I read with interest the commentary by Carmela Coyle and Hank Greenberg attacking the Senate bill designed to modify the Affordable Care Act, or Obamacare (“Costs too great in Senate health care bill,” June 26). While I am not a fan of many aspects of the health care legislation being considered in Congress, I can’t help but marvel that anyone would defend the status quo.The Affordable Care Act has not fixed the fundamental problems with health care in the U.S. In fact, it has made many of these problems worse. Something needs to be done to fix the mess made by Obamacare.

With its subsidies, mandates and Medicaid expansion, Obamacare masks the financial issues that continue to plague the health care sector. Simply put, health care spending — and especially government spending on health care — is rising at an unsustainable rate.This is especially true for Medicaid. Ms. Coyle and Mr. Greenberg may not like the Senate’s proposed changes to Medicaid, but that program must be reformed before its fiscal burdens crush taxpayers.This was true prior to the passage of Obamacare and is even more urgent with this law’s Medicaid expansion.

Obamacare also reduces patient choice. As we see in Maryland’s insurance market, this law’s rules are making it impossible for many insurance companies to offer policies. Maryland is far from the only state that has seen providers exit the market, leaving health insurance consumer with few choices. The bill also gives health care providers an incentive to consolidate, leading to fewer options for those looking for care.

In addition, as stories around the country attest, for many Americans the law’s promise of “affordable” insurance has turned out to be a cruel joke.

While there are more Americans with health coverage, the U.S. health care system still suffers from underlying problems that will only worsen as time goes on. It’s time for real health care reform, not a defense of the unworkable tenets of Obamacare.

Marc Kilmer, Rockville

The writer is a senior fellow with the Maryland Public Policy Institute.