With the Affordable Care Act soon to be implemented, people on all sides are grabbed by small pieces of news showing that the law will either be a big success or a failure. Part of this divergence in predictions is there are vastly different criteria by which to even define “success.”
There are at least six ways to possibly judge Obamacare and it is only using the most generous criteria that you can make the case it will succeed.
1) Comparing the ACA to other first world countries – Under this criteria it will be a clear failure. Even the supporters of the law admit after it is implemented the United States will still have the most expensive, complex, and wasteful health care system on earth.
2) Compared to Obama’s original promises – Again by this standard the law is a failure. While the ACA does contain several provisions Obama campaigned on in 2008, such as guaranteed issue and subsidies to buy insurance, the law lacks/broke many of his biggest promises. It does not contain a public option, a national exchange, drug re-importation or Medicare-direct drug price negotiation. It will not save the average family $2,500 a year. Thanks to the Cadillac tax, many people who like their current insurance will not be allowed to keep it, directly contradicting Obama’s promise.
3) Compared to the smaller promises made when the law was signed – Even by this modest benchmark it would be hard to argue that current indicators point to the law being a success. The law will cover significantly fewer people than originally projected, although that is mainly the fault of Supreme Court and Republicans at the state level.
The news about what the law will do to premiums in the individual market is a mixed bag. We still don’t know if a critical mass of people will actually use the exchanges or if they will turn into a dumping ground for the sick. The design of the employer mandate now seems very problematic. On the plus side, there are some signs the law might be helping to bend the cost curve.
Most damaging though is that the law won’t fulfill one of President Obama’s most cited justifications for the law. Evidence from Massachusetts is that the law will not stop people from going bankrupt if they get sick.
4) Compared to the status quo – This is the low criteria by which many supporters of the law use to predict it will be a success. Since the law will significantly expand Medicaid and Medicaid is a good program that helps many people, on that provision alone a decent argument can be made.
That said, there will also be many losers as a result of the law. Rich people will see higher taxes. Some young professionals will see a big increases in their premiums. The poor design of the employer mandate could result in part time workers getting their hours cut. Insufficient subsidies combined with a bad employer mandate could leave some people in a no man’s land where they can’t really afford insurance but are forced to pay the individual mandate. The Cadillac tax will also cause people with good insurance to see their benefits cut and deductibles increased. Most concerning, the law basically locks in place our broken private for-profit insurance system.
5) Compared to the conservative dystopian nightmare – Some conservatives have gone so over the top by claiming that Obamacare will be the beginning of a Stalinist state, that it will be impossible for the actual implementation of the law not to seem mundane by comparison.
6) Will it ever become popular – This is the purely political way to judge the law and no one honestly knows the answer. Opinions about the law have remained remarkably stable since it was first approved, but that could change when the law is implemented.
Some people will be better off because of implementation which could help the law, but the law will also produce many losers. There is the possibility people will start to blame all the problems with our health care system on Obamacare.
The thing that is most likely to help improve support for the law is humans’ overwhelming status quo bias. After the law is fully implemented it will become the new status quo and people are reluctant to change even when things aren’t working very well.
At least some of the disagreement about how well Obamacare will turn out is actually not the result of individuals having vastly different predictions of what will happen, they simply have different ideas of what should constitute a success. One man’s success is another man’s failure. Anything can be labeled a “success” if the bar is set low enough.