PUT THEM INTO NATIONAL HEALTH AND GIVE THE REST OF US SAVINGS ACCOUNTS:

The 2010 health law, also known as Obamacare, forced insurers to sell coverage to anyone, at the same price, regardless of their risk of incurring big claims. That provision was popular. Not so were rules requiring nearly everyone to have insurance, and higher premiums for healthy people to subsidize the costs of the sick.

If policyholders don't pick up the tab, who will? Letting insurers refuse to sell to individuals with what the industry calls a "pre-existing condition"--in essence, forcing some of the sick to pay for themselves--is something both parties appear to have ruled out. Insurers could charge those patients more or taxpayers could pick up the extra costs, two ideas that are politically fraught.

The problem hits people who don't have access to coverage through an employer or government program such as Medicare. For Congress, addressing the cost of covering sick people who buy their own plans "is the absolute key challenge they have to deal with," says health-care economist Gerard Anderson, who says he generally supports the health act. Whether it is the government or healthy insurance-buyers that pay that tab, "somebody has to subsidize their cost for them to afford health insurance."

A small number of high-cost patients have long generated a large proportion of health spending. The 10% of people with the highest costs accounted for about two-thirds of health spending, according to the Kaiser Family Foundation, a health-care research nonprofit, when it quantified the phenomenon in 2013.

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