Healthcare is the policy problem that humbles everyone. It is too expensive, too complex, and too entangled with decades of accumulated government intervention to yield to simple solutions. Anyone who tells you otherwise is either running for office or selling something.

The 2017 debate over the Affordable Care Act’s replacement exposed just how difficult the problem really is. The proposed American Health Care Act satisfied almost no one — too disruptive for moderates, not market-oriented enough for purists, and deeply unsettling for the millions whose coverage depended on the existing framework. That’s not a coincidence. It’s a reflection of how thoroughly the healthcare market has been distorted by a century of policy layered on policy, each one responding to the unintended consequences of the last.

The starting principle should be straightforward: every American deserves access to affordable, quality healthcare. That’s not a radical statement — it’s a moral baseline. The disagreement is entirely about how to get there, and that’s where honest thinking matters most.

A functional market requires broad participation. Tax credits structured around both age and income — rather than one or the other — are a sensible way to keep more people covered, particularly younger Americans who currently opt out and destabilize the risk pool for everyone else. This isn’t a government handout; it’s an acknowledgment that the individual market cannot work if only the sick show up.

Medicaid deserves the same honest treatment. It serves the most vulnerable — the poor, the disabled, those who fall through every other crack in the system. Any reform that reduces its funding without a credible plan for those populations isn’t fiscal responsibility. It’s cost-shifting dressed up as principle.

The most underused tool in this debate is genuine market competition — across state lines, across provider networks, with transparent pricing that actually means something. The healthcare industry has operated for too long behind a wall of opacity that benefits incumbents and punishes patients. Real market reform would dismantle that wall, not just rearrange who sits behind it.

None of this is simple. But the direction is clear: more choice, more competition, more transparency, and a genuine safety net for those who need it most. That combination isn’t a contradiction — it’s the only approach that has any chance of actually working.

For reference, see the AHIP letter on the AHCA from March 2017: AHIP Letter re AHCA 3-8-2017

We can still do this.