Michael Gerson

For liberals, it is a cruel twist of history that Harry Truman's dream of universal health coverage, carried forward by generations of committed Democrats, should fall to the Obama administration for its fulfillment.

Barack Obama seems to have adopted this cause in January 2007 as a last-minute speech insert. "We needed something to say," one adviser told Politico. "I can't tell you how little thought was given to that thought other than it sounded good." Eventually, the Affordable Care Act was passed by a partisan vote, draining the law of legitimacy outside the Democratic Party. Over the next three years, Obama proved incapable of explaining Obamacare's virtues and its popularity fell. Then its implementation was entrusted to a Cabinet secretary, Kathleen Sebelius, who gratuitously alienated religious groups and massively bungled the law's rollout.

Obamacare is a multiyear, multifaceted fiasco. It is a case study in how to alienate a country you intend to help. And it could become an intellectual crisis for modern liberalism. The "glitches" are shockingly serious systemic failures, which were caused, in part, by a political calculation. Obamacare's mandates and regulations drive up health insurance costs. Late in the planning process, the administration decided that it could not allow people on HealthCare.gov to see their raw price increases without also seeing their offsetting federal subsidies (for those who get them) -- which means that consumers must provide their financial information before they can browse their insurance options. The techies objected that this would introduce needless complications and reduce eventual enrollments. The Obama administration insisted.

And these interface problems may be the easiest to solve. The new system requires the smooth transfer of information among massive databases. Even the trickle of enrollment files currently going from the government to insurance companies has been lumpy with errors. The greatest risk in the implementation of Obamacare was always adverse selection -- that the exchanges would not attract enough young and healthy people to make them economically viable. If there are too many sick people in an insurance system, premiums rise, further discouraging younger, healthier people from participating, resulting in higher premiums, etc. ... The insurance "death spiral."


Michael Gerson

Michael Gerson writes a twice-weekly column for The Post on issues that include politics, global health, development, religion and foreign policy. Michael Gerson is the author of the book "Heroic Conservatism" and a contributor to Newsweek magazine.
 
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