Obamacare Isn't a Success -- or a Failure
The big takeaway from the latest Affordable Care Act statisticsthis week is ... the same takeaway that we should have had from the very start.
Stop thinking about whether the ACA will "succeed" or "fail."
It's a question driven by the Republican demands for repeal of the entire law. But those demands are long past their expiration date; the status quo ante, for better or worse, no longer exists and hasn't existed, really, for some time now. In other words, the Republican "repeal" position has become just as purely rhetorical as their (fictional) "replace" bill has always been. The current Republican hope (or perhaps belief) is that the law will just collapse by itself, something that again is somewhere between wishful thinking and active self-delusion.
But the thing is: Just because the act won't "fail" in this sense hardly means it will "succeed." Yes, as Ezra Klein says today, a premium death spiral isn't going to happen next year (although that doesn't mean it won't happen down the road -- after all, spirals start slowly!). But that doesn't mean that health care will indeed be affordable down the road. Or, more precisely, it doesn't tell us how affordable it will be, and how that will vary for different populations.
The other arguments surrounding ACA are similar. Such as, for example, the question about the effects of reform on overall health care costs. Sure, liberals can gloat that conservative fears that reform would explode the cost of health care have proved wrong. But it surely matters quite a bit (for the economy, and for government budgets) what happens to cost levels.
Or, to put it another way: ACA has been implemented. That's the new status quo. And the new status quo will turn out to have some things it does well, and some things it does badly, and some things it does pretty well but could be better ... and it's not going to matter very much whether we call new sets of reforms "changing Obamacare" or not.
In other words, the policy challenge very soon, maybe even now, isn't so much "will Obamacare work?" but "how well does the health care system work, and what can be done to improve it?" And declaring the ACA a success or a failure really doesn't help answer those questions.
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Jonathan Bernstein at firstname.lastname@example.org