The Affordable Care Act should be a future case study in setting expectations. What has been defined publicly as “success” or “failure” swings dramatically depending on what narrative dominates that month.
Take for example the great press and victory lap President Obama took yesterday for get just over 7 million signups on the exchange. If you take the long view on this one metric they deserve a grade of B-. After all before the website problems Kathleen Sebelius said success looked like “at least 7 million.”
Just barely crossing your minimum benchmark is an acceptable but not stellar performance.
Taking a slightly broader view a C grade on exchange signups is probably more appropriate since the main goal of the exchanges was to cover the uninsured but people just switching plans seem to make a larger than expected percentage.
This decent performance was treated as a great triumph because the administration started this semester with an F and, most importantly, because Republicans in their glee began publicly redefining success with their over-the-top predictions of collapse. By saying total failure was a real possibility the GOP made almost any legitimate outcome look like success.
Given how many ways there are to legitimately judge the law to make it look horrible or respectable this was a big political mistake for Republicans.
When the law is only graded against Obama’s own promises and set goals it repeatedly comes up looking bad. It is not going to reduce families premiums by $2,500. Not everyone can keep their insurance and/or their doctor. Medical bankruptcy is not going away because of high deductible policies on the exchange. Some are still not going to get affordable care. It probably won’t stop double digit premium increases. There will still be millions of uninsured
On the other hand, whenever the law is compared against the dystopic predictions of the GOP it can’t help but look good. There are no death panels, no total collapse, no IRS raids or creepy Uncle Sam mascots performing prostate exams. If Republicans could just stay quiet and let the law be judged against Obama’s own claims the shortcomings would keep becoming evident, but often Republicans end up buying into their own fantasies.
From the broadest perspective, the Affordable Care Act looks like a C- law that haphazardly duct tapes over a few holes in our jury rigged healthcare system, but will not even get use close to a sensible health care system. Disappointingly it will fail to live up to many of the Democrats’ promises, but it will never turn into one of the Republican’s bizarre nightmare scenarios. Whether Democrats or the media claim it is a “success” will depand on what curve they are using to grade it that day.
Official White House photo by Pete Souzza