After years of offering up nonsense about Benghazi, Fast and Furious, and the New Black Panther Party, conservatives finally have a bona fide scandal dumped in their lap. Three weeks after its launch, the healthcare.gov portal for the federal health care exchange still doesn’t work. Nobody can really say when it will work properly. For all the talk of “glitches,” there appear to be fundamental flaws in the site’s basic architecture, perhaps driven by poor incentives for government contractors and an overall flawed contracting process. At a Monday afternoon White House briefing for journalists on how things are going, I was tempted to grab a senior administration official by the lapels and demand: “What did the president know and when did he know it?”
Except in this case, the most disturbing thing is how little the White House seemed to know.
Anyone who spoke to administration officials about the Affordable Care Act in August or September can tell you that they spoke very proudly about their forthcoming Web product. Hopes were high that the site itself would be not only a practical way for people to sign up, but actually a key selling point for the law—because it would deliver a customer service experience above the generally low standard set by private health insurance. This talk seemed plausible, since it was a rare situation in politics where nobody had any incentive to lie. If the website proved to be a disaster in October, then having spun it as a triumph back in September would only make the administration look foolish in retrospect.
And now it does look foolish. The product doesn’t work, and for whatever reason, key people didn’t know it didn’t work. That’s a mess, and it fundamentally undermines assurances that the current “tech surge” will lead to major rapid improvements.
Conversely, having been foiled in their effort to repeal the Affordable Care Act by shutting down the government, conservatives are now engaged in a campaign of hilarious overreach to pronounce an entire legislative framework doomed on the grounds of poor Web infrastructure. Charles Cooke, a particularly dimwitted National Review writer, recently unearthed a summertime tweet of mine that read, “Laying down the marker—Obamacare implementation’s going to be great and people will love it.” Cooke’s sleuthing has led to a schadenfreude-fest on conservative Twitter, but few people seem to have read through to the actual post I was teasing. Here was my key prediction:
But you have to understand that the media, for non-ideological reasons, is just massively biased toward negativity about this kind of thing. You never read a newspaper article headlined "A Bunch of People Got Free Dental Care Today Because They Live In A State That Offers Dental Benefits Under Medicaid," but if something goes wrong in a state's Medicaid program, that warrants a story. That's the nature of the news business. You add in the fact that Republicans have a vested interest in making hay about problems plus the fact that liberals have never been all that enthusiastic about the Affordable Care Act's reliance on private insurers, and a lot of negative coverage is baked into the cake. But fundamentally a lot of this criticism comes in the form of comparing the reality of the ACA to an abstract idealized system rather than comparing it to the status quo.
This, I think, holds up pretty well. The massive failure of healthcare.gov is a story that’s gotten much more coverage than the 10 percent drop in Oregon’s uninsurance rate within two weeks of the program’s launch. Things moved unusually quickly in Oregon because the state’s Medicaid system is set up to auto-enroll many people in a way that the vast majority of other states aren’t. But large Medicaid expansions are rolling forward in most states, and more and more Republican governors are embracing this aspect of the program. Monday’s most important health care story wasn’t the president’s speech about the website; it was John Kasich’s maneuver to extend Medicaid coverage to 275,000 Ohioans over the objections of his fellow Republicans in the state legislature.
The right was hoping for a massive backlash to Obamacare. What it’s found instead is massive frustration with the difficulty signing up for it. Fox News columnist Sally Kohn wrote on Monday about her problems with New York state’s site, and her pleasant surprise when she did manage to make the site work and found out how much money she’ll be saving under the new law. Nor is the law causing employers to limit workers’ hours as conservatives told us it would.
The basic fact of the matter is that countries all around the world have been running social safety net programs since long before there was any such thing as a government website. You can apply for Obamacare coverage by phone, you can do it in person, and you can do it by mail. Even if the website literally never works, that won’t make the program unworkable any more than the absence of a great website made Medicare unworkable in the 1960s and ’70s.
Of course this isn’t the 1960s or ’70s, and the Affordable Care Act was envisioned as having a heavy Web component for the same reason the National Park Service and the Justice Department and the EPA have websites. It’s 2013, and you’re supposed to have a damn website. The signature initiative of an administration associated with youth and forward thinking really ought to have a great website. And Obamacare doesn’t. It has a barely functional website. The administration should be embarrassed about this. Ashamed, even. But websites can be repaired. Conservatives who once confidently predicted a massive public revolt are now reduced to complaining that many of the people eager for benefits are having an unduly hard time signing up. Relative to the highest hopes of the White House, that’s a real failure. Relative to the disaster the right has been predicting, it’s a smashing success.