Or is he being disingenuous (i.e., lying) to actually discredit the basic principle of insurance?
'The fatal conceit of Obamacare is that we’re just gonna make everybody buy our health insurance at the federal-government level, young and healthy people are going to go into the market and pay for the older, sicker people. So, the young healthy person is going to be made to buy health care, and they’re going to pay for the person, you know, gets breast cancer in her 40s or who gets heart disease in his 50s. […] The whole idea of Obamacare is … the people who are healthy pay for the people who are sick. It’s not working, and that’s why it’s in a death spiral.'
Yes, that is the principle of an insurance pool, a shared risk pool. By making the pool large enough, everyone pays a little to make sure that those who need a large payout are covered.
It's difficult to believe Ryan doesn't understand this. Which makes me think that his bottom line is to make such cooperative actions seem somehow wrong, dirty, coercive, evil. "I got my health, why should I care about yours?"[1] That would be in keeping with his other pious philosophies about social welfare programs, but doesn't seem to be a palatable enough message for him to speak it directly.
(And, actually, Speaker Ryan, the ACA is working, which is why enrollment is up. What's not working is that the basis on which insurance companies can charge, etc., has not been updated since the original ACA passed because the GOP wouldn't let it be. That's why insurance companies have been dropping out, not because they cannot possibly be profitable doing that business, but because the GOP wouldn't fix the problems that were keeping them from profitability. Which they aren't doing now, either.)
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[1] The big problem being that health is not pre-determined. While one can say, "Hey, Susan has a pre-existing condition, ew, let's throw her out of the insurance pool or make it too expensive for her to be in it," nobody can say who amongst the presently apparently hale and healthy will not be struck tomorrow by some cataclysmic accident or new condition. A large insurance pool protects everyone, not just the presently-safe.
