These days it seems there is little the government can do right. From shut-downs to endless filibustering; approval ratings for Congress have never been lower. The Executive Branch has not fared well either. The implementation of Obamacare, manifested most recently in the technically flawed debut of the federal Health Insurance Exchanges, has been publically lampooned. Seizing on what was inarguably a troubled start to a key part of the Affordable Care Act (ACA), Republican congressional members are calling for the resignation of Secretary Sebelius and have deemed Obamacare a failure. After all, the administration had three and a half years to implement what most people see as “a website”- how could they have fared so poorly?
As a former fed (yes, we exist here) and part of the health reform team, I know firsthand what it is like on the other side. Though I did not work specifically on the Exchanges team, I helped set-up similar systems for our Accountable Care Organization program. I could bore you with details of the under-resourced, overworked lives of ACA staff and contractors, or with the fact that the Exchanges were one of literally hundreds of incredibly complex items being implemented from the thousand page bill, but those are all excuses. The reality is that this troubled launch, while a public relations nightmare, does not matter. I guarantee that in a few months, the Exchanges will be functional and in a few years, people will fail to remember this even happened. I can say this with certainty because this is a case of history repeating itself.
In 2006, Medicare launched a prescription drug benefit called Part D. The program was launched in a similarly aggressive timeframe and experienced severe technical issues. Computer systems weren’t talking to one another; seniors had to wait hours to get through to technical support. Approval ratings for the program plummeted. Democrats called for probationary measures against former President Bush. Sound familiar? These issues were largely resolved within a few months. Now, Part D is an essential part of the Medicare structure and is hugely popular amongst seniors. There are countless implementation stories like this.
The Exchanges will be functional. People are already using them to sign up for much needed and reasonably-priced insurance, vastly improving the challenging access issues we have in this country. Obamacare has already had successes: extending familial insurance to those under 26, implementing payments for quality of care, the launch of the accountable care program. The Exchanges will be on this list soon.
But who’s to say that these changes are permanent or won’t be technically marred in the future? No one knows for sure. What I believe is more important than this laundry list is the fundamental change Obamacare has wrought on the healthcare industry; it has shifted the conversation to value. The healthcare conversations of the past were about volume: how do we get more people into our beds, using our devices, etc. In a very real way, the abusers of our system were paid the most. Now, the changing incentive structures have pushed companies to focus on improving the patient experience and containing our skyrocketing costs. Even the most conservative companies are hedging for this change; they cannot afford to live in the past. Neither can we.