Measuring the Success of Obamacare: Don't Be Misled

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Many key provisions of The Affordable Care Act were finally implemented earlier this year, and widespread dismay over the reality of an overreaching government immediately followed. Initially, the predominant focus was on the inept rollout of the Obama administration’s website, a fiasco that cost well over $500 million of American taxpayer money -- more than was spent to develop Facebook and Twitter combined, more than the cost of developing Apple’s iPhone. With more than two dozen executive branch decisions to delay some of the law’s deadlines -- but ignoring fixes more substantive than repairing the basic functions of its website -- the Obama administration cynically pushed forward.

Intentionally or simply out of naiveté, the focus of many media outlets initially remained on low hanging fruit, the IT challenges that would undoubtedly be overcome. The message to the public was set in nearly as perfect a manner as any propaganda machine could want: Diverting attention from the destructive longer-term consequences of the law on American health care access, choice, and quality as well as its drastic damage to the economy and jobs, the depiction of Obamacare was dumbed down to simple, but solvable, ineptitude.

Meanwhile, millions of Americans personally experienced far more significant harms from the new law. They lost their existing insurance coverage, and with it they lost access to their chosen doctors and hospitals. Millions saw dramatic increases in insurance prices and higher out-of-pocket costs, with insurance premiums now higher in more than 40 of the 50 states compared to before the law.

Despite the unsettling assessment by the Congressional Budget Office that millions of Americans will become newly dependent on government subsidies and will exit from the workforce specifically because of this law, President Obama simply declared that a superficial number of insurance enrollees would be the definition of the law’s success. And once again, the media bought in.

We now see the headlines. Albeit under threat of penalties imposed by the ever-intimidating IRS and after a massive billion-dollar marketing campaign, the short-term magic number of enrollees was achieved. President Obama then claims that “the final score speaks for itself” and “the law is working,” so we should all move on.


Our problems from the ACA have only just begun. Excessive regulations for health insurance, such as fixing prices and profit margins while requiring bloated coverage that most people never wanted, and then minimizing the fundamental considerations of risk in pricing insurance, is a recipe for increasing premiums and reducing coverage choices. Major insurers all across the country are already declining to participate in the exchanges or limiting their offerings to plans that severely restrict choice of doctors and exclude many of America’s best hospitals. These trends are certain to worsen after the expiration of the administration’s ad hoc deadline delays.

Longer term, even if Obamacare doesn’t lead to an overt single payer system run by the government -- the admitted preference of the president and leading Democrats -- the future is quite predictable unless this law is drastically revised. Just as in the United Kingdom and all systems where everyone is “insured” by government-defined health insurance, we too will soon be plagued with problems unheard of in our pre-Obama system. It’s only a matter of time until we see unconscionable waits for care, overt restrictions on access to tests, drugs, and treatments, worse treatment outcomes -- all proven by the data and the facts from floundering nationalized health systems, as we see reported in the news all over the world.

True to form for big government lovers, our president presses forward. We have yet another technocrat (rather than a health care expert), Budget Director Sylvia Mathews Burwell, appointed to run the Department of Health and Human Services and oversee our entire health care system.

The greatest irony of all lies in what will undoubtedly also follow the first taste of Obamacare -- a full blown, two-tiered health system. No one here should doubt that those with money or power in our society will react like those in Britain, where the overwhelming majority of financially successful people avoid the NHS and use a separate, parallel private system with private insurance. And rest assured, the most vocal proponents of more government authority over health care, the very elected officials who socked it to the average American despite widespread disapproval of the policy, will manipulate and connive behind the scenes to access the best doctors, the latest innovations, the leading edge tests and treatments, for themselves and their families. As in the U.K., only the lower and middle classes in America will suffer the full consequences of ObamaCare.

This story is not speculation. It has already been written in other countries with unmitigated government control over health care. Government-controlled health care is unraveling before our eyes, if we choose to look. And paradoxically, just as countries like England -- the very nation that served as our president’s model for health care -- turn desperately to more privatization to solve the problems their overreaching governments created, we in America will become further divided, with even more inequality, directly due to the greatest government fiasco in generations, driven by our own elected leaders whom we, the voters, empowered. 

Scott W. Atlas, MD, is the David and Joan Traitel Senior Fellow at the Hoover Institution, Stanford University.

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