I’m not sure what I accomplished in yesterday’s post, Obamacare as a feat of engineering, except to make a metaphor for metaphor’s sake. What I wanted to point out was that given the goals of Obamacare, the “disastrous” rollout was entirely predictable. And those goals are not to ensure that everybody who needs to see a doctor gets to see one even if they can’t afford it or even to make sure everybody has health insurance but to ensure that everybody can see a doctor because they have health insurance and do this without costing taxpayers too much or requiring a total overhaul of the insurance industry.
That meant it was going to be a confusing mess to start.
By predictable I don’t mean “Should’ve seen it coming and fixed it before it happened.”
I mean, it was a necessary part of the design.
(Except for the bungled website. That was predictable in the first sense.)
It’s a very complicated bit of machinery (There I go again, metaphorizing again.) with lots of moving parts that have to function both autonomously and in synch and it all has to be timed just right---if it moves too slow, insurers and potential customers drop out; if it moves too fast, insurers get scared off and potential customers can’t keep pace and fall away.
What this means is that it was always going to be the case that moving too smoothly and swiftly would be as bad or worse than what people are afraid is happening, that things are moving too slowly and roughly.
So…built into the design was encouraging competition among insurance companies as a way of keeping down costs and making sure buyers had a variety of decent policies to choose from.
But requiring that the choices be decent meant the cancellations and the rate shock (for many but not all or most or even close to a large percentage) were built in to the works.
Here’s where the President’s assurance that nobody would have to give up a policy they liked falls into the first category of predictable. He should have known this wasn’t true, that is, if he understood his own program. Makes you wonder if he didn’t or if he was lying the way salesmen do or if he was assuming that people holding junk policies knew their policies were junk and of course didn’t like them and were just itching to dump them for something better. I’d bet the last one. He seems to have a habit of assuming that what he regards as the obviously intelligent thing is obviously the obviously intelligent thing to everybody else.
At any rate, the cancellations and rate hikes are features not bugs…or were. But for a similar reason so was the initially slow rate of sign up.
Encouraging competition increased choices, all right, but that increases the time necessary to evaluate those choices and make a decision between them.
To put it simply, you don’t buy insurance the way you buy a book from Amazon or decide what video to stream tonight.
Buying insurance is a complicated, confusing, worrisome, bothersome, time-consuming chore.
And that’s with the help of an agent.
Having to do it on your own, without an agent, without a Staff Recommendations or a People Who Purchased This Policy Also Purchased…is terrifically more vexing and intimidating and anxiety-inducing. No matter how careful you are, you can’t escape the feeling that you overlooked something or checked the wrong box or misread the instructions or could have made a better choice, because odds are you did, did, did, and could have.
So of course if you’re going to buy a policy you’re going to be extra-careful, you’re going to take extra time, you’re going to put off a final decision until you’ve gotten all the advice you can get and read and re-read all the fine print, and, because it’s how human beings are, you feel time’s up and you can’t put it off any longer.
I would bet that the designers, whom I’m assuming understood that, would have liked to have built into the design more time for people to sign up, but they had to plan against another potential problem.
There are many potential customers who can’t put off the decision as long as possible. They have to buy today because they need to see a doctor today. The effect is what it was always going to be, the first wave of sign-ups were going to be the people insurance companies don’t want as customers. Sick people. People with pre-existing conditions. Older people. Poorer people.
But to get back to the slow sign up rate.
Anyone who points to that as proof people don’t want Obamacare should be asked when was the last time they bought insurance themselves.
Any type of insurance. Life insurance, home owner’s, auto, health.
And not the last time they updated an existing policy. But bought a whole new one.
Then they need to prove that when they did, they read the whole contract including all the fine print through and through, understood it all, and finalized their decision in an hour!
They should also have done it online without the guide of their agent.
Or they should be asked if they have good health insurance at work if their company changed insurers or altered coverage recently and if so did they read the memos and brochures that came down from HR? Did they read over everything in the folders and binders handed out? All the fine print too?
Or did they change jobs and when they were hired did they look deeply into their new employer’s health insurance package? Did they do all the above?
Almost certainly not.
Almost certainly they glanced at the basics and assumed the rest was good, trusting their bosses or unions to have made the best choices for them.
If they tell you they did read it all, including the fine print on the fine print, then either they are OCD, or paranoid, or much smarter and more diligent and blessed with more free time than us average mortals or…they’re lying.
Buying insurance takes time and trouble under the best circumstances. If people were rushing to sign up it would mean there are a whole lot of reckless and careless and foolish people out there or a lot more people who need to see a doctor today than we knew, an absolutely horrific thing to contemplate, or some insurer somewhere is offering gold policies at bronze prices to all and sundry, which would be great, although I’d be surprised if that wasn’t foreseen by the designers and designed against from the start.
At any rate, we need to wait until people have had more time to do some smart and careful shopping or until time’s running out and people feel they can’t put it off any longer.
Two articles from the Los Angeles Times via Eric Boehlert, who tweets the first link with the preface "wouldn't it be nice if LATimes columnists didn't have to fact-check God-awful Obamacare reporting?": a column by Micheal Hiltzick, The Myths of Obamacare's 'failure' and a story by Noam N. Levey, Healthcare plan enrollment surges in some states after rocky rollout, which may be a more optimistim-inspiring headline than the whole story warrants but is still good news for the President or at least encouraging news.