That does not work because of the adverse selection problem. Your pundit is just wrong. If only old, at risk people buy cancer insurance, that coverage becomes unaffordable. You may think you don't want to pay for someone's pregnancy coverage, but you definitely want to be in a pool with young people. The choose from a menu approach changes the pools in ways that are not good for anyone.
I agree that a government sponsored single payer plan is better than the cobbled up approach first tried by Mitt Romney. I also think that Dems expected Obamacare to gradually replace employed sponsored insurance, which would have changed the politics of it. HEalth insurance can't be re-organized in a rational way because no one wants to give a plan that someone else pays for, and that is a lot of people. That would change if employer plans were gone.
And what we have works now? You should at least do some homework. In 2014 8M people paid the penalty, that was $1.7B that was taken from people that ended up in general revenue. Yea, that helped spread the risk and I am sure those folks could afford it too.
In 2017 the average bronze level premium for age 60+ is $8900 and the deductable is $6900. It jumped 27% in one year for all age groups. Next year places like Knoxville Tn will have no plans available because all the providers are pulling out. Costs are skyrocketing, companies are leaving the market, I would call that a failure.
I agree with this to some extent. Trump is certainly helping the "death spiral" along by making it harder for insurance companies to get paid.
Look, even Obama wasn't happy with Obamacare. He knew he couldn't get single payer through, and hoped that the individual mandate would create an inevitable slide towards single payer. Without the mandate Obamacare is toast.
That said, it seems there is really no turning back to the way it was, so we'll probably end up with single payer, but it's likely to be a more painful route.
"If it's my mountain, I'm installing a fixed grip and telling the lifties to stuff the beginners into chairs as aggressively as they have to to keep it going full speed." —Brownski