The Obamacare mess reminds me of the BP oil spill, in part because everything reminds me of the BP oil spill, including what’s going on this season with the Gators. They lost to Vanderbilt! At home! This is just not done. There are supposed to be safeguards, backups, contingency plans, and other mechanistic, technocratic systems that stop such disasters before they can unfold.
But back to Obamacare: Clearly the website was one of those single-point failures you always hear about. Like the Deepwater Horizon blowout preventer not sealing the well. (President Obama misses the days when he only had to worry about easy problems, like a gushing well at the bottom of the Gulf of Mexico.)
Critics will say that there’s much more that’s wrong with Obamacare than just a balky website, and I’ll get to that in a second. What’s certain is that the technical flaw with the website undermines the extremely delicate process at the heart of the Affordable Care Act, which is the enrollment of millions of relatively young and healthy people into these new insurance exchanges. The harder it is to navigate that site, the more likely it is that only the truly desperate, the extremely sick, the terminal ill and the actually dead will stick with the process long enough to get enrolled.
Question: Did anyone in the highest levels of government countenance even the possibility that the website might not be functional?
Or did everyone — including Obama — simply assume that technical people, those geeky folks, would make all that stuff work?
Did anyone imagine failure?
To fail to imagine failure is a failure of imagination. (Something like that.)
Just as deepwater drilling is inherently risky, so is a major reform of the health care industry. Some call that social engineering, as a pejorative. But the existing system, pre-Obamacare, was its own form of social engineering, one that left tens of millions of people uninsured or underinsured. The Obamacare critics see the ACA as monstrous socialist over-reach, but I seem to recall that ACA had roots at the Heritage Foundation, that it conspicuously earned buy-in from private stake-holding industries, including insurers who saw a whole new pool of customers, and that it wasn’t what the liberals and Bernie Sanders (an actual socialist) wanted, which was a single-payer plan. Hey, maybe single payer would have worked much better!
This new system may yet work, but it won’t work if the people in Washington decide that their highest priority is to limit the political damage of the disastrous roll-out.
Complex systems fail in complex ways, and sometimes can’t be readily fixed. Obama yesterday offered an administrative fix, of sorts, to let people with canceled insurance policies renew them for another year, but that’s really just calling in the skimmers to deal with the oil slick rather than sealing the well (sorry to be so stuck on this metaphor! Someone call a shrink…). No wonder the insurance companies reacted unhappily (see the Sarah Kliff story on Wonkblog) to the president’s announcement: The exchanges need more people to enroll, and this move works directly against that goal.
As long as I’m mired in this oil spill concept: I was amused to see the lede of the Glenn Thrush story that’s in the debut Politico magazine. Thrush writes, “President Barack Obama even credits Chu with solving the 2010 Gulf oil spill, claiming that Chu strolled into BP’s office and ‘essentially designed the cap that ultimately worked.’ On the Achenblog I deconstructed and harrumphed about that Obama comment at the time he made it. By sending Chu to “fix” the BP oil spill, Obama demonstrated that he believes that smart people can achieve almost anything. Take the smartest guy in the Cabinet (Nobel Prize!) and get him to go down there and plug that well, even if he didn’t know a darn thing about petroleum engineering. And Obama apparently thought that that’s exactly what happened (incorrect).
The government didn’t have the ability to plug that well. The industry had to do it. And my guess is that Obama is going to have to work very closely with the insurance industry — awkward though that may be — to create viable exchanges. Otherwise this whole thing is likely to be kaput.
[Update: Obama has called insurance industry bosses to the WH for a meeting this afternoon, Politico reports.]