Atlas Shrugged is a novel set a world in which the productive people get sick of government red tape and go on strike.
In my opinion, it's about time for U.S. health insurers to shrug.
To some extent, they already have gone on a very polite, quiet strike, by "reducing their Affordable Care Act exchange footprint" and refusing to pay agent and broker commissions in the individual health insurance markets in which they continue to operate.
But, given that even Republican candidates and officials have been talking about them as if they were the useless spawns of Satan, it would serve the United States right if the health insurers could figure out how to transport all possible operations to a resort hidden deep inside a volcano somewhere and let the rest of us figure out health finance.
What makes the departure of health insurers critical right now is lawmakers' utter lack of interest in their solvency.
The "moderate" Republicans, including Senate Majority Leader Mitch McConnell, now seem to be inclined to repeal parts of the ACA quickly, through a fast but complicated and limited process called budget reconciliation, and then replace the ACA later.
If the Republicans figure out a reasonably complete repeal-and-wait strategy that insurers believe protects their solvency: Great. Whether I like or dislike the new system, at least that approach to replacing ACA with "TrumpCare" would start out making apparent financial sense.
The replacement system might not end up working any better than the ACA system, but you pay your money and you takes your chances. If the Republicans at least make an honest effort to resolve the solvency problem, that's all that can be expected.
If, on the other hand, Republicans go ahead with some kind of repeal-and-replace strategy that depends on the "replace" component to keep the health insurers solvent, and they have no idea when they'll be able to get the replacement component through Congress: That's not very nice.
The whole point of voting for Republicans is that, in theory, they're supposed to be the party of people who listen to actuaries and accountants and make the machinery work. If Republicans are going to turn into the party of "Let's hope!" when it comes to something as big and important as health insurer solvency, then we might as well have elected Jill Stein president. That way, we could joyfully pretend that everything is free, paid for by a big tax on the 1 percent (in the two weeks or so before everything collapsed and we ended up living in caves).
