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| Obamacare falling, by http://www.flickr.com/photos/charlesfettinger/ |
Under the Affordable Care Act, better known as Obamacare, people who lack health insurance have to sign up for insurance on health insurance exchanges, which opened up on October 1st. Unfortunately, the exchanges haven't worked so far. If you're curious about why, Sarah Kliff made a video explaining the exchanges' technical problems.
At this point it isn't clear whether Obamacare is just facing a few bumps in the road, or if it's a disaster in both politics and policy. If the latter is true, millions of people could lose their health insurance.
But I think there's a longer-term danger as well. If Obamacare is a disaster, it could discredit government in general in the eyes of Americans. And the American welfare state could use some visible successes. Many government programs are extremely popular, particularly Social Security and Medicare for the elderly, but a substantial minority of recipients don't even know that they're both government programs.
Obamacare, on the other hand, is quite conspicuously known as a government program. If the most conspicuous government program doesn't work, people will think government doesn't work. Citizens who expect less from their government don't expect high-quality government programs, and they don't demand them either, which makes government programs worse, which lowers expectations, et cetera.
And that's bad.
It's bad with regard to healthcare because managing healthcare costs, and improving outcomes, in the United States will most likely require more government involvement, not less. It's bad because government spending on redistribution, infrastructure, science, the arts and education are all important. And frankly, it's bad because a functioning government can use money much more effectively than rich people can.
Before anyone says it: Yes, Obamacare's problems could be avoided in a single-payer system. And no, that wasn't going to happen.
