The Grinch That Stole Health Care (or, Can Government Always do a Thing Better?)

By R. Alan Clanton | published Friday, December 20, 2013 |
Thursday Review Editor

In yet another in a series of fluid, make-this-up-as-we-go-along improvisations, administration officials early today announced that not only would they continue to "not enforce" the mandate which was to accompany the Affordable Care Act, but they would also recommend a "hardship extension" for those Americans--now perhaps in the millions--for whom the radically-shifting health care market may have forced out of coverage through cancellation or cost increases, or for those who simply can't afford any of the options available to them under Obamacare. This is the latest in a series of convolutions and contortions by the White House to contain the deepening damage caused by what has become a medical insurance train wreck of epic proportions.

But perhaps, to put this in historical context, any conversation about Obamacare requires a brief travel back in time.

In the middle 1980s much sport was made of President Ronald Reagan’s perceived disconnect from the day-to-day realities of his administration and the pending agendas of Washington. Reagan’s inescapable likeability and high approval ratings were always tempered by the media’s prevailing narrative, a quasi-comedic thread of an affable, kindly, but clueless chief executive. When, in 1986, details began to emerge of a complex, seemingly bizarre plan to channel a secret pipeline of money—mostly revenue from the sales of arms to Iran, cash which was then redirected to the anti-communist Contra rebels in Nicaragua—a money conduit engineered by Lt. Col. Oliver North, Reagan’s eventual mea culpa was that of a president who had not been informed of the deeds and actions of his own national security staff members.

The President first denied that such cockamamie schemes existed, then, later acknowledged to the American people that the deeds had in fact taken place right under his nose and without his authorization—a debatable and contentious point to some liberals even to this day, but within the context of those who knew Reagan best, an entirely plausible scenario for the honest, trusting man who often deferred to the strategic thinkers of his inner circle.

The deeper paradox was the more important issue: while running for office, the extremely popular Reagan had campaigned, in part, on a platform which included the great national imperative of re-establishing U.S. prestige and clout internationally, and rebooting a competent, integrated foreign policy. But the Iran-Contra affair seemed—to some, at least—not just a meddlesome and Machiavellian backroom program to circumvent a Congressional ban on arms sales to Iran, but a comic, even surreal deconstruction of the President’s core values and one of his central foreign policy goals.

From the middle 1980s, fast forward to 2007 and 2008. In the bitter, contentious primary and caucus battle between Democratic front-runners Hillary Clinton and Barack Obama, no social policy discussion was as heated as the sometimes hair-splitting arguments over the various health care overhauls proposed by liberals (and a few conservatives) for decades. Obama and Clinton fought feverishly very nearly to the door of the convention, and though Obama won the fight, he graciously embraced Hillary and folded her neatly into his inner circle—absorbing, almost completely, Clinton’s proposal for a government-managed reform of health care.

The health care insurance overhaul became Obama’s central domestic policy initiative.

Further, candidate Barack Obama’s nomination was assured, some analysts had concluded, by what was arguably the savviest merger of technology with grassroots fundraising ever deployed in U.S. history. User-friendly and fast, the Obama campaign website was a model of performance and elegance, and his outreach through nimble, handheld technology, social media and the internet was unprecedented. By January of 2008, candidate Obama was bringing in record monthly contributions, and very quickly he was able to easily outspend Clinton. By the time the conventions ended, Obama was outspending Republican Senator John McCain by a margin of three-to-one.

Fast-forward again, and during the first four years of his administration the Technology President was at least partly responsible for a daily newsfeed of dazzling, sometimes eye-popping success stories. Using high-tech tools, terrorist acts were thwarted, perpetrators caught and tried, storms and tornadoes tracked with astonishing accuracy, enemy combatants pinpointed from the air across the Jihadist world, and the most sought-after mass murderer of the millennia tracked and killed in his upper-middle class lair in Pakistan. Drones, used as a weapon only sparingly during the George W. Bush years, were upgraded and deployed as one would deploy an army, and thousands of al Qaeda and Taliban operatives were killed with virtually zero risk to U.S. personnel, while drone “pilots” sat in small operational rooms in distant locations, sometimes on the opposite side of the globe, piloting the machines with joysticks and computers and watching the outcome on high-definition screens.

When it was revealed earlier this year that the NSA was nearing completion of its super-secret data center in Utah, a facility capable of collecting and storing trillions of electronic transactions—from emails to text messages, from phone calls to credit card activity, from search engine requests to online purchases—it seemed to most of us that technology had reached the tipping point, shepherding us into sci-fi, and that there was truly nothing that the government or its agencies could not accomplish, for better, or for worse.

Meanwhile we watched the much-ballyhooed arrival of government-managed health care—by this point President Obama’s premier piece of domestic legislation—stumble through a barrage of nastiness and contentiousness, including a court fight, a high stakes budget showdown, partisan hostage-taking, scenery-chewing theatrics by both parties, and a government shutdown—all accompanied by the usual media frenzy and revolving blame-game. Members of Congress engaged in juvenile gamesmanship, a collective “I’m-holding-my-breath-until-I-explode,” Democrats and progressives turning a pasty shade of blue, Republicans and conservatives morphing to apoplectic red.

As if the political fighting had not been enough, the impasse and eventual shutdown arrived at a crucial moment for the economy, still not fully recovered from its recession low point. Concern by strategists of both parties that the shutdown would be blamed on them became almost irrelevant as Americans, on the whole, expressed general outrage and disgust that their elected leaders in Washington could be so ineffective and self-serving.

But Obamacare, the President’s signature legislation (known officially as the Affordable Care Act), arrived finally amid much anticipation and a thousand media eyes upon its every nuance. Finally, the President could watch as his easy embrace of technology merged neatly into a sweeping program designed to bring health care to anyone willing to sign up. This would be the President’s shining moment of domestic success. The website, expected to be model of elegance and ease-of-use, was rolled out early on the morning of October 1.

Then…well…problems.

Never before had such a widely anticipated program met with such instantaneously farcical results. That now infamous website’s front page remained frozen for days, alternating between the familiar on-screen message of “this page can’t be displayed at this time,” or not moving at all for hundreds of thousands of potential registrants. The White House, circling its wagons, retreated into a comedic stonewall of oblique non-answers and vague obfuscations, briefly settling on the boilerplate answer that the website’s problems only proved that the program must be popular—after all, millions of people were trying to register. When asked by reporters, officials gave no information about the actual numbers, if, in fact, actual numbers even existed.

Then, things got much worse, and very quickly. Every major news organization and very nearly every local TV station had daily and hourly reports of individuals attempting—without success—to navigate past the welcome screen. By mid-October, Saturday Night Live mocked the fiasco with an “official” message from “Kathleen Sebelius,” in which she smilingly admitted that though the program was designed to register millions, the antiquated online design “only allowed for six visitors at a time.” She recommended people turn their computers off, then, back on. This was classic SNL satire. But less than 48 hours later, SNL’s parody would prove not merely insightful, but freakishly accurate, when it was revealed that, in fact, only six people had registered in that first day of the website rollout, with fewer than three dozen registering over the following 24 hours.

Art imitates life, satire imitates politics—only to have politics imitate the parody with deadpan noir accuracy.

Public officials and government managers and overseers dodged accountability or stonewalled with such an impenetrable lack of charm one was tempted to think that John Erlichman and Bob Haldeman were in charge of the show. Democratic partisans on Capitol Hill fell into a comically naïve script of Don’t Worry, Be Happy. Just a few glitches here and there—nothing we can’t debug in a day or two. Nancy Pelosi and Harry Reid seemed, for a week or so, like members of the Flat Earth Society, defending the website and suggesting that the bugs were minor. Kathleen Sebelius (the real one, not her SNL counterpart), infamously refused to explain herself before Congress, and through her staff spoke of her “very busy schedule,” which included attending social parties and making appearances on comedy shows—a more surreal convolution of management arrogance and detachment from reality than anything a fiction writer could have concocted. Life imitated art. Her total disconnection from the crisis handed Republicans in Washington the precise tool they needed: proof that Obamacare was—and would be—a badly deployed use of billions in taxpayer monies.

Meanwhile, the website continued its farcical slide downward—frozen for hours, sometimes overnight, with entire states reporting only 40 or 50 successful registrations. When it was revealed that the website developers and designers had serious misgivings that it would work as expected, right up to the hours and minutes before its rollout, comic absurdity morphed quickly into outrage. In the days before the grand opening, government employees and government contractors had warned—with frightening unanimity—of the failure of nearly every component of the pre-rollout testing. With strange reluctance, Obama and those in his administration finally conceded that things were not moving smoothly, but promised a fix. Calls were made to top people in Silicon Valley. Deadlines were moved, grim assurances were made, and declarations that experts would be recruited were bandied about.

That a program of such enormity became a laughingstock so quickly seemed to transcend what had been—up to that point—a largely partisan debate. Supporters of Obamacare and their partisans on Capitol Hill could no longer point to those annoying and irascible obstructionists in the GOP.

How is it that President Obama’s signature piece of legislation suffered so mightily in a fiasco seemingly so easily avoidable? And did the website's now infamous failure speak to a deeper problem?

Many of the apologists raised the issue of complexity: Americans were being asked to provide a uniquely personal set of responses and then make direct comparisons of highly arcane numbers inside a template with lots of moving parts. As Pelosi and others pointed out, nothing like this had ever been attempted on the internet.

This defense was, of course, patent nonsense. Online businesses have for decades asked that their customers provide deeply personal data, and web-based comparisons of complex sets of figures and plans have been around for some time. Major insurance providers like Blue Cross Blue Shield and United Health Care engage in this process routinely with thousands of customers at a time. Companies like Amazon, Travelocity, Hotels.com, eBay and hundreds of other familiar names manage the flow of many thousands—sometimes millions—of transactions every day. Banks and mortgage institutions—large or small—manage to process thousands of complicated financial transactions every hour, with remarkably few shutdowns or system failures.

This brings to the forefront a crucial question, philosophical to some, practical and street-level to others: are there certain marketplace processes and interactions best left to the organic actions of the market itself? And are there certain activities, save for routine oversight and agreed-upon types of regulation, the government should keep its distance from?

There was a time when Thursday Review readers might have instantly defined themselves as liberal or conservative simply by offering a yes or no answer to those basic questions. Those of a libertarian stripe would surely respond by saying the government does not have the capacity to manage much more than the common defense and the filling of potholes. Progressives will argue that it is not only possible, but, in fact, the government’s responsibility to intervene when citizenry health and well-being is at stake.


For now the website is finally working at something close to optimal speed, but enrollment figures are substantially below the goals and the original projections of the Department of Health and Human Services. Many states have millions who are not insured.

Even now, many Americans are divided on the issue, and the use of the website itself. Yesterday, polls conducted and released by CBS News/New York Times showed “only 16 percent of the Americans who responded thought the law would help them.” As many as one third of those polled will make the choice to pay the minimum penalty ($95, or one percent of income, depending on the formulation) rather than sign up for the Affordable Care Act. Well over half of those surveyed thought the website was confusing and difficult to navigate.

Still, others are signing up at a healthy clip, especially as younger and healthier registrants discover their lower premiums, and as others qualify for government subsidies and offsets.

Many liberal Thursday Review readers will make the reasonable argument that the website’s technical failures and operational limitations have little, if anything, to do with the health care law itself. But one can also make the argument that a government so shockingly unable to anticipate the logistical demands of a comprehensive program of such breadth has little business attempting to macromanage that particular marketplace. The devil is in the details.

Case in point: the subcontractor primarily responsible for the websites development and design, a Canadian firm known as CGI, had—prior to Obamacare—a well-documented track record of missed deadlines, website failures and other technical mishaps due to poor, or poorly-trained, staffing. Long before its ACA project, CGI was also known for its failure to communicate proactively to its clients on those occasions when it was headed for trouble.

The uncomfortable spectre of watching a President explain to the American people, only after the ACA roll-out had become a train wreck, that he would be “bringing in experts” on website design and operations, left many wondering why such a seemingly simple step had not been taken at the start.

Now the math becomes a dangerous but inevitable Ponzi scheme. The only way that the ACA can be made affordable for older Americans (those roughly north of age 50 and presumably requiring higher levels of health care activity) is by offering cheap insurance to many millions of younger Americans, especially those in their 20s and 30s and generally healthier than their senior counterparts. The website’s frequent issues have begun scaring off those young people in large numbers, youthful but frequently impatient users of technology who may give the ACA site one, perhaps two shots. Then, they walk away.

Many government officials are now acknowledging what insurance analysts have been saying all along: if those millions of young people do not sign up—and quickly—total costs will soon skyrocket, defeating the very goal of the Affordable Care Act. According to the Associated Press, this has led a few states, like California, into absurd forms of social consciousness-raising, asking each older registrant to make sure they convince a younger person to sign up for a minimal level of coverage. So large will that gap be in several large states, that many insurance company executives and analysts are already predicting widespread increases on all forms of health coverage at the beginning of 2014.

Compounding the problem was the long-standing, oft-repeated pledge that Americans could, if they chose, keep their existing plans. This, too, was patent nonsense, and a bold statement which never should have been allowed to become the mantra of the White House position. Employers, large or small, are under no requirement to provide medical coverage. Insurance companies have no mandate—from state or federal jurisdictions, nor from courts—that they must guarantee anyone, or any entity, insurance. Implicit in any arrangement between an insurance provider and those it insures is the age-old boilerplate language: this policy may be cancelled at any time, for any reason.

President Obama had little business making such a sweeping assurance in the first place; but then, to compound the mess, Obama said he would make good on his word by asking those same insurance companies to go back and offer—presumably temporarily—alternate and makeshift plans to cover those now lost in the hinterlands between political rhetoric and painful Main Street realities. Indeed, it may turn out that for a large number of Americans, things were made worse, not better.

Libertarian conservatives draw from this the inescapable conclusion that sometimes government can not do a thing better than the private sector, even when there is general agreement among the population that the private sector choices are neither optimal nor ideal.


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