Let me try to understand this: the key incentive for small businesses to support Obamacare was that they would be able to shop for the best deals in health care superstores — called exchanges. The Administration has had three years to set up these exchanges. It has failed to do so.
This is a really bad sign. There will be those who argue that it’s not the Administration’s fault. It’s the fault of the 33 states that have refused to set up their own exchanges. Nonsense. Where was the contingency planning? There certainly are models, after all — the federal government’s own health-benefits plan (FEHBP) operates markets that exist in all 50 states. So does Medicare Advantage. But now, the Obama Administration has announced that it won’t have the exchanges ready in time, that small businesses will be offered one choice for the time being — for a year, at least. No doubt, small-business owners will be skeptical of the Obama Administration’s belief in the efficacy of the market system to produce lower prices through competition. That was supposed to be the point of this plan.
Certainly, the Republicans who have stood in the way of these exchanges — their own idea, by the way, born in the conservative Heritage Foundation — deserve a great deal of “credit” for the debacle. But we are now seeing weekly examples of this Administration’s inability to govern. Just a few weeks ago, I reported on the failure of the Department of Defense and Veterans Affairs to come up with a unified electronic health care records system. There has also been the studied inattention to the myriad ineffective job-training programs scattered through the bureaucracy. There have been the oblique and belated efforts to reform Head Start, a $7 billion program that a study conducted by its own bureaucracy — the Department of Health and Human Services — has found nearly worthless. The list is endless.
Yes, the President has faced a terrible economic crisis — and he has done well to limit the damage. He has also succeeded in avoiding disasters overseas. But, as a Democrat — as someone who believes in activist government — he has a vested interest in seeing that federal programs actually work efficiently. I don’t see much evidence that this is anywhere near the top of his priorities.
One thing is clear: Obamacare will fail if he doesn’t start paying more attention to the details of implementation, if he doesn’t start demanding action. And, in a larger sense, the notion of activist government will be in peril — despite the demographics flowing the Democrats’ way — if institutions like the VA and Obamacare don’t deliver the goods. Sooner or later, the Republican Party may come to understand that its best argument isn’t about tearing down the government we have, but making it run more efficiently.
Sooner or later, the Democrats may come to understand that making it run efficiently is the prerequisite for maintaining power.