A failure in the press coverage of the health-care exchange’s rocky launch has been in allowing people to believe that the problem is a glitchy Web site. This is a failure of language: “The Web site” has become a confusing stand-in phrase for any problem relating to the law’s underlying infrastructure. No one has a very good word to describe everything that infrastructure encompasses.

In brick-and-mortar terms, it’s the road that leads to the store, the store itself, the payment systems between the store and the government and the manufacturers, the computer system the manufacturers use to fill the orders, the trucks that carry the the product back to the store, the loading dock where the customers pick up the products, and so on…

If they just blow through the deadlines entirely it doesn’t mean the entire program unravels. But it does mean that it will do a much worse job helping people for years. It does mean that there will be fewer people on Medicaid and many more people paying premiums they can barely afford, or, in some cases, that they can’t afford at all.

With the supposedly state-of-the-art $600 million HealthCare.gov portal malfunctioning, President Barack Obama is urging Americans to go ahead and try to get health coverage by mailing in a paper application, calling the helpline or seeking help from one of the trained “assisters.”

But the truth is those applications — on paper or by phone — have to get entered into the same lousy website that is causing the problems in the first place. And the people processing the paper and calls don’t have any cyber secret passage to duck around that. They too have to deal with all the frustrations of HealthCare.gov — full-time.

POLITICO reporters who got recorded announcements earlier in the week — sometimes directing them to try HealthCare.gov — can now get through to the call center. Once they connect, staffers like “Justin” try to get people’s information into the online system…

“The site does not work for us either,” he said.

Despite the best efforts of President Obama and doting tweeters in Jersey City, government isn’t groovy. The standard rap on Obamacare is that it’s turned America’s health system into the DMV. If only. I had cause to go to the DMV in Twin Mountain, N.H., the other day. In and out in ten minutes. Modest accommodations, a little down-at-heel, nothing cool about it at all. But it worked just fine. Friendly chap, no complaints. Government can do that at the town level, county level, even (more sparingly) at the state level.

But a national medical regime for 300 million people? Not in a First World country. And, when you’re mad enough to try it, the failure is not the insignificant enrollment numbers, but the vaporization of the existing health plans of 119,000 Pennsylvanians, 160,000 Californians, 300,000 Floridians, 800,000 in that tech tweeter’s New Jersey . . . That’s the magic that happens when you disdain the limits of prosaic, humdrum, just-about-functioning government. Perhaps things will get so bad the coolest president ever will no longer seem quite so hip. But, alas, you’ll have to wait three years for a hip replacement. That’s government health care for you.

Via Enroll Maven:


An insurance death spiral is a feedback phenomenon — a bad risk pool in Year One causes drastically higher premiums in Year Two which causes an even worse pool that year and on and on. The key to it is that it causes consumer premiums to go up so that only people with high expected health costs (for whom the high premium is still less expensive than staying uninsured) stay in and drive the cycle on. But in the Obamacare exchanges, the subsidy system is intended to prevent people from feeling the effect of annual premium increases after the first year. The subsidies are designed to make sure that each recipient pays only a certain percentage of his income in premium costs. That percentage stays essentially the same year after year, so if premiums get more expensive the government covers the difference…

[T]he sort of severe adverse selection the exchanges may experience would dramatically increase federal spending and would drive unsubsidized exchange participants (other than those in very poor health) and many insurers out of the exchanges. It could also destabilize the portion of the individual market that remains outside the exchanges, since it will not be possible to keep the parts of the individual market that are inside and outside the exchanges quite separate (in no small part because Obamacare requires insurers to treat plans they sell in those two markets as drawing on a single risk pool). And it would be difficult to shield the employer-based insurance system from such effects too; if the exchange system were to become simply an ultra-expensive and poorly formed high-risk pool, the entire insurance system would pay the price.

Christopher Ruddy, founder and CEO of Newsmax, makes an interesting point about this: “The key to stopping Obamacare is for its opponents to win in congressional elections in 2014. Delaying Obamacare only helps the Democrats who support this boondoggle.”…

Experts like Laszewski are now talking about the possibility of 16 million people getting pink slips for their current insurance. That’s no insurance. No doctor. Nothing. Already, over 1 million people have lost their insurance, with cancellation notices actually soaring above Obamacare enrollment rates…

The mainstream media have in large part turned against Obamacare, and all these factoids are going to be reported. So that raises the question regarding 2014: Do Republicans really want to bail out Obama by handing him a year’s delay? If all the flaws in Obamacare do pan out, they may well overshadow the shutdown negatives suffered by the GOP.

I think I am lining up on Chris Ruddy’s side. There’s an old political adage: If your opponent is determined to hang himself, for Heaven’s sake, don’t take away the rope.

Why should we believe that the federal government is remotely capable of managing something as complicated as American health care? The complexities of the task make a mockery of the very notion of “expertise.” The disastrous rollout of the health insurance website indicates quite clearly the hubris of governmental experts who populate Washington, D.C., these days. Moreover, it is only a matter of time until perverse second-, third-, and fourth-tier effects of this law undermine its goals. Already, there is plenty of evidence that Obamacare, like the AAA and NIRA, invites political interference. Politically connected groups like unions and large businesses have received exemptions that average people simply cannot enjoy. And politics heavily influenced the implementation timeline, which was set to culminate almost at the midpoint between two national elections…

This is why conservatives—at the grassroots or inside the Beltway—cannot blithely assume they will be able to undo Obamacare. This is not simply a matter of individual freedom or efficiency in the provision of health services, as conservatives so often argue. This is a law that promises to do something the government has never successfully accomplished during peacetime. Even so, it will work for some people, and history shows that a motivated minority who receive direct benefits from Uncle Sam can prevent commonsensical changes to their precious programs, even to the detriment of the public good.

Obamacare, in other words, combines the worst bureaucratic innovations with the best political innovations of the last century. Conservative leaders have never faced a foe quite like this, and must rise to the occasion. So far, they have failed.

Democratic National Committee Chairwoman Debbie Wasserman Schultz (D-Fla.) said the troubled rollout of ObamaCare’s enrollment website, which has frustrated thousands trying to enter the site and bruised the administration, won’t hurt Democrats in next year’s midterm elections.

“Democrats will run on the Affordable Care Act and win,” Wasserman Schultz said.

BILL DALEY: [Secretary Sebelius] is being held accountable. She is the secretary, it’s under her watch. Some people are calling for her to be fired, to me, that’s kind of like firing Captain Smith on the Titanic after it hit the iceberg. It’s not going to do much right now. I think they’ve got to get it fixed, they’ve got to get it straightened out. And then there’s the question, obviously, whether there needs to be new leadership at that department. Not only with the secretary, but other things going forward.

Greenfield added that, if more Democrats and public policy professionals come out in favor of a delay, “this dooms Obama’s second term.”