Friday, December 6, 2013

Noise is no measure of chance of success

    There is a lot of noise about the Affordable Care Act not succeeding. Trouble with the rollout of the federal website, annual year-end cancellations of current policies by private health insurance companies, and potential political effects on future elections are upping the decibel level. However, predictions of the end of Obamacare are premature and fly in the face of the long history of social safety nets in this country.
    Government assistance for those in need of assistance is certainly not new. Early in the American adventure, the colonists saw the need for “poor relief” in the colonies and made sure that help for those on the bottom existed in each colony in the form of “general assistance.” The Affordable Care Act is continuing in that same tradition along with trying to dampen increases in health care costs.
    With the coming of the Great Depression, early Social Security programs began to provide at least a partial social safety net for grandparents, the group least able to fend off abject poverty on their own. The principle that when people have no other means of subsistence the county should provide support from public funds has always been part of America’s story.
    No large, public social program started without months or years of solving implementation problems. Medicare became law on July 30, 1965, after a long legislative struggle to create government-sponsored health care for Americans 65 and older. In that debate, few in or out of government seemed to realize that more than 45 percent of those born between 1890 and 1920 could not initially prove their age because they lacked birth certificates.
    The 2005 launch of Medicare Part D, President George W. Bush’s prescription drug benefit plan, initially created confusion and anxiety among both seniors and insurance companies. Now, it’s just one of the choices for every American over 65.
    All of these programs had rocky rollouts, only to be widely supported later. According to a new Kaiser Family Foundation/Robert Wood Johnson Foundation/Harvard School of Public Health survey, 58 percent of citizens want no cuts to Medicare or Social Security, regardless of concerns about federal deficits.
    As the ACA moves into the mainstream of America, it also is facing a period of time before it works more smoothly. Rocky rollouts say nothing about whether the program itself is worth the trouble. That part of the debate should have ended when the program became law.
    There will be plenty of time for further noise once there are actual program results to measure.

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