regarding your editorial <u+201c> the trump obamacare panic <u+201d> (nov. 15): you argue that obamacare<u+2019>s rising costs are due to its attempts at income redistribution, and that it<u+2019>s a myth that only government can require insurance for those with pre-existing conditions. i remind the journal that original medicare, medicare advantage and the medicare drug benefit all involve income redistribution. each of these programs requires insurers to take all comers. excluding people with pre-existing conditions is prohibited. obamaccare is much closer to a market-based health-insurance solution than medicare, medicaid or employer-based insurance. obamacare at least allows insurance companies to punish consumers for smoking, for living in high-health-cost areas and to some extent for getting older. it doesn<u+2019>t allow individual ratings that a purely free-market approach would. a pure free-market approach cannot succeed for universal health insurance. low-income people and those with pre-existing conditions simply will not be able to afford insurance with a free-market plan. huge public subsidies (refundable tax credits are the same thing) are required if everyone is to have insurance at an affordable price. you can do away with obamacare but you still have to pay for subsidies one way or another. republicans now seem resigned to a program of tax credits instead of the obamacare subsidies. if they do this on a sufficient scale, president obama and the liberals will have achieved their policy goal: universal coverage and a further expansion of the welfare state. john pearson alexandria, va. my nephew recently passed away from cancer. he was a carpenter who had been laid off. his cobra policy expired several months before obamacare<u+2019>s provision prohibiting insurers from considering pre-existing conditions in issuing a health-care policy came into effect. he searched fruitlessly to find a policy that he could afford in the interim. he could get a policy that excluded treatment of his cancer or a policy with a premium and deductible he could not afford. he struggled to pay his doctor and chemotherapy bills out of his savings and luckily had no hospitalizations while he had no insurance. then obamacare kicked in. he was able to get an expensive but affordable policy that covered most of his treatment costs, including a long hospitalization at the end of his life. your editorial does not square with my nephew<u+2019>s experience. tom meyer valhalla, n.y. quality, patient-centered affordable health care will become a reality once again only when working families take back responsibility for rationing and paying for their health care. before employer paid <u+201c>insurance<u+201d> coverage became the norm after world war ii, most families spent about 5% of their income on health care. families today are spending 18% of their income for health care. the big difference between generations is today<u+2019>s working families think they are spending their employer<u+2019>s money, not their own money. family rationing for health care spending is a thing of the past and <u+201c>costs<u+201d> exploded. rick leavitt chatham, mass. health-care insurance companies require that premiums are paid in advance. when you fill out your application, you include your first premium. it even works this way when enrolling under the affordable care act. tax credits of any kind are given retroactively, so that the tax credit for 2016 won<u+2019>t be awarded to taxpayers until they file their income tax in 2017. under the plan you suggest, a family might have to find the $1,000 (for example) a month premium for 2016 ($12,000) before being able to apply for their tax credit subsidy when they do their taxes in 2017. many people won<u+2019>t have that $12,000 to pay for health-care insurance. the discussion regarding a <u+201c>fair<u+201d> price for health care must begin before anything can move forward. is it 10% of your income? is it 15%, 25%? if you pay income and payroll taxes of 20%, a mortgage of 30% and health-care policy consuming 25% of your income, you have 25% of your income to pay for everything else. do you forego owning a home so you can have health-care insurance? do you not save for your retirement or the kids<u+2019> college education so you can have health care now? kim eyring kalaheo, hawaii
trump has his health-care work cut out - wsj
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