Michael Gerson

No one even considered the scenario we are now seeing: a partially working system in which it is difficult to sign up but not impossible. This means that the most motivated consumers (the sickest) are likely to persevere in creating accounts, while the younger and healthier are more likely to skip an unpleasant process and risk a minimal fine. "If they don't get the necessary volume and demographic mix in the exchanges," Yuval Levin of National Affairs told me, "it could set off a catastrophic adverse selection spiral that would not only render the exchanges inoperable but badly damage our large health care systems."

This is possible, not certain. The administration could dramatically step up its game by year-end and reach the enrollment levels and demographic mix necessary for the system to function.

But the failed rollout has already raised ideological issues of broader significance. It has reinforced a widely held, pre-existing belief that government-run health systems are bureaucratic nightmares. And it has added credence to the libertarian argument that some human systems are too complex to be effectively managed. Perhaps the problem with Obamacare is not failed leadership, but the whole project of putting a federal agency, 55 contractors and 500 million lines of software code in charge of a health system intended to cover millions of Americans.

I am not a libertarian who argues against the need for programs such as Medicare and Medicaid. But Friedrich Hayek has this much going for him: He understood that the challenge of technocratic planning is always limited information. "The peculiar character of the problem of a rational economic order is determined precisely by the fact that the knowledge of the circumstances of which we must make use never exists in concentrated or integrated form but solely as the dispersed bits of incomplete and frequently contradictory knowledge which all the separate individuals possess."

Which is why planning tends to fail, particularly in highly complex systems. "This is not a dispute about whether planning is to be done or not," Hayek said. "It is a dispute as to whether planning is to be done centrally, by one authority for the whole economic system, or is to be divided among many individuals."

So maybe the problem is not Obama or Sebelius but rather a government program that requires superhuman technocratic mastery.


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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