United States House of Representatives Speaker Paul Ryan is right. High-risk pools could be the solution that solves some of the current problems with our health-care system.

Even though high-risk pools have not worked in the past (most immediate for me is the example of my home state, Iowa); even though I believe that states have neither the expertise, the competency, nor the will to run high-risk pools; even though I have railed time and again against high-risk pools as being anti-universal coverage, I now propose a new concept for high-risk pools.

A quick primer: High-risk pools are used to offload a particular group of individuals with chronic diseases, such as diabetes, heart diseases, and chronic obstructive pulmonary disease, from the general insurance market because they have pre-existing conditions that will cost insurance companies too much to care for them. Separating these individuals from the healthier general insurance pool allows for lower rates for the larger majority of people buying health insurance. Several years ago, we did this separation of individuals when we set up a program to pay for renal-dialysis patients.

Why do I propose high-risks pools might work now in the current political climate of repealing and replacing the ACA? My proposal is that we consider people 55 years old and older as a high-risk pool and allow them to buy into the federal high-risk pool that currently exists using income-adjusted subsidies. That high-risk pool is called Medicare.

This Medicare idea is a version of an idea I admit “stealing” from Dr. Michael Kitchell, a neurologist and a leading medical thinker in Iowa.

For all the same reasons that I listed in my May 2016 and March 2017 blog posts regarding Medicare expansion, I think this proposal works. I am merely renaming it. As Victor Hugo said, “No army can withstand the strength of an idea whose time has come.”