On the Third Hand: Mean

Editors here got fed up with me putting phrases along the lines of “if the Patient Protection and Affordable Care Act takes effect and works as drafters expect” in my PPACA articles.

At a certain point, the editors said the disclaimers were clogging up the articles and made me take them out.

But I think the fact that I kept putting them in until my editors cracked down shows that I’ve had an accurate sense that making reliable predictions about the PPACA exchange program and other major PPACA private health insurance provisions is difficult.

A year ago, I could easily imagine that the exchange program could face information system delays, hacking, low enrollment and a death spiral. I never could have imagined that states like Oregon or Hawaii would have had such a hard time getting an enrollment website. 

This week, I see a lot of articles about opinion polls showing that consumers are skeptical about the exchange program, and that Congressional Budget Office analysts have tweaked their PPACA forecast in a way that makes their outlook on the exchange program less rosy.

Well, fancy that. Trying to change a bureaucratic, chaotic, rickety system that turned access to decent health care into a roll of the dice for many people has turned out to be controversial, complicated and erratic. Who woulda thunk!

Of course, on the one hand, all sorts of known, unknown and little-known forces could kill the PPACA exchange system quickly or slowly.

On the other hand, PPACA also could work well, in expected and unexpected ways, and improve the health insurance market and the health care delivery system in nice, self-sustaining ways. Example: I see people complaining about Summary of Benefits and Coverage (SBC) formatting details, but I don’t see anyone going to the barricades to stop The Man from imposing the infernal SBC notice requirements on us. Maybe some other PPACA provisions will be fine.

On the third hand: I think the fundamental concern about PPACA isn’t any particular technical problem with websites, or even ordinary actuarial illiteracy in, say, the PPACA risk-management programs. A teeny bit of (actuarially assisted) bipartisanship could melt many of those ice dams away.