Monday put two of my favorite topics in the headlines: Donald Trump, and cost-sharing reduction payments. Plenty of folks have spilled plenty of ink on that first problem. Let's spare a moment for the second. Cost-sharing reduction payments, a subsidy built into Obamacare, are not just a policy problem, but a potent symbol of the larger political disease ailing our nation.
They were designed to address a real challenge: similar policies may have very different effects at different income levels. Say you make $75,000 a year, and your health insurance policy has a $5,000 deductible. If you get something serious, something expensive -- well, ouch, that's going to hurt your budget, but you'll scrape together the $5,000 and get the care that you need. If you have the same policy but earn only $25,000 a year … ummm, you don’t really need that liver transplant, do you?