Adding one more delay to the already-dawdling implementation of the Affordable Care Act (ACA), the Obama administration has allowed some insurers to set higher out-of-pocket costs limits, or no limits at all, for the year of 2014. The grace period had in fact been stated on the Labor Department's website since February, but had been hidden under what the New York Times described as "a maze of legal and bureaucratic language."
The so-called discovery, which comes in the aftermath of the announcement that the employer mandate would not come into effect until 2015, has generated doubt over whether Obamacare is a little too much for the government to handle. It is a valid question.
For Republicans, the answer seems to be an unequivocal "yes." For Democrats, it's an issue of careful implementation — some parts of the system are admittedly not ready yet, and the bill will only work if it is implemented at the right time.
The truth is, however, that neither the Republican nor the Democratic party can provide an answer to that question, at least not yet. And both parties need to be more humble in that regard. In debating the intricacies of Obamacare, they need to consider that a bill like ACA has never been implemented in the United States. As such, the million-dollar question does not concern delays or intricacies in the implementation of Obamacare. Rather, the question is whether Obamacare will jibe with the current social philosophy of American society.
Consider the issue of whether younger people, who will see their premiums rise, will opt out of health insurance and choose to pay the fine instead. During a one-on-one discussion on the bill, healthcare specialist Avik Roy and journalist Ezra Klein both agreed that if this happened, the bill would be a disaster. Yet they didn't seem to agree on whether that would in fact happen. On the one hand, healthcare specialist Avik Roy is swift to point out that Obamacare will give rational-choice-theory-oriented citizens an incentive to leave the healthcare system altogether and pay the fine. The cost of paying the fine would be less than the cost of staying in the system.
On the other hand, however, Ezra Klein readily brought up the examples of countries such as Switzerland and France, where a similar mass movement away from health insurance has not occured. Klein seems to suggest that a series of non-pecuniary factors prevent an exodus from the health care system as is proposed by Roy.
Ultimately, no one really knows how Americans will react to it. The success of a reform as comprehensive as Obamacare is directly tied to the social values of the country in which it is implemented, and a quasi-socialist (pardon the term) bill like the one that is going to be introduced has never really come to fruition in America.
As such, debate over the impact of one-year delays in the implementation are meaningless in light of the true test that Obamacare is going to face: will it be compatible with the relatively ultra-capitalist societal values and structures that exists in the U.S.?
The discussion then shifts to what these American values are, and how they attune, or not, with the ACA. Notably, this is a matter of personal opinion. From my experience as a foreigner who has been studying in the United States for the past three years, American society is epitomized in the motto "you get what you pay for" — emphasis on the you. This apothegm gets to the crux of America's notorious individualism: if I am working, and paying for something with the fruits of my labor, then I need to be getting something tangible in return.
In of itself, the issue of whether this is to the benefit or detriment of the United States as a society merits an article of its own; but relative to the matter at hand, this ideal is in sharp contrast to what Obamacare is proposing. What the ACA is trying to do is precisely force individuals to make a contribution to a social program that is not going to necessarily provide direct, immediate, and tangible returns to the individuals making the investment. But this would require acceptance of a social philosophy that simply does not jibe with the values that Americans grow up with. For the average American citizen, the answer to the question why should I make a contribution to a system if I may not even directly benefit from it, is simply: "I shouldn't."
In this way, although the ACA may be well-intentioned, it does not take into consideration the social values that permeate the average individual in America. As such, if I were to take sides on whether the Act will be successful or not, I would have to side with conservatives, not because I believe that Obamacare is in of itself is flawed, but because in my opinion, American society simply isn't ready for a bill of this form. Fundamentally, it is culture, not politics, that is going to be responsible for the failure of the Affordable Care Act.