Friday, April 18, 2014

We’re lost, but we’re making good time

Today's Wall Street Journal reports President Obama saying that eight million people had picked health-insurance plans through the Affordable Care Act.  “The point is, the repeal debate is and should be over," the president said. "The Affordable Care Act is working..."

Well yeah, it's a start, but it's still at most only 20% of America’s uninsured, leaving aside what this obsessively word-smithing president might mean by "picked".

The insurance underwriter in me knows what Obama said is sales talk.  His are not the words of a knowledgeable experienced salesman, or an experienced executive, or even a realistic person. They are the words of someone trying to persuade me with weak logic, scant evidence, and a story contrary to what I can see with my own eyes.  They are the words of a man trapped inside some Mary Poppins fairy tale in which “Well begun is halfway done.”  In short, it's sales talk.

And the problem with the president's sales talk is that he is selling a fantasy world, not the real world.  The real world sets a higher bar for "it's working":  people who have enrolled must be able to obtain services they need when they need them; their personal costs counting premiums, deductibles, co-pays, and wait times must be truly affordable; after first enrolling, people must be willing to re-enroll for the next year.  Not only that, but in the real world, almost all the remaining 30+ million uninsured Americans must soon also enroll.  In the real world, physicians and hospitals must be able to accommodate millions of additional patients without harming quality or accessibility. In the real world the insurance companies must be able to set premiums with confidence based on hard facts about the covered populations.  In the real world, the feds must actually, you know, get around to building the back-end systems needed to transmit enrollment info and premiums to the insurance companies.  And of course, in the real world, our president promised back in 2009, “I will not sign [The ACA] if it adds one dime to the deficit, now or in the future, period.”  And yes, he really did say “period”.

All of that and more is how the real world will decide if “it’s working.”  Clearly, despite what the president wants me to believe, this administration still has promises to keep, and miles to go before it sleeps.  Those promises cannot yet be counted as kept.  That's why I think it's misleading to say The Affordable Care Act "is working."

For right now at least, it's much closer to the truth to say, as Yogi Berra once said, “We’re lost, but we’re making good time.”
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