If US society believes government is always bad, that’s what it will get
Healthcare reform is being stymied because of an ideology that is hostile to any kind of state support
The Healthcare.gov website’s early days have been plagued with problems. Photograph: Andrew Harrer/Bloomberg
The good news about HealthCare.gov, the portal to Obamacare’s health exchange, is that the administration is no longer minimising its problems. That’s the first step towards fixing the mess – and it will get fixed, although it’s anyone’s guess whether the new promise of a smoothly functioning system by the end of November will be met. We know, after all, that Obamacare is workable, since many states that chose to run their own exchanges are doing quite well.
But while we wait for the geeks to do their stuff, let’s ask a related question: why did this thing have to be so complicated in the first place? It’s true that the Affordable Care Act isn’t as complex as opponents make it out to be. Basically, it requires that insurance companies offer the same policies to everyone; it requires that each individual then buy one of these policies (the individual mandate); and it offers subsidies, depending on income, to keep insurance affordable.
Still, there’s a lot for people to go through. Not only do they have to choose insurers and plans, they also have to submit a lot of personal information so the government can determine the size of their subsidies. And the software has to integrate all this information, getting it to all the relevant parties – which isn’t happening yet on the federal site.
Imagine, now, a much simpler system, in which the US government just pays people’s major medical expenses. In this hypothetical system, you wouldn’t have to shop for insurance, nor would you have to provide lots of personal details. The government would be your insurer, and you’d be covered automatically by virtue of being an American. We don’t have to imagine such a system, because it already exists. It’s called Medicare, it covers all Americans 65 and older, and it’s enormously popular. So why didn’t we just extend that system to cover everyone?
The proximate answer was politics: Medicare for all just wasn’t going to happen, given both the power of the insurance industry and the reluctance of workers who have good insurance through their employers to trade that insurance for something new. Given these political realities, the Affordable Care Act was probably all we could get – and make no mistake, it will vastly improve the lives of tens of millions of Americans.
Still, the fact remains that Obamacare is an immense kludge – a clumsy, ugly structure that more or less deals with a problem, but in an inefficient way.