One strange phenomenon in contemporary American life is what I call “Affordable Care Act denialism” in which someone will simply refuse to acknowledge that the most significant bill of the 111th Congress existed, passed, and contains provisions that do things. For example, Matt Bai complains that “Either we’re being told that centralized, 20th-century systems can never be changed to accommodate more individual flexibility (like say, decoupling health care from employment), or we’re being told that all federal programs are wasteful and that every American should basically fend for himself.”
That’s shameful! An appropriate policy remedy might be to set up health insurance exchanges in which people will be able to choose from themselves one out of several health insurance plans offered by different providers. Needless to say, in order to avoid adverse selection problems you’d need a regulation forcing participation in the exchanges. You’d also need to provide subsidies to make purchase affordable to people with modest incomes. To avoid needlessly disrupting people’s lives, you’d want to transition away from the employer-based system into the exchange-based one gradually. And to raise some of the necessary funds, you might launch a phased rollback of the current tax subsidy for employer-provided health insurance. All this and more was done by the last Congress amidst a widely publicized and highly contentious debate.