Tom Price knows how to replace your knee. That may not be the same thing as knowing how to pay to replace your knee. (Photo: Price's office)

I think the reality is that whatever Democrats hate, or find themselves surprised to like, about Donald Trump’s U.S. Department of Health and Human Services, a little cabinet secretary stock won’t have all that much to do with those reactions.

This week, Democrats in the Senate grilled Rep. Tom Price, R-Georgia, Trump’s nominee to be the next HHS secretary, over possible violations of congressional conflict-of-interest guidelines.

But, of course, the fundamental problem with Price is that he’s intent on dismantling the Affordable Care Act.

Related: HHS nominee hearing bares Senate ACA stabilization fight

He may not necessarily have the world’s most detailed slidedeck to support his proposals for replacing the ACA. But, on the other hand, whatever the recent presidential elections proved, it seems fair to say that many voters are skeptical of the player with the best slidedeck. They want to see a 140-character tweet that seems to make sense at first glance, not to wade through 30 pages of graphs that may well prove to them that up is down and back is front.

Many voters out in the areas where the only decent jobs with benefits left are government jobs are tired of looking at graphs and slidedecks that make it look, on a monitor, as if they are doing well. Meanwhile, out in the brick-and-mortar world, they feel awful.

On the other hand, the HHS secretary is in charge of some of the biggest health insurance programs in the world. Not just the ACA public exchange system, and the ACA rules and programs that affect the off-exchange commercial health insurance market, but also Medicare, Medicaid and the Children’s Health Insurance Program.

Price is an orthopedic surgeon. He wants patients to get great care. He wants his colleagues to do well without so many horrible hassles. He probably wants every other good thing anyone can want.

But, at some point, he was talking at a confirmation hearing about how deductibles are keeping patients from getting some of the care they need, and it occurred to me that he might suffer from a weakness that affects most people who have not spent a great deal of time looking at the health care system from the perspective of people in the insurance industry: the idea that you can solve most health care finance problems by getting health insurers to lie on the ground, put a big board on top of the health insurers, and then have everyone jump up and down on the board.

No, that won’t work. Health insurers don’t eat up all that big of a share of the U.S. health care dollar, and, when they do eat some of the dollar, that’s often because they’re trying to comply with some government mandate that sounds great in conversation but is expensive and difficult to implement.

So, OK: This is earth, not the Planet of the Bright Blue Democrat Fairies. The Democrats in the Senate should swallow hard, approve Price, and be glad he has first-hand experience with what it’s like to be a physician treating a broke patient.

I think insurers should lobby for Price to agree to appoint a top deputy who is an actuary who has extensive experience with community rating programs that unraveled, small-group purchasing coalitions unraveled, and all sorts of other experiences that drove home the point that making health insurance programs work is a lot harder than it looks, and takes a lot more than getting on top of the health insurers and jumping up and down really hard.

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