I'm of two minds about the failures of Healthcare.gov. On the one hand, the rollout is obviously a botch, and that's a threat to the reputation of anyone who believes that government can do good things for people -- a notion that's been challenged so relentlessly over the past few decades that it has to be strenuously rebutted at every possible opportunity. On the other hand, there's this:
The technology of a customer-service interface is difficult to navigate? You think this is unheard of? Try getting through a telecom's phone tree if you have a service problem. Try disputing a claim rejection with a private health insurer right now.
Right-wingers have made Obama and Obamacare seem so evil and menacing and totalitarian -- death panels and all that -- that technological incompetence might actually be defusing the fear. See? We're not all being shipped off to extermination camps. We're just getting 404 errors for hours. Bumbling has to seem less scary than the Big Brother tactics Republicans prepared us to expect.
That said, this from Ezra Klein (via Andrew Sullivan) is a problem if it's true:
The problem here isn't just technological. It's managerial. The White House's senior staff -- up to and including the president -- was blindsided. Staffers deep in the process knew that HealthCare.gov wasn't ready for primetime. But those frustrations were hidden from top-level managers. Somewhere along the chain the information was spun, softened, or just plain buried.Any top government official who's liberal or even semi-liberal, and who has or shares the responsibility for rolling out a new government program, needs to be deeply, deeply invested in getting it done right. The right attacks government at every opportunity, and the mainstream press absolutely loves stories about government waste and inefficiency and incompetence. Heartlanders are bombarded with this narrative; they're inclined to believe that government is no damn good at anything, even though there are a lot of services they want from government. Officeholders and aides in Democratic administrations don't put enough emphasis on proving the naysayers wrong by getting programs to work right. That needs to change.
The result was that the White House didn't know the truth about its own top initiative -- and so they were unprepared for the disastrous launch. They didn't even know they needed to be lowering expectations. In any normal corporation, heads would roll over a managerial failure of such magnitude and consequence.
Sullivan goes on to quote W. James Antle III of The American Conservative, who worries about precisely the outcome I'd prefer:
Nothing would better vindicate [conservatives'] case against Obamacare than the "death spiral" that would follow young people fleeing exchanges that are being flooded with the old and sick.Sully adds:
Yet if Obamacare undermines the entire individual health insurance market, it will make it even more difficult -- and perhaps impossible -- to ever implement any free-market health care reforms. In fact, single payer may loom ever larger as the only viable remaining option to an employer-based system that both conservatives and liberals would like to substantially remodel.
[Republicans] will continue a policy of sabotage -- and the possibility that we could all end up in single-payer as a result is not the kind of empirical thing they can compute.Hey, I'd be delighted if the end result of all this were single-payer. But anyone who thinks that an irreversible Obamacare failure would lead to single-payer is smoking crack.
First of all, right-wingers will never acknowledge the failures of the marketplace, including the marketplace that would be left after an Obamacare failure. More important, right-wingers don't give a goddamn whether anyone except the 1% has heath insurance, as long as the uninsured don't take it out on them at the polls, and as long as corporations are fat and happy. Right-wingers would be perfectly happy to replace Obamacare with whatever washes up in its aftermath, if voters put up with that. Alternately, they would be happy to create a system in which insurance sales across state lines put all health insurance in one state with incredibly pro-business laws, the way so many credit cards originate in South Dakota, where the sky's the limit on interest rates charged. They would be happy to put such great restraints on malpractice suits that the deserving just gave up on seeking redress. They would be happy to watch the numbers of the insured steadily climb. They would, in short, be perfectly happy to turn America into one big Texas as far as health insurance goes.
All they'd need to do is persuade the voters that it's their fault if they're insured, or it's the fault of the poor sucking up all the Medicaid, or, well, it's because Obamacare screwed everything up permanently. Alas, I think voters , who've been abused by the economic and politic and health-care systems for years, would just sigh and go along with that.
So I suppose that's one good reason for the administration to get this right -- not because the alternative will be socialized medicine, but because it will probably be PerryCare.