Affordable Care Act deserves patience, not defeatism

12/31/2013 1:56 PM

01/01/2014 5:38 PM

Whatever happened to American 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.

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.”

The round-the-clock naysaying is having an effect. Support for the law has plummeted to 35 percent of those questioned in a recent CNN poll, a five-point drop in less than a month.

Even liberal-leaning commentators are openly worrying. On ABC’s “This Week,” Cokie Roberts warned of “a whole other wave of reaction against it” if employers start dropping their insurance. And some Democrats are getting cold feet.

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. CHIP, the Children’s Health Insurance Program, got off to a slow start in 1998. The Congressional Research Service reported “general disappointment with low enrollment rates early in the program.” CHIP 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 — was widely scorned at the time, and many states were reluctant to sign up. Today, more than 8 million Americans are covered.

If mistakes are made implementing the Affordable Care Act, the appropriate response is to fix them. When George W. Bush’s Medicare Part D drug benefit was launched, large numbers of low-income seniors had to be switched from Medicaid The website for the plan initially malfunctioned. Pharmacies got the wrong information. 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 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. A full year later, Alf Landon, the Republican presidential candidate from Kansas, called it “a fraud on the workingman.” Not until the 1970s did Social Security cover most working-age Americans.

As Alexis de Tocqueville recognized as early as the 1830s, what distinguishes America is our pragmatism, resilience and optimism. We invent, experiment and fix what has to be fixed.

Of course there will be problems implementing the Affordable Care Act. But if we’re determined to create a health-care system that’s cheaper and more effective than the one we have now, we have every chance of succeeding.

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