Obamacare: Too complex to work?

The Affordable Care Act's “mind-numbing complexity” will make it difficult—too difficult?—to implement.

Two weeks into the age of Obamacare, said John Sununu in The Boston Globe, the program’s constantly crashing HealthCare.gov website serves as vivid proof of the bureaucratic program’s crippling complexity. Despite spending three years and $600 million on setting up an online system, Health and Human Services Secretary Kathleen Sebelius has utterly failed the millions of people who have tried to get information or sign up. The bugs in the software may eventually get fixed, but not so the “deeply flawed,” 2,000-page Affordable Care Act itself. To enroll a citizen in the program, said Gordon Crovitz in The Wall Street Journal, the website first must gather detailed income and other data from the applicant, combine it with eligibility data from dozens of state and federal agencies, and then offer a plan in compliance with 47 separate statutory provisions. It’s that “mind-numbing complexity,” not glitchy software, that’s Obamacare’s fatal flaw.

The admittedly inept rollout “is not the end of the world,” said Stephanie Mencimer in MotherJones.com. In 2006 both George W. Bush’s Medicare Part D program for seniors, and the “Romneycare” plan in Massachusetts upon which the ACA is based, got off to starts just as chaotic as Obamacare’s, if not worse. Romneycare’s rollout was so bad that a full two months after launch, only 18,000 of the state’s 300,000 eligible citizens had successfully navigated the enrollment process and signed up. “Eventually the kinks got worked out,” and today 96 percent of Massachusetts residents have health insurance—more than in any other state. If Obamacare’s engineers can debug the system by early December, this rocky debut will be forgotten.

Even if Obamacare does end up “working,” said Christopher Conover in WeeklyStandard.com, there is still a “gargantuan gap between what was promised and what is now being imposed.” The fundamental lie at the heart of the ACA is that health insurance can be extended to tens of millions of people at no cost to taxpayers—indeed, that the ACA will actually reduce deficits. The reality is that the law imposes about $1 trillion in new taxes over the next decade, mostly on employers, insurers, and individuals making more than $200,000 a year. Those costs will eventually get passed on to consumers. Another lie is that it won’t be expensive to extend coverage to the uninsured, who currently cost taxpayers an average of about $1,000 per year in uncompensated care at emergency rooms. Give that person full coverage, and his consumption of health care will boom. Realistic projections are that taxpayers will pay $50 billion in additional costs every year.

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Don’t be “bamboozled by the frantic fictions of the right wing,” said Bill Keller in The New York Times. Obamacare is exactly “the kind of market-driven reformation that Republicans pretend to believe in,” and it is already bringing down America’s sky-high spending on health care. The law sets up robust competition on insurance exchanges, and gives compelling financial incentives to doctors to emphasize preventive care and focus on patients’ long-term health. In some regions that’s already brought about a 20 percent drop in ER visits, and a 30 percent decline in hospital admissions. If Obamacare was really fatally flawed, “why would conservatives be so suicidally intent on preventing it from taking full effect?” asked Ana Marie Cox in TheGuardian.com. Their great fear is that “it won’t be too long until the ACA isn’t a new and scary socialist plot, but just part of American life,” like those awful programs called Social Security and Medicare.

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