I still think the idea of using a public health insurance exchange system to help everyone get health coverage was a nice idea to try.

Some states, like California, have gotten their exchange programs working well enough that the programs could be politically self-sustaining. Maybe the politicians will have to find a way to keep those exchange programs going.

If, instead, we moved to a pure government-run, single-payer system: One way to keep it moving might be to have an A Plan version and a B Plan version compete for enrollees through an exchange. At least that way, each plan would have some incentive to provide decent service.

If we moved to a pure free-market system, then we’ll go down that road knowing that health insurance supermarkets are great. Some people need to talk to live humans to get suitable coverage. Other people need to buy coverage that’s sort of OK right now, this second, online.

Unfortunately, one huge obstacle to taking the next step is that many ACA opponents hate the ACA too much to look at the exchange system with clear eyes. They can’t learn from it because they can’t see it.

Another, related problem is that the U.S. Department of Health and Human Services and its child, the Centers for Medicare & Medicaid Services, have run the exchange system, the ACA risk-adjustment system, the ACA risk corridors program and the ACA Consumer Operated and Oriented Plan program in such a secretive way that they’ve ruined its educational value for ACA supporters, and for people who would prefer that the country shift to a single-payer system.

One sign of the ACA’s complete lack of educational value for people on the left and center left: The people who blame ACA World’s current problems mainly on high health insurance company executive salaries, health insurers’ atrocious greed, and the mere fact that private organizations are involved in the health care system.

Related: Insurers fight to keep suit over $5 billion in ACA payments alive

(Photo: Thinkstock)

Shame health insurance company executives, some seem to think, and they might cut their spending on diamonds and gold coins enough to lower premiums a bit. (Photo: Thinkstock)

One popular approach: Louder yelling

I think the CO-OPs have been dying like flies because running a stable health insurance company is hard, not because the executives at those new, nonprofit, member-owned carriers were all greedy bastards who were raking in the big bucks.

All we have to do to make things better is yell at the insurance companies harder, until they’re ashamed of themselves and lower prices. Then buy fewer diamonds and spend a little less time playing with their giant chests full of gold.

Some slightly more sophisticated ACA supporters are chuckling and saying the departure of companies like Aetna, Cigna, Humana and UnitedHealth Group from many state exchange programs is no big deal, because, hey, Centene, Molina and small, local plans will rise up to fill the void.

In some cases: Sure. In other cases: How are the surviving carriers supposed to handle hordes of new enrollees who were too sick for Aetna and UnitedHealth to handle? Too much enrollment love might smother the surviving carriers with claim costs they have no realistic way to pay.

I think one reason ACA supporters have learned so little is that the ACA program managers are about as open and transparent as the government of North Korea.

Related: Clinton names 3 transition leaders with health experience

Failing CO-OPs put out failure announcements that seemed to come from the same standardized CO-OP failure template. Some hinted that nondisclosure agreements or non-disparagement agreements kept their former managers from talking freely.

Similarly, it’s not clear how much freedom the managers of the state-based ACA exchange programs have to talk about what they’ve seen.

The result is that few, if any, progressive-hearted ACA World insiders are talking about their experiences in a language that other progressive people can understand.

The ACA haters continue to hate. The ACA lovers continue to repeat some talking point or other that’s too silly for anyone else to process.

People who like the goals of the ACA, appreciate what the creators of the various programs were trying to do, and have direct, detailed knowledge about what wrong mostly keep their mouths shut. 

If, for example, more progressive-hearted former CEOs of failed CO-OPs were out there talking about what paying claims is really like, maybe people in the independent, non-partisan think-tank-ocracy that somehow always echoes Democratic positions would have a better understanding of what would-be health reformers are up against. 

Related:

Sanders says Aetna move shows need for Medicare for all

Colorado single-payer plan would quickly implode

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