Obamacare: Glitches or death spiral?
It’s not easy to wrap your mind around a program as complex as Obamacare, which features 381,517 words in its actual bill and 11,588,500 more words in added regulations.
Thankfully and mercifully, in trying to understand this migraine-inducing puzzle, I found some relief in one simple idea: The system won’t work unless it entices enough young and healthy people to sign up.
Right now, the big news is that the launch of the HealthCare.gov Web site has been a flop, with countless horror stories of people who haven’t been able to enroll because they were lost in a digital and bureaucratic maze.
Many liberal supporters see this initial failure (wishfully, perhaps) as a case of annoying but fixable “glitches” on the way to a more humane universal health care system.
Many conservative critics see it (wishfully, perhaps) as the kind of “disaster” that happens when Big Government bites off more than it can chew.
As of now, the critics are on a roll.
“With the GOP’s antics now over,” Kimberley Strassel of The Wall Street Journal writes, “the only story now is the unrivaled disaster that is the president’s health care law. Hundreds of thousands of health insurance policies cancelled. Companies dumping coverage and cutting employees’ hours. Premiums skyrocketing. And a Web site that reprises the experience of a Commodore 64.”
Even a liberal, fair-minded policy wonk like Ezra Klein of the Washington Post admits that, so far, Obamacare “is not working well at all.”
Conservative wonk Yuval Levin of National Review Online goes as far as seeing a potential “death spiral,” which he describes as follows: “The fact that it is so difficult to sign up for exchange coverage may mean that only highly motivated consumers do sign up, and those are likely to be people with high expected health costs.
“If the exchanges end up containing too many people in poor health and not enough people in good health, insurers could take massive losses in 2014 and be forced to dramatically raise premiums for 2015 plans. … Those higher premiums would cause even more healthy people to avoid getting coverage … and the cycle would continue.”
The importance of getting young, healthy people to enroll is echoed by Klein, who, after interviewing White House officials and asking “repeatedly” how they defined success, reported that “everyone in the White House shared a singular definition: Success meant setting up the exchanges and attracting enough young people [so] that premiums stayed low.”
Let’s face it — no matter where you sit, this is a scary thought: The success of Obamacare depends on getting millions of young people with short attention spans to spend hours in front of an exasperating government Web site with zero entertainment value — and trying to enroll in something they’re not sure they want.
But enroll they must, if they want to save the president’s plan. As Klein reports, the administration figured that if they got 7 million people to sign up for the exchanges in the first year, about 2.7 million needed to be young.
That’s 5.4 million jaded eyeballs to entice.
You’d think that with the $600 million they budgeted for this Web site, the government could have splurged for a few creative types in Hollywood whose business is to keep people entertained. Put them together with the tech geniuses who built Amazon and you’d have at least the possibility of wooing these jaded eyeballs with something other than a threatened fine.
But the user-unfriendly Web site, as bad as it is, is only a symptom of deeper issues. As Klein explains, what’s causing “deep problems” for the health care law is the mess in the infrastructure of the program, which he describes metaphorically:
“In brick-and-mortar terms, it’s the road that leads to the store, the store itself, the payment systems between the store and the government and the manufacturers, the computer system the manufacturers use to fill the orders, the trucks that carry the product back to the store, the loading dock where the customers pick up the products, and so on.”
For the program to run smoothly, that whole infrastructure needs repair. The question is: Can the bureaucracy which created the mess do that repair work?
Many conservative critics believe that it can't, and that the program will fall under its own weight. Klein believes there’s still time to right the ship, but not much. He quotes health care experts who suggest that the Web site needs to be running smoothly by “Thanksgiving at the latest.”
It shouldn’t shock anyone that Obamacare has been at the center of one of the nastiest partisan battles in recent memory. When a government tries to take over one sixth of the U.S. economy as it pushes through a controversial and gargantuan entitlement program on a strictly partisan vote, it can’t expect smooth sailing.
In any event, as Klein notes, the president’s program “isn't a political abstraction any longer. Its success doesn't depend on spin or solidarity. What matters for the law — and for the people who are depending on it — is how well it actually works.”
There’s something refreshing about that. After years of fighting, spinning and promising, we’re down to results.
Even a well-meaning and eloquent president has to face this reality: Ultimately, government comes down to how effectively you can solve people's problems. Either you do or you don’t.
President Obama fought tooth and nail for his 12-million-word health care legacy. Now, he needs the government he believes in and the young people who voted for him to help him deliver on that legacy. It’s far from clear that this will happen.
David Suissa is president of TRIBE Media Corp./Jewish Journal and can be reached at firstname.lastname@example.org.