I write this five weeks before Donald Trump is set to take office as president of the United States. About all I feel confident about predicting is that the universe will contain molecules.
If Donald Trump persuaded all of the Democrats in Congress to vote to repeal and replace the Affordable Care Act during his first month in office, that would make me nod sagely and read a few ACA repeal articles.
If Trump simply kept most of the ACA in place as is, tweaked the premium tax credit system and expanded the health savings account program, that would make my head spin, but slowly. Health reform is hard.
Trump is a man who’s used to cutting through complicated problems, and many of his early cabinet secretary picks are people who are used to finding clear, straightforward paths through complicated problems.
A pick for Defense secretary, James Mattis, is a retired Marine Corps general who has said that he has never been at a loss for ideas because he has read widely and learned from the experience of the people who have come before him.
On the one hand, that kind of respect for the idea of reading up could come in handy for anyone who hopes to replace the Affordable Care Act commercial health insurance programs with something simpler and cheaper, rather than replacing one snarl of regulatory spaghetti with a new snarl of regulatory spaghetti. Someone who respects reading might scour the libraries of the nation for old bound print volumes of National Underwriter Life & Health. Cabinet secretaries who peruse those will learn of the sad fate of health reformers in states such as Kentucky and Washington, which eliminated individual medical underwriting and chased most of the carriers away.
On the other hand, cabinet secretaries who are used to finding simple, straightforward solutions to problems might have a hard time dealing with health insurance. People who are used to wandering around wondering where they left their phone might be more comfortable with that foggy universe.
Some free-market purists do have a simple solution: They say that people who can pay for care, or persuade others to pay for it voluntarily, should get it, and that no other free adult civilians should.