The Daily Item, Sunbury, PA

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November 9, 2013

Health law's defects the price of bad politics

By Clive Crook

Bloomberg News

The rollout of Obamacare could hardly have gone worse. To understand what happened and judge whether things might improve, notice that the problems fall into three fairly distinct categories: defects in the plan, defects in its initial execution and defects in the way it was sold. In the end, only the first will matter.

The website failure is a case of bungled execution — a landmark of managerial incompetence. Glitches were to be expected, but this has turned into something else. Apparently, officials saw it coming. The only surprise is that the White House, despite knowing what was at stake, stood there and let it happen.

The other big embarrassment is that insurance policies are being canceled despite President Barack Obama's promise that people could keep them. Again, the fault isn't with the plan — it's with the way the plan was sold. Obama's promise was either an audacious oversimplification (if you're feeling generous) or a bald-faced lie (if you aren't). Even so, the cancellations don't point to fatal defects in the design, any more than does the website farce.

The Patient Protection and Affordable Care Act was always intended to disrupt the individual health-insurance market. Forcing insurers to meet new standards was a core goal. The grandfathering of pre-reform policies was presumably intended to limit the initial disruption, but insurers declined to play along.

More generally, the reform aims to create new patterns of risk-pooling, cross-subsidy and cost recovery across the industry. It's a far-reaching restructuring — and its effects, by the way, won't be confined to the individual market.

Instead of trying to explain what was about to happen and why — no easy task — Obama and his allies offered false reassurance. They decided to say that the reform, though ranking as a world-historical achievement, was at the same time no big deal. This made no sense, but they said it anyway to get the law passed.

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