The Affordable Care Act isn’t a perfect law. It’s not even a good law. But it’s better than what we had before and it’s worth fighting for.
The law has not worked as well as expected. Three of the problems with the ACA roll-out were not to due to the law itself, but rather Republican intransigence. First, the Medicaid expansion was hurt by the Supreme Court ruling that made the expansion optional for states. Twenty-five governors (almost all Republican) have refused to push forward with the expansion, even though it will be paid for almost entirely with federal funds. This leaves millions of poor Americans without health insurance (and will likely end up costing the states more money). Second, many of those same governors refused to set up health care exchanges, meaning that the Department of Health and Human Services had to for them. The HHS requested an additional $1 billion (far below the $5 billion the CBO estimated would be needed) to set up the exchanges, which congressional Republicans denied. Third, right-wing organizations have been attempting to persuade young people to opt out of the program, claiming that they will be better off without health care. This is bad for both the young people and the system. The young people will still be treated (just like the poor without Medicaid), but their treatment will place an expensive burden on the system, and because they aren’t paying for premiums, the cost of other plans on the exchange may rise.
Even with Republican support, the bill would have run into trouble. Obama, being temperamentally conservative, has tried to modify the system rather than overthrow it. He has followed the advice of Edmund Burke, who cautioned legislators to “approach to the faults of the state as to the wounds of a father, with pious awe and trembling solicitude.”
But conservatives are pretending that the bill is a radical overthrow of the health care system, rather than the few minor, incremental changes it is. The bill leaves the health insurance system largely intact, expands already existing programs, and implements a collection of pilot projects that can easily be expanded.
Conservatives argue that the failure of Healthcare.gov proves that the government can’t do anything. That strikes me as a little absurd. The argument is that the government that sent a man to the moon, built the Hoover Dam and National Highway System, rebuilt Europe, runs the wildly successful and efficient SNAP program, and has become the most successful military in the world, has lost its legitimacy because of a glitchy website. If anything, the government should be doing more projects in-house and avoiding the costly contractors who screwed up the whole program.
The Human Genome Project cost the government $3.8 billion but generated $796 billion in economic gains. The project is expected to bring about returns of 140 to 1 to the public. Research by Kenneth Flam finds that “18 of the 25 most important breakthroughs in computer technology between 1950 and 1962 were funded by the government, and in many cases the first buyer of the technology was also the government.”
In every other country, government-run systems produce far better results for far cheaper. The United States spends twice as much of its GDP on health care as the OECD average, getting little in return (Britain pays 40% less for slightly better outcomes). The U.S. health care system leads the industrialized world in administrative costs and wastes, an estimated $750 billion each year due to unnecessary procedures, inflated prices, excess administrative costs, and poor delivery systems. The system also leaves 40 million people uninsured, which is unique among developed countries.
The fact that the failure of Healthcare.gov has garnered so much press is quite frankly shameful, especially when there has been so much good news from the program: the rate of uninsured people in Oregon has dropped 10%, the recent Medicaid expansion in Ohio will give 273,000 people access to health insurance, many state-run exchanges are working fine, and there is evidence that Obamacare is slowing down the growth of health care costs. Guys, even a Fox News contributor has admitted the programs are working!
So don’t be fooled by all the horror stories. Obamacare is far more than merely a website. Britain's National Health Service survived for decades before the invention of the internet (by the government!). The program has already chalked up some important success and will continue to do so in the future. The hullabaloo about the website is just a reflection of the media cycle. The good parts get ignored while the minor failure of a website becomes front page news. Man bites dog and all.