Oh, the irony. A Republican strategy that attempted to hold first the US government and then the global economy to ransom over the Affordable Care Act, succeeded only in distracting attention from the travails of its launch far more effectively than the President could have done.
Despite more than 40 attempts to kill it – including a Supreme Court appeal and a 16-day government shutdown – Obamacare lives on. Now that a US debt default has been at least temporarily averted, however, the glitches that have plagued the new healthcare exchanges since they went live on 1 October are firmly atop the agenda.
The principle is simple enough: insurance marketplaces will offer subsidised cover to the 48 million Americans without it, and anyone still uninsured by the end of March will face a fine. In practice, though, Obamacare represents a complete overhaul of a $3 trillion market – a fiendishly complicated challenge even without the toxic politics.
The problem – and it is a familiar one – is the technology. Nearly 20 million people have tried to access the healthcare.gov website over the past three weeks. They report registration difficulties, paralysing slowness, and unfathomable procedures. The President took to the Rose Garden on Monday night to try to calm the growing storm, stressing that “nobody’s more frustrated” than he is and promising that the “best IT talent in the entire country” is working on the problem. But it could still be months, not weeks, until it is fixed.
Given the chaos, is it any wonder that Republicans – still smarting from their debt-ceiling humiliation – are gleefully sharpening their claws? The fireworks will begin with a congressional committee grilling of technology contractors tomorrow, climaxing with next week’s appearance from the much-vilified Health Secretary, Kathleen Sebelius.
It did not have to be this way. The first mistake was to raise expectations with talk of Amazon-style marketplaces. And the error was then compounded by ignoring the central lesson of decades of large-scale IT, namely that vast systems are best phased in slowly and gently, with much re-working along the way. Such an approach may be at odds with politicians’ desire to make a splash, but the current mess is hardly preferable.
Make no mistake, the Affordable Care Act is long overdue. It is as shameful as it is indefensible that millions of citizens of the richest country in the world cannot afford to be ill. But by bungling the technology, the administration has handed ammunition to its opponents. Nor is this just a matter of bad public relations. Never mind the hysterical forecasts of socialist fiscal ruin; the real risk to Obamacare is that young, healthy people prefer to pay a nominal penalty than buy insurance, torpedoing the economics of covering the older and sicker. A website that does not work is no way to convince them.