Love Pelosi or hate her, her career is over. Not a single poll has Dems holding on to the House and historically the polls have tilted in the Democrats favor relative to the actual results.

With the economy heading into the toilet and nine vulnerable Democratic Senators up for re-election in 2024, the Republicans at this point look poised to win both Houses by 2024 and the White House.

So, Pelosi's next opportunity based on history, would be in the mid terms of 2026 (if Republicans screw up their next turn at the "wheel"). Mid-terms are typically when the out of power party takes the House, if things are not going well (and sometimes even if they are).

At that point, Pelosi would be 86. If the best the Democrats can do is elect an 86-year-old white woman as Speaker, that says a lot. But even if Pelosi was still in office by then, the Dems would be foolish to "burn" the Speaker position on her, the political thing to do would be to select a 2028 Presidential contender to give that person visibility.

So, love her or hate her, I think she is "done".

Regarding health insurance

A minor point on your ACA comments. I supported the Medicaid expansion part of the ACA because it encouraged low wage earners to work rather than remain on welfare to get Medicaid coverage. So, I am not "anti" the ACA.

But the elimination of pre-existing conditions from normal health insurance underwriting was a disaster. The better way to handle high risk people like myself, were the high-risk pools that many states operated. I helped to write California's in the 80s when I was an executive of Blue Cross of California.

I never dreamed I would be a "customer" of the program 20+ years later when I moved to California in 2010 with pre-existing conditions. Fortunately, the high-risk pools were still in place, and I could secure standard health insurance for my family and high-risk coverage for me for a total of $1300/mo.

Then along came the ACA and eliminated the state high risk pools. Within four years of the ACA passing, my "Affordable Health Care” plan purchased on the exchange" cost $3200/mo. With deductibles my health care cost for my family nearly double to around $40K a year. That part of the ACA was a disaster. I wondered how people not qualifying for subsidies could afford health insurance, and subsidies largely disappeared at around $100K a year, so 40% of your gross income at that point went to "Affordable Health Care".

It is always a bad idea to "mix" the sick like me (fortunately, I am now on Medicare) with the healthy. It is the biggest mistake people with no knowledge of health insurance make including politicians and university professors and journalists. Never mix them, period. You create what is referred to as an adverse risk pool and that creates a premium cycle that is brutal.

Finally, a few states are trying to fix the disaster that the ACA created. There are a lot of options, but the one I like best is one Minnesota tried (I hope it is still in effect).

Minnesota provided "reinsurance" to insurance companies to fix the problems of high-risk individuals causing premiums to skyrocket.

Health insurance is really several products in one wrapper. For healthy people, it is like your car insurance, you don't expect to need it, but if you have an accident, you are covered. Health insurance for healthy people, especially young people remained very affordable without the ACA and is less so because of the ACA.

Health insurance also involves a manage care organization, that helps to control health care costs in a variety of ways. Whether you have an HMO or PPO plan or a Medicare Advantage plan you benefit from this... and while it is annoying to say the least at times, studies show people have better outcomes and live longer under these types of plans than plans without them. High risk people benefit more than most people because they use the health care system more and generally have medical conditions that benefit from close medical management.

The third feature of a health insurance plan is it acts as a prepaid health care program. And this is where mixing the sick with the healthy blows up the cost. 1% of those with preexisting conditions account for more than 20% of the health cost and 10% account for 63% of the cost according to Federal data.

So, if you exclude 10% of the population from standard health insurance you can reduce its costs to young families by almost 2/3rds. That lowers the resistance of people buying health insurance mainly to cover catastrophic events.

But what about that 10% of people like me? The best solution is not to "subsidize" them through the “exchanges” where only 20% of Americans (the ones that buy health insurance through the exchanges) support the very sick, that is a huge burden for such a small percent of Americans to pay. Instead, if you want to help these individuals with pre-existing conditions without screwing up the health insurance market, you find another way to subsidize the cost other than layering it on to the health insurance premiums of 20% of Americans. The risk pools did that, Minnesota's reinsurance program does that, there are different ways to do it, but the ACA's solution was terrible.

I shared this with you since while we don't agree on many things, I think we both support "affordable health care" and the ACA failed in that goal. Read the link about Minnesota's solution, I think it is a good one and to make it work better, the reinsurance needs to be funded through a broad-based tax not a targeted premium increase on 20% of the people.

https://www.startribune.com/minnesota-s-reinsurance-program-helps-calm-health-care-rates/438416573/