The Affordable Care Act deserves your patience

Posted Wednesday, Jan. 01, 2014  comments  Print Reprints
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Whatever happened to American can-do optimism? Even before the Affordable Care Act covers its first beneficiary, the nattering nabobs of negativism are out in full force.

“Tens of millions more Americans will lose their coverage and find that new Obamacare plans have higher premiums, larger deductibles and fewer doctors,” predicts Republican operative Karl Rove. “Enrollment numbers will be smaller than projected and budget outlays will be higher.”

Rove is joined by a chorus of conservative Cassandras, from Fox News to the editorial pages of the Wall Street Journal, all warning that the new law will be a disaster.

Robert Laszewski, president of Health Policy and Strategy Associates, anticipates a shortage of doctors: “There just aren’t going to be enough of them.”

Professor John Cochrane of the University of Chicago predicts the individual mandate will “unravel” when “we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance.”

Even liberal-leaning commentators are openly worrying. On ABC’s This Week, Cokie Roberts responded to my view that the law eventually would prove popular by warning of “a whole other wave of reaction against it” if employers start dropping their insurance.

Get a grip.

If the past is any guide, some fixes will probably be necessary — but so what?

Our current health-care system is the real disaster — the most expensive and least effective among all developed countries, according to Bloomberg’s recent ranking. We’d be collectively insane if we didn’t try to overhaul it.

But we won’t get it perfect immediately. What needs fixing can be fixed. And over time we can learn how to do it better.

If enrollments are lower than anticipated, the proper response is to keep at it until larger numbers are enrolled.

CHIP, the Children’s Health Insurance Program, got off to a slow start in 1998 and didn’t reach its target level of enrollment for five years. Now it enrolls nearly 90 percent of all eligible children.

Richard Nixon’s Supplemental Security Income program of 1974 — designed to standardize welfare benefits to the poor — was widely scorned at the time, and many states were reluctant to sign up. Even two years after its launch, only about half of eligible recipients had enrolled. Today, more than 8 million Americans are covered.

When George W. Bush’s Medicare Part D drug benefit was launched, large numbers of low-income seniors had to be switched from Medicaid. Many needed their prescriptions filled before the switch had been completed, causing loud complaints.

The website for the plan initially malfunctioned. Pharmacies got the wrong information. Other complications led even Republican Rep. John Boehner to call it “horrendous.”

But the transition was managed, and Medicare Part D is now a fixture in the Medicare firmament.

If young people don’t sign up for the Affordable Care Act in sufficient numbers and costs rise too fast, other ways can be found to encourage their enrollment and control costs.

If there aren’t enough doctors initially, medical staffs can be utilized more efficiently. If employers begin to drop their own insurance, incentives can be altered so they don’t.

Why be defeatist before we begin? Even Social Security — the most popular of all government programs — had problems when it was launched in 1935. Not until the 1970s did Social Security cover most working-age Americans.

Of course there will be problems implementing the Affordable Care Act. But if we’re determined to create a system that’s cheaper and more effective at keeping Americans healthy than the one we have now — and, in truth, we have no choice — we have every chance of succeeding.

Robert Reich, former U.S. Secretary of Labor, is professor of public policy at the University of California at Berkeley. www.robertreich.org

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