MICHAEL L. MILLENSON HIGHLAND PARK, ILL.

The writer is president of Health Quality Advisors.

To the Editor:

I commend Bret Stephens for pointing out the inconvenient truth that both Obamacare and Trumpcare suffer from an insurmountable problem: For-profit health care is a contradiction in terms. Insurance companies are most concerned about profitability, and profits are derived from high co-payments and premiums, discrimination against those with pre-existing conditions, expensive prescription medications (often with adverse side effects), excessive high-tech screening and surgical solutions. These approaches are not affordable for many people and may not produce good health, which frequently depends more on healthy diet and lifestyle choices, which are not profitable.

As Mr. Stephens points out, both Democrats and Republicans are only tinkering with the same unfixable formula. There is a solution to this problem, however, and it is not the H.S.A.s that Mr. Stephens endorses. The solution is a single-payer health care system. Single-payer health care, by eliminating the pursuit of profit, both reduces health care costs and improves health care outcomes. It is a disgrace that the United States pays at least twice as much per capita for health care and yet has some of the worst health care outcomes in the industrialized world.

Why is the United States the only industrialized country without a single-payer health care system? Perhaps the insurance and pharmaceutical company lobbyists have the answer.

BEVERLY BURRIS ALBUQUERQUE

To the Editor:

Bret Stephens is right to point to the importance of medical cost control, but his suggestion that the Obamacare exchanges are fundamentally unworkable is nonsense. In essence, all Obamacare attempted to do was bring the benefits of group insurance, which covers most working-age Americans, to those without employer-sponsored coverage. Thus the core concept had substantial precedent and was perfectly sound.

And it has succeeded. In an April analysis reported on by The Times (Insurers Stem Losses, and May Soon Profit, From Health Law Plans), Standard & Poors showed that Obamacare enrollee medical costs which shot up rapidly during 2014 and 2015 have since fallen back to comparability with group-policy enrollee costs. We have now weathered the start-up storm. The primary remaining threat to stability in this market is uncertainty around potential disruption by the president and Republican-controlled Congress.

STEVE LEOVY, BOULDER, COLO.

To the Editor:

Re Understanding Republican Cruelty (column, June 30):

Paul Krugman rightly laments the gratuitous cruelty of Republicans in their proposed health bill. It didnt used to be this way.

In 1935 in the House of Representatives, 284 Democrats and 81 Republicans voted to pass the Social Security law; 15 Democrats and 15 Republicans voted against.

In the Senate, 60 Democrats and 16 Republicans voted in favor; one Democrat and five Republicans voted nay.

After the House vote on the bill, The New York Times editorialized that the Republicans, who were its chief critics during the debate, wound up by voting for it overwhelmingly. That was before a morally indefensible agenda, in Mr. Krugmans words, became the name of their game.

SUSAN DUNN WILLIAMSTOWN, MASS.

The writer is a professor of humanities at Williams College.

To the Editor:

Paul Krugman attempts, as so many others have, to explain the brutal and inhuman cruelty of opposition to Obamacare by some fellow Americans. We can reduce the difference between the major parties to bumper-sticker length. For Democrats: Help Others. For Republicans: Help Yourself. The difference of a single word can explain a divided nation.

HOWARD SCHAIN, NEW YORK

To the Editor:

Re Going Small on Health Care, by Ross Douthat (column, July 2): The fundamental problem with going small, as well as the current attempt to repeal and replace, is that both do nothing to bend the curve on the growth of health care costs and spending. A braver approach would be to go even bigger.

Rewrite Medicare, Medicaid and our employer health care plans to mandate capitation (a fixed fee per patient) with health care providers. This gives providers more skin in the game vis--vis overall cost. Give foreign drug companies, vaccine manufacturers and device makers easier access to our markets, and have the government negotiate with them directly accepting only prices that are no higher in the United States than in other G-20 countries. Make high-deductible plans with health savings accounts the standard across the board, even if government has to partially fund these accounts to give all health care recipients a stake in the use of medical resources. Democrats and Republicans should either go big or go home.

RACHEL BRONHEIM, NEW YORK

To the Editor:

Ross Douthat nicely summarizes the difficulties both parties faced in attempting unilaterally to solve our national health care problems. And while I am no fan of our new president, he should recognize that he now has a chance to do something positive by forcing a bipartisan approach.

First, a family member must explain to him that both the House and Senate Republican health care bills fail to meet his own requirement of containing a heart. Second, he should announce that he will sign only a health bill that has strong bipartisan support. President Trump has a chance to demonstrate his alleged skill in the art of the deal by helping to solve a real national problem.

LAWRENCE CHRISTMAS OAK PARK, ILL.

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A version of this letter appears in print on July 9, 2017, on Page SR10 of the New York edition with the headline: How to Improve U.S. Health Care.

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How to Improve US Health Care - New York Times