Roy's plan

I found two novel (to me) and interesting points in the heath insurance reform plan  put forward by Avik Roy of the Manhattan Institute. (His Forbes articles here.)

First, the ACA establishes that it is ok to help people by subsidizing their purchase of private health insurance. It is not necessary to provide completely free insurance, medicaid, VA, medicare, and so on.

Yes, the health insurance you can buy has been salted up with extras, competition severely restricted, and large insurers so deeply in bed with their regulators that to call insurance "private" is a stretch and "competitive" a dream. But people do have to pay something, if they want better coverage they have to pay more, and the insurers are still nominally private companies.

Second, it is ok to ask people to contribute pretty substantial copayments.  That's a vital component to getting a functioning health care market.

Avik cleverly suggests to ACA opponents not try to throw the whole thing out. Instead, expand on these good parts.  Keep the exchanges, reform and open them up, reform the policy requirements, then slowly transition medicare, medicaid, and even veterans and government workers to exchange policies. Shh, don't call it a "voucher."

If King v. Burwell surrenders to simple logic, it's clear that there will be a quick renegotiation: what reforms do ACA opponents get in return for allowing federal subsidies.  These points offer an interesting direction for that negotiation.

It is sad that the ACA's legal problems are completely unrelated to its economic problems. Whether subsidies go through Federal or State exchanges is an economically irrelevant question. And the Federal Government has the constitutional power to pass all sorts of economically disastrous laws. This divergence is leading to particularly pointless arguments.