It has been interesting watching the Democrats in recent days try very hard not to learn any lessons from the rollout of Obamacare.
In a sense, the development of the Obamacare website offered a window into the thinking behind the program as a whole. The federal government spent three years building a system in an intensely centralized and consolidated way (refusing even to hand over the basic project management tasks) that is characteristic of the technocratic mindset of Obamacare’s larger approach to American health care. That system failed on launch and turned out to have been ill-designed, retrograde, and sclerotic. It seemed almost beyond repair, but a group of private sector engineers from Silicon Valley firms were able to come in at the lowest point in the crisis and essentially do in six weeks what the government couldn’t do in three years (and was probably never going to be able to do). And yet somehow, the president and others are trying to have people draw from this the lesson that the government actually can handle huge, complicated projects well after all.
Obamacare’s basic policy architecture is similarly technocratic. It expects federal bureaucrats to ably manage from the center a mind-bogglingly complicated system and assumes such management would be more effective than a decentralized market-oriented approach. The fact that the people charged with making all this happen could not properly manage the development of a web site does not prove the proposition false, of course, but it surely ought to raise big red flags. The early failure of the enrollment site also created real and practical obstacles to the implementation of the new system, which the administration has had to respond to with a variety of legally dubious kludges and workarounds that still continue. And the way in which the website was saved offers a lesson for that larger system too.
The core of that lesson seemed implicitly evident to some in the administration in December, when an HHS press release on the progress of the website rescue sought to reassure the public by noting that “the team is operating with private sector velocity and effectiveness, and will continue their work to improve and enhance the website in the weeks and months ahead.” There are, of course, ways for public policy to help the American health-care system function with something approaching “private sector velocity and effectiveness.” Some have even been proposed in Congress. But those would require giving our system far more of a market orientation and actually enabling the private sector to improve its cost-effectiveness, reach, and quality. Obamacare is working to do the opposite—moving a system that was already heavily government dominated in an even more prescriptive and centralized direction on the premise that consolidated bureaucracies are better at solving problems.
Now, as the new insurance arrangements created by the law begin their real-world trials, Democrats argue that the fact that the system survived its earliest self-inflicted wounds should end all debate about its prospects.
That seems a pretty odd conclusion to draw from the past six months.