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ObamaCare: Hiccups, cold, or critical illness?

October 21, 2013, at 6:34 PM

The Affordable Care Act, or ObamaCare, has three central functional goals: Allow tens of millions more Americans to purchase private health insurance; expand Medicaid's coverage of the poor; and slow or temper the growth of health care costs over the long term by more equitably distributing the financial burden and by tinkering with the incentives that have evolved along with the current system.

The glitchy website places none of these three goals in jeopardy. If you don't now have health insurance, then you still don't have health insurance. Your life is pretty much status quo ante.

Speaking of burdens: A swift launch to the exchanges would have eased doubts about the program. Americans worry about ObamaCare because they don't know what to expect from it. Both those who oppose it because they fear a transition to socialism or because it doesn't go far enough can point to the government's failure to kluge properly as evidence that the entire system is dysfunctional. But that's not going to get them very far.

To the extent that the website failures reflect a fact about government, it is simply that big policy changes are hard to implement. It gets harder when states refuse to accept Medicaid subsidies, or when they actively make it harder for people to get information about the Affordable Care Act. It isn't easy to pull off the biggest expansion of a domestic entitlement (Medicaid), coupled with a significant upgrade to the health care infrastructure. Whether the warnings of contractors were ignored because of HHS or White House hubris or because there really is no way, given current rules and regulations, to build a complex system this quickly is an open question and one that ought to be diligently pursued.

There is no natural period of time within which one overhauls a health care system given a set of rules and regulations that constrain how the system can be built. But the legislation imposed one, because it had to; the program has to start somewhere. Remember, the 2014 start date for the exchanges was written into the law because it allowed the administration to build in certain complex assumptions about costs. Obamacare's alleged lack of revenue neutrality was, remember, a very big political weapon that opponents tried to use, but it failed because of the way the legislation was scored. The calendar for implementation was a key part of that score.

ObamaCare isn't failing. The parts of it that have started — the actual coverage parts — are working well. But the fact of ObamaCare continues to be an albatross around the neck of the administration; the quicker Americans have faith in the government, the more people will take advantage of the subsidies ObamaCare provides, and the quicker the program, the real big parts of it, will start to work as planned. The more delays, excuses, glitches, and impediments there are, the less efficient the program will be. The real threat to ObamaCare posed by what's happening now is not that the policy is in peril or won't work — it's that the slow start will undermine confidence in the Affordable Care Act over the long term.

Politically, of course, Democrats who voted for the ACA don't want to campaign on its promise. They'd rather be able to say that it's working. And they can't really do that now.

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