"It's back to square one" says the Wall Street Journal after the collapse of Republican proposals to repeal and replace The Affordable Care Act. President Trump says his plan is to "let Obamacare fail."

This episode looks at how any reform of America's healthcare system - whether by Republicans or Democrats - is so difficult. Whether it's controlling costs, rationing care or extending coverage to all, there are no easy answers. Today, the future of healthcare is uncertain and coverage for many millions of people hangs in the balance.

Our guest, Megan McArdle, a columnist at Bloomberg View explains why The Affordable Care Act is flawed and that many consumers have misconceptions about the true costs of health insurance. 

"What people are doing is they're gaming the system," she says about those who have moved in and out of healthcare marketplaces. When an illness or medical emergency strikes, many people without employer-based health coverage are "signing up for a few months, using a ton of services and then dropping it again."

Jim and Richard debate the future of healthcare from different perspectives. While Jim argues for a more free-market approach, Richard says the only way that a system of universal coverage can work is if everyone has to sign up for coverage, however unpopular that may be. "The penalties for not having insurance should be greater than they were under the Obama Administration," he says.

Megan McArdle is the author of "The Upside of Down: Why Failing Well Is The Key To Success."