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A Hospital CEO Watches Washington Struggle Over Health Care


House Minority Leader Nancy Pelosi sent a letter the other day to Republican leaders saying that she was ready to take up one portion of proposed GOP changes. So that leads to our other big question - what should change in the insurance markets? Michael Dowling is on the line. He's the CEO of Northwell Health, which is New York's largest health care provider and also provides insurance plans. Good morning, sir.

MICHAEL DOWLING: Good morning.

INSKEEP: So Nancy Pelosi has said she's willing to talk about market stabilization, which Republicans also have wanted to talk about. What needs to be stabilized?

DOWLING: Well, one thing that has to be done is make sure that they don't sabotage what currently exists at the moment, even though legislation did not pass the Senate. The administration has to be sure that it doesn't try to undermine what currently exists.

INSKEEP: Oh, because you are - you're - because many companies are dependent in one way or another on subsidies to keep the markets stable, and there has been talk of the administration not doing that in the way it's been done.

DOWLING: Well, that would be - that would be an unbelievable thing for the administration to do. It would be, I think, pretty ridiculous if they tried to do something like this. So you've got to continue to fund the out-of-pocket costs for people that have high out-of-pocket costs.

They should be talking about putting in place a practical reinsurance program. They should be working together - bipartisans - in a bipartisanship way now to figure out how it you make sure that people who are healthy also buy insurance. Because if the only people who are buying insurance are the very, very sick, you know that premiums are going up. So there is...

INSKEEP: Oh, I'm glad you mentioned this because what you're pointing out is that a lot of younger, healthier people, instead of buying insurance as they're mandated to do, are just paying a penalty, which is cheaper for many people.

DOWLING: Absolutely. So they have to take a look at how to deal with the penalty and how to fix the mandate in such a way that people are incentivized to get insurance because, otherwise, you've just got only sick people getting insurance, which means premiums go up. And it makes it less stabilized. So I do think that there is an opportunity for bipartisanship solution here if both sit down at the table, as they should have done months and months ago, and figure out how to fix what is rather than try to throw out the whole thing altogether.

INSKEEP: You have said that you were concerned about overregulation with Obamacare. What's a regulation that's costing you?

DOWLING: We've felt - you know, there's a risk adjuster regulation that was a part of Obamacare that - it provides unbelievable problems for new insurance companies. The formula is - does not work correctly, penalizes new, stopped-up companies. And then there is the overall issue of regulation, where there is this assumption that nobody has good intentions unless they are overseen on a regular basis by the bureaucrats out of Washington.

INSKEEP: Oh, you're feeling like you are just - people do not like insurance companies, and you're feeling like you are not trusted, basically.

DOWLING: Yes, basically. We're all bad people trying to do bad things unless there's some bureaucrat looking at us all of the time, and I think that's a ridiculous position to be taking. I do believe that a lot of the regulatory body needs to be released. This does not mean that I'm against regulation. I was a regulator myself one time. But there is sensible regulation, and then there is unnecessary microregulation. And when it goes too far, it becomes dysfunctional.

INSKEEP: Well, Dr. Dowling, thanks very much for your insights. I really appreciate it.

DOWLING: Thanks so much.

INSKEEP: Dr. Michael Dowling is the CEO of Northwell Health in New York, which provides health care as well as health insurance. And he's speaking on this Monday after the United States Senate rejected several health care plans.

[POST-BROADCAST CLARIFICATION: In this story, CEO Michael Dowling is referred to as Dr. Dowling. While he does hold honorary doctorates, he is not a medical doctor.] Transcript provided by NPR, Copyright NPR.

Corrected: August 1, 2017 at 12:00 AM EDT
In this story, CEO Michael Dowling is referred to as Dr. Dowling. While he does hold honorary doctorates, he is not a medical doctor.

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