In 1970 the eccentric but insightful economist Albert Hirschman published a book called "Exit, Voice and Loyalty." It explored how people respond when a private firm's or a government agency's performance is deteriorating.
Some people choose to leave, buying another product or service or leaving the government's jurisdiction. Others use voice, complaining about defects or lobbying for change.
Hirschman tended to deplore exit and exalt voice, and urged firms and governments to nurture loyalty so consumers and citizens would stick around and improve things.
There's obviously some relevance here to a current government program now performing far below even its detractors' expectations: Obamacare.
Central to the goal of Obamacare's architects, universal health insurance, was preventing the possibility of exit. Its individual mandate meant everyone had to sign up for insurance.
The Supreme Court created a big exit door when it ruled unconstitutional, by a 7-2 margin, Obamacare's attempt to coerce states into expanding their Medicaid programs. Many states declined to make the change.
Obamacare's proprietors have also punched big exit holes in its structure. The employer mandate was suspended for a year. Labor unions and other political cronies of the administration received waivers and exemptions.
And it's not clear that even the supposedly fixed website will enable people to actually get health insurance. The website for insurers to receive applications and charge premiums hasn't even been designed yet.
If Obamacare's architects were keen on preventing exit, they blithely ignored voice. The legislation was unpopular when it was proposed, while it was passed and in the months and years afterwards.
Barack Obama seldom mentioned it in the 2012 campaign except for the provision allowing "children" under 26 to stay on mommy and daddy's policies.
The architects of Obamacare also had to deal with loyalty.
Polls have consistently shown that about 80 percent of Americans are satisfied with their health insurance and doctors. They have chosen each at one point or another and were not eager to change absent some serious aggravation.
There was discontent in the late 1990s when health maintenance organizations limited options. But the move for restrictive legislation -- voice -- fizzled when aggravated consumers switched to different policies -- exit -- while those satisfied with HMOs stuck with them -- loyalty.
Recognizing this, President Obama assured Americans dozens of times that if they like their insurance and their doctors they could keep them.
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