President Barack Obama's signature accomplishment is teetering. The Obamacare website is a national punch line. Millions of Americans, repeatedly reassured by Obama that they could keep their doctors and health plans, are discovering that they can't. Their insurance policies are being canceled. The price of new coverage is substantially higher. The new coverage may force them to choose new doctors. And the law says they have to buy insurance or pay a fine.
People are deeply concerned, and for good reason. This is, as Democratic Sen. Max Baucus famously predicted seven months ago, a "train wreck."
No wonder worried Democratic lawmakers are pelting the White House with suggestions for various changes to Obamacare. Among them: Rescind those cancellations and allow consumers to keep their coverage, even if it doesn't meet Obamacare mandates. Extend the coverage enrollment period and delay the law's mandate that everyone obtain insurance or pay a penalty.
Much of the focus in Washington has been on the political consequences of the Obamacare disaster, whether Democrats are vulnerable and Republicans can take advantage.
No surprise there. Democratic leaders forced the law through Congress without a single Republican vote. The architects of Obamacare brushed aside sharp warnings from tech wizards that the computer system wasn't tested and ready. They piled hundreds of pages of last-minute regulations on insurers. They forced insurers to cancel policies by the thousands because those policies fell short of the soup-to-nuts coverage required by the law.
The American public is having a credibility-shattering debate about the president: Did he not bother to learn the details of the law before he told us we could keep our doctors and our insurance, or did he know the truth and flat-out lie?
Political consequences from the early failure of Obamacare are likely. But far more important are the personal consequences for American consumers.
There are early indications that many young and healthy people are opting not to buy insurance. There are two likely reasons: It's nearly impossible for anyone to sign up, and the cost is prohibitive for people who have modest incomes but don't qualify for subsidies.
If this continues, you'll hear the phrase "death spiral" more and more. That's the term insurance execs use to describe what will happen if young and relatively healthy people don't pay into the system while older people with greater health care needs sign up. If that happens, increased costs will vastly outstrip increased revenues, putting enormous financial pressure on the whole scheme.
The administration has delayed the insurance mandate on employers. Meanwhile, the stream of carve-outs for special pleaders continues to grow. The latest: a break for some labor unions and businesses on a $63 tax for each person in a heath plan, imposed to compensate insurance carriers that wind up with larger costs than anticipated. Last week, Obama apologized to people who are losing their health insurance despite his repeated assurances to the contrary. "I am sorry they are finding themselves in this situation based on assurances they got from me," he told NBC News.
People don't need an apology — heartfelt or, as this one appeared, grudging. They need to know their health coverage isn't in jeopardy.
Republicans, and a growing number of Democrats, are pushing bills to save existing insurance plans. Bipartisan support is growing for a delay in the individual mandate.
The Obama administration wants an administrative fix so it can avoid legislation that might open the door to other changes to the Affordable Care Act. The president had better recognize he's in no position to sidestep Congress. He's losing the confidence of the public and leaders in his own party.
He needs to cooperate on short-term fixes. In time, though, Obamacare is going to require more than that.
The odds against a fundamental restructuring of the law are steep, given the deep distrust Republicans and Democrats have for each other. But that's what will be needed. A bold reboot, a Manhattan Project for health care reform that starts fresh with some basic principles.
An essential first step: Accept that government doesn't know what's best for everyone. That people can decide what coverage they need and can afford. A strong marketplace offers choices for every wallet. Obamacare's rules curtail those choices. Why, for instance, should only people under age 30 be eligible to purchase lower-cost "catastrophic" insurance? Pinching Americans' coverage choices is one big reason this law doesn't work.
Republicans will have to be constructive. They've talked "repeal and replace," but the public has no idea what they would offer as a replacement.
Democrats will have to avoid being defensive. It was a mistake to attempt such a massive government intrusion on a marketplace and a mistake to do so without anything close to a public consensus.
