To say the Affordable Care Act has had challenges in its startup is like suggesting a hurricane is just a rainy day with some wind.

From the websites early failures to this week’s delay of small business implementation, mistakes have continued to plague the launch of this important legislation.

But how did we get here?

The U.S. had perhaps the most dysfunctional health care system of any developed nation. Seven US presidents tried to fix the maladies connected with the chaos that was American health care with no success.

The system was at odds with itself at virtually every juncture. The insurers, operating to maximize profits, could only do so by minimizing care. That meant no plan for preventative care that reduces long-term care because profits are measured more by short-term results than long term commitments. Profit also meant refusing to insure those who might need insurance the most and cost insurers the most.

The hospitals were conditioned to treat the uninsured through emergency services that are billed at the highest tolerable price. Hospitals then raised the costs of all services to transfer the costs of charity care to paying insureds.

Hospitals also were more profitable when readmissions were frequent and comparable costs at other institutions were not measured. In short, the hospital community had absolutely zero incentive to reduce costs.

Doctors were paid for procedures completed instead of outcomes, so they were encouraged by the system to order a maximum number of tests, blame litigation, and profit from each test ordered with every visit to report on those tests.

Medical equipment providers created an industry rife with corruption, where markups were in the range of 1000 percent on equipment provided patients who had coverage.

With all of these profit structures the outcome was the most expensive, least effective, healthcare system on the planet; a system that could provide anywhere from world class care to no care for those who became uninsurable.

From this Obamacare was born.

Certainly, there needs to be an appreciation that the good parts of Obamacare are gains we will never surrender. From millions insured to the age of 26 on their parents insurance, to preventive care and free testing, to no lifetime limits on coverage or cancellation for severe illness, the ACA has already made American health care better.

But the ultimate test is not about a website that malfunctioned for 45 days; it is about converting the American health care industry to one with full access, responsible contributions by those receiving care and preventative care with a “best practices” approach that bends the cost curve downward.

That all may happen, but the delays have caused many Americans to question if these outcomes are going to be realized in the near future, and to wonder if the administration is playing politics with implementation.

This week, when President Obama delayed another key component of the ACA until after the November’s elections, the timing struck many as questionable at the very least.

What should have happened, and did not, was a clear and understandable explanation of why the delay was necessary, in terms that eliminated the question of political motivation.

Obamacare is not going to be reversed, and those studying it know as much. There is no putting this Genie back in the bottle.

But sooner rather than later progress needs to become predictable and implementation needs to rise to nearly seamless status.

The interim period, filled with maddening mistakes, needs to be over.

 

Jim Crawford is a retired educator and political enthusiast living here in the Tri-State.