Obamacare: the rollout

Gross generalization time: Liberals tend to be liberals because they believe fundamentally that government is competent, good, able to fix big problems without causing bigger problems.  Conservatives tend to be conservatives because they believe this isn’t true; that big federal programs often fail, that the law of unintended consequences means that well-meaning government actions can lead to unforeseen problems down the road. Both sides have evidence to support their claims; both are right some of the time.  So let’s start there.

Obamacare, otherwise and officially known as the ACA–the Affordable Care Act–is a big federal program.  It’s also kind of controversial–you may have heard.  The funny thing about it is that conservatives absolutely hate it right now, despite the fact that it’s essentially a conservative program (first proposed by a conservative think tank, the Heritage Foundation; first implemented in a state with a Republican governor, Mitt Romney, in Massachusetts).  Liberals find themselves in the position of defending something which we have never been more than lukewarm about.  It’s a program that one side hates and the side is pretty ‘meh’ about.  (Most liberals would much have preferred a single-payer option.  Personally, I would simply have expanded Medicare to cover everyone).

And yet, it passed.  It’s the law of the land. All constitutional and everything.  Boom.  And the first day of implementation was a rousing success. Six whole people were able to negotiate the website and buy insurance on the exchange.  That’s six actual human Americans.  Six. 6. Hey, better than nothing.

The Healthcare.gov website, let’s face it, is a mess.  It simply wasn’t ready for prime-time.  A company called CGI Global was given the main contract for building the website despite a track record of proven failure. Turns out, they’re a company that’s good at lobbying–just bad at building complicated websites. This article in the Daily Beast does a nice job of laying out all the specific failures that led to the current fiasco.  The wrong people were given a job they weren’t up to, and now other smarter people are having to fix it.

And this is nothing new.  Big government programs are often initially plagued with difficulties.  Take Medicare, for example.  This story details the problems that arose in 1965 when it was rolled out.  Medicare was a program where eligibility was tied to age–you were eligible for it at the age of 65.  But forty percent of the population in that age category didn’t have birth certificates.  1890-1900, birth certificates weren’t as routine as they are now–some states didn’t issue them.  So people were hauling in family Bibles to try to prove they were 65 or older.  One dude famously was declared eligible based on a chest tattoo.  It was a huge boondoggle. Plus there was tons of misinformation out there–a lot of older folks were suspicious of Medicare, and wouldn’t sign up. Bob Hope and Jimmy Durante did PSAs, to no avail.  (Old folks were stubborn then, too!). Initially, Medicare didn’t work well at all.

Neither did Social Security.  This story lays it out–it was a mess, back in 1937. Angry rhetoric, furious Congressional hearings, accusations of disloyalty, even.  It looked like a catastrophic failure.  Now: works great.

As a liberal, I wish Obamacare had been better designed, I wish the website worked, I wish the whole process had been a lot more transparent.  Above all, I wish President Obama hadn’t lied about it.  His frequent assertion ‘if you like your current (health insurance) policy, you’ll be allowed to keep it’ isn’t true, wasn’t true, and he knew it wasn’t true when he said it.  To be fair, he was trying to defend a program that had been attacked repeatedly and mendaciously and ferociously.  Remember some of the ridiculous nonsense we kept hearing, like Obamacare provided for ‘death panels’?  Orwellian scenarios in which faceless government bureaucracies would decide who lived and who died?  President Obama was combating that rhetoric.  He was saying, in essence, ‘it’s not what you’ve been hearing.  It’s actually a fairly minor change to how health insurance works.’ Which was basically true.

The problem was the word ‘like.’  Lots of people had high deductible, catastrophic care only, low benefits, low premium policies.  If they were healthy, they ‘liked’ those policies just fine.  They liked not paying much for them.  They came to ‘dislike’ those policies only if they got seriously ill.  President Obama knew perfectly well that one of the goals of Obamacare was to prevent insurance companies from issuing crappy low benefit policies.  And he had to know that healthy young people who had those crappy policies liked ’em just fine, because they were cheap.  So now, when lots of people are getting cancellation notices from their insurance companies, they’re furious, and they feel like they were lied to.  And they were lied to, by the President.  Hey, politicians lie sometimes.  It happens.

So the conservative critique of government turns out to be quite accurate.  A bad company was given the contract to build a website, a contract they got because they were well connected.  They messed it up, and it’s going to have to be fixed, and that’s going to cost more money.  And poor Secretary Sibelius has to go before Congress and get beat up by angry Republicans, who are simply reflecting the entirely justifiable anger of their constituents.

(The House Republican response, by the way, is really pretty comical, when you think of it.  They’ve spent months and months screaming about how Obamacare is worse than slavery, how it’s going to Destroy America.  Plus, now, it’s hard to sign up for!  “That restaurant, the food there is terrible!  Worst food in the city!  Plus the portions: so small!”)

The federal government in 1965 had to know that lots of Americans eligible for Medicare didn’t have birth certificates.  They didn’t know that, and the result was a big ugly mess.  A comical mess, with people showing up to sign up for it baring their chests to show off their tattoos proving their ages. And today, Medicare is the most effective delivery system for medical care in the United States.  It works brilliantly, with much lower administrative costs than any private insurance company can hope to match.  It delivers outstanding health care to elderly Americans.  I just got off the phone a couple of hours ago with my parents, age 80 and 78.  They talked about their doctors, how good they are and what excellent care they’re receiving.  Medicare’s a brilliant success.

Conservatives would point out at this point that Medicare has a demographic problem; that it’s going broke.  What I’m saying, though, is that, yes, that’s a problem.  And it’s going to be fixed.  And it’s going to be fixed because the American people won’t allow it not to be.  They’re going to get all over their elected representatives until it gets fixed.  That’s how representative government works.

Same with Obamacare.  Yeah, the roll-out was ugly.  But it’s going to work.  We know that, because there’s no substantial difference between Obamacare and Romneycare, and Massachusetts residents like it a lot.

So every part of the conservative critique of the federal government turns out to be right, and especially in regard to Obamacare.  It’s a big, ugly, mess.  And a President lied about it.  And cronyism was rampant.  And the implementation of the program has been terrible.

But the liberal response will also turn out to be justified.  It’s going to work just fine.  Medicare rolled out badly, and look at it now.  Social Security was one butt-ugly baby, which grew up to become a perfectly lovely adult.  The Obamacare fiasco, it turns out, is just a glitchy website.  It happens.  It’s not going to be allowed to keep happening.

7 thoughts on “Obamacare: the rollout

  1. starbugary

    I agree with everything that you said. I too find it comical that the Congressional Republicans are complaining so much about the roll out of this and the web site glitches. As if the Congressional republicans really care, isn’t this what they wanted? They want failure so one would think they’d be happy about this. I also agree the President should not have said if you like your insurance you can keep it, he should have explained that better. It likely would have been taken out of context anyway and chopped up into sound bites but at least him explaining what he meant when he said it would still be there, a blunder indeed. Honestly I am a little surprised at how many people have such crappt insurance policies, I am even more surprised when I hear Republicans that I know complain about this who are eligible for Medicare, they don’t have to worry about the mandate as they are already covered. All of the rhetoric has really sunk in, I hear the same mantras repeated by different people who don’t know each other, things that came straight from FOX News…its weird, I wonder if that happened before with SS and Medicare’s roll outs, the weird mantra part? Thanks for sharing this!

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  2. Matthew Ivan Bennett

    You might like this surprising defense of Obamacare on the Fox News website:

    http://www.foxnews.com/opinion/2013/11/05/insurance-cancelled-dont-blame-obama-or-aca-blame-america-insurance-companies/

    Basically, he says what you say about the fact that Obamacare gets rid of crappy insurance plans. He even goes so far as to blame insurance companies (not Obama) for cancelling plans. After all, the companies *could have* brought the policies up to code and still offered them at the same price.

    That companies aren’t complying with the law, and keeping their prices the same, means only one of two things: (1) the companies can’t offer the legally-new policies at a profit, which I suspect is untrue, or (2) they’re charging more because they can, which I suspect is definitely the case (in many cases).

    I won’t tirade here about corporate greed, but it is worth pointing out that corporate profit margins—in several sectors, including health care—have recently increased. Even in the Great Recession this was happening. How? A 2011 Mother Jones article laid it out clearly: companies have been saving oodles by laying people off and not hiring new people.

    “Off-loading” is becoming a cultural phenomenon now, an accepted ethical business practice for protecting the bottom line. For instance, in 2000, when my father began working for UDOT, there were 11 people in his department. There are now two. With no plans to hire new people.

    The job crisis in the US is directly tied to this practice, because of a new cultural standard that work means working constantly.

    Is it screamingly liberal to say that some things should not be monetized? I don’t think so. And that’s the essence of the ACA—it’s a law that says there should be limits on what insurance companies can make money on, i.e. people’s suffering or history of suffering.

    As Profit has almost the status of value now, saying this is “liberal,” unfortunately.

    Yet, in reality—and I keep saying this to conservatives who, for some reason, refuse to believe this—the ACA is pro-business. It sacrifices “freedom” in the name of human dignity, but it also puts money in pockets.

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  3. an unlike mind

    I don’t think I’ve ever seen anything more apologist than this. There is no excuse to be made for the level of deceit and cronyism that led to the ACA unveiling, yet this attempts to make it entirely excusable. Like a woman who is beat upon by her violent husband and still says she loves him, this crowd will never cease to believe that those who are proven to be full of purely ill intent mean them any harm. Medicare never took away healthcare that already existed. Social Security never divested wealth that was already possessed. The ACA does both of these things. Yet no matter how bad this gets, I expect the law and its namesake will always have a home here in this blog space.

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    1. admin Post author

      “Proven to be full of purely ill intent?” Because we think poor people should have health insurance?

      Reply
      1. An unlike mind

        If only that were their true intent. And the means by which they’d accomplish it are fundamentally flawed. When the president claimed to want to provide healthcare, but rolled out a plan which he knew does more damage than good, then yes…. we can see that his intent was not to provide healthcare. He is, as of now, trying to claim he did not know these things would happen, but this reveals either malice or incompetence (either he passed a law he knew would hurt more people than help, or he passed a law he did not read or understand… either way he’s dead wrong). Politicians lie. But few are chronic liars. And fewer still are those who are willing to entirely falsify their plans in order to achieve reelection. Without the promises attached to the ACA, his prospect of a 2nd term would have been in total jeopardy. Thus the one thing that did the most to secure the election was in fact completely made up. This was not a “misrepresentation” or “shading” of the facts. It was as much a lie as a lie can get, and a lie told to serve personal and party power agendas.

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        1. admin Post author

          Think this through. Why on earth would anyone deliberately sponsor legislation that he knew would do more harm than good? And in fact, we know, for absolute certainty that the ACA WILL do good, because it’s been tried. In Massachusetts. Where it works fine.

          Reply

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