As my colleague Brian Balfour has pointed out, as of the most recent report, the total Affordable Care Act (ACA) enrollment for North Carolina is: one.
And that’s putting it charitably: That one apparently hasn’t forked over any money yet, so it’s a bit of a stretch to count him/her as enrolled.
Now, the website’s failures display the Obama administration’s arrogance and incompetence. However, the problems are far more profound than mere tech glitches.
I’ve heard it said that the site can be fixed because it isn’t much different from, say, Amazon. The truth is that the ACA is the opposite of Amazon, or any other successful website, or any kind of business.
When you want to order a book online from a free-market retailer online, you go the site. Often you’ll have a reasonable choice of options — e.g., new or used, hard cover or paperback. It may be of a rare book that most people wouldn’t care for but you would really like. You hit a button, make a payment. The warehouse sends out the book, and it gets to your doorstep. If there are problems, most online retailers work to make sure you are satisfied.
Now imagine that online bookselling worked like the ACA.
First, the government would charge your bank account to pay for the number of books the government thinks you should read every year. To your surprise, the bill probably would be for more than you have ever paid for books in any year.
You would have a heck of a time signing on to the site. If you did get on to the site, more surprises would await. A panel of professors and literary critics would have decided which books you should read, and you could only order those. Instead of a vast range of choices, you would only be able to select from a very short list of titles. If you were to order, your order would go to a huge warehouse in Washington, D.C., where civil service employees would handle it. You’d like to need lots of patience.
Meanwhile, the publishing company may decided not to sell a title you wanted. Say the book cost $10 to print; the government may have ordered the company to sell it at $8 — meaning that providing products at those prices will drive the company bankrupt. So it wouldn’t sell that title anymore.
And if you complained, government officials with access to the media would blast you as selfish and too stupid to understand which books were best for you.
The administration may throw enough money at the ACA website problem to make the problems harder to see, and may produce enough political spin to hide the problems from time to time, but eventually they will emerge.
The problem isn’t the technology. The basic problem would be the same if you were signing up by mail, or over the phone, or by carrier pigeons or the Pony Express.
Successful businesses provide things you want; the ACA tells you what you must take. In a matter as important and complex and medicine, that spells certain failure.
What could succeed would be health insurance that left people in charge. Recently the Heritage Foundation put out a look at what patient-centered reform might look like.
This is not to endorse that plan, but to point out that is one way conservatives might move forward.