• Booting up
    October 16,2013

    The difficulties slowing enrollment on health care exchanges around the country, including the one in Vermont, show that the compromises embodied in the Affordable Care Act make health care more complicated than it needed to be.

    The health care exchanges are a way for people to sign up for insurance coverage. They are meant to allow consumers to compare with clarity and simplicity several comprehensive and affordable options. In Vermont, consumers go to Vermont Health Connect to choose among plans offered by Blue Cross Blue Shield of Vermont and MVP and to determine the subsidies that will allow them to afford coverage.

    Many states decided not to set up their own exchanges, relying on the federal government to operate them. Early reports suggest the states that decided to do it themselves are faring better. Further, higher than expected demand combined with a cumbersome federal website has prevented a high percentage of consumers from enrolling. Vermont is said to be doing better than most states, but state officials are still trying to address problems slowing the enrollment process.

    Compare these problems with the simplicity of signing up for Medicare. Medicare is the federal health care plan that covers the elderly. People can go to a website to sign up. Or they can drop by their Social Security office (if they are not prevented by the government shutdown). It is a system that covers millions of people with efficiency all across the country.

    Part of the problem besetting the federal system is that signing up for coverage requires the website to draw information from numerous sources to permit enrollment. To determine subsidies, confirmation of income information must be obtained from the IRS. The identity of individuals must also be confirmed. Thus, the website where the consumer is enrolling must reach out and collate a range of information from assorted sources. With millions trying to do this at the same time, delays have raised questions about when or if the system will be running properly.

    Advocates of single-payer health care have long promoted what they call Medicare for all — a single, government-run program like Medicare that takes the place of insurance. Much of the complexity bogging down the new websites is due to the fact that President Obama felt compelled to keep the insurance industry in the game. He had a hard time as it was gaining passage of the hybrid program that eventually became Obamacare. A single-payer system would have been the ultimate big government program and would have been a bridge too far politically.

    Incorporating the necessary hubs within the health exchange portals that are designed to compile the information to allow people to sign up for coverage is the price we are paying for resistance to health care reform. The good news for supporters of Obamacare is that the high level of participation shows the need for coverage and the interest of the public. Now the scramble is on to make the adjustments to the websites that will allow people to get the health coverage they need.

    Opponents of government-run health care may point with glee to the difficulties the Obama administration and the states are encountering. But as long as people eventually gain care, then nothing is lost (except money) if the startup is slowed or delayed. The point is to make it happen. Maybe some deadlines will be missed. They can be pushed back. People are showing they are eager to get health care coverage, and that is what is important.

    Those who find satisfaction in the government’s problems also ought to reflect on the fact that the entire Obamacare endeavor was caused by the fact that the private sector had already failed to provide a health care system that worked for the American people. It is one of the costliest, most unfair, irrational and arbitrary health care systems in the industrial world, with poor results to boot. Gloating about the government’s difficulties is unseemly when the private sector has already failed so badly.

    At least the public now has hope that people are working to give them the care they need.

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