 18). we can only hope! the only way to have affordable and adequate care that doesn<u+2019>t exclude the sick and the marginally poor is a taxpayer-funded system that would expand medicare to cover all americans. as long as 15-30 cents of every dollar we spend on private insurance goes toward profit, marketing and exorbitant executive compensation, it will be impossible to achieve reasonable cost and universal coverage. we already spend more than twice as much per capita for health care than any other country and have nowhere near the best outcomes. i would be surprised if a president hillary clinton pushes for a single payer, but good for her and us if she does. gerald gollin, m.d. solana beach, calif. contrary to phil gramm<u+2019>s excellent op-ed, the hillarycare single-payer <u+201c>goliath<u+201d> will more likely be public-corporate cartels having the facade of private insurance. hmo/aco (accountable-care organization) cartels protected by government sovereignty are now being created through 2011 federal trade commission waivers of antitrust laws. the cartels are enabled to collude in price fixing, franchising and <u+201c>gainsharing<u+201d> profits through centers for medicare and medicaid services waivers of antifee splitting and antiself-referral laws. further, the 2015 <u+201c>doc fix<u+201d> law legalizes coercion of clinician gatekeepers at the nation<u+2019>s bedsides to profit the cartels. order <u+201c>too much<u+201d> and gatekeeper pay is deceased<u+2014>a <u+201c>negative payment adjustment<u+201d>; order less and pay is increased<u+2014>a <u+201c>bonus opportunity.<u+201d> this is fed-speak for volume (or utilization) pay; it is not for <u+201c>quality<u+201d> or <u+201c>value<u+201d> pay. doctors not playing corporate-cartel gatekeeper roles will be out of the income stream. mr. gramm is correct. goliath <u+201c>reforms<u+201d> will continue with hillary clinton. robert w. geist, m.d. st. paul, minn.
how clinton will try to build on obamacare - wsj
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