Six years into Obamacare and almost three years into the exchanges, we've learned a lot.
First lesson: management is important. Not to beat a dead horse, but Healthcare.gov's disastrous launch was due partly to the website's complexity, partly to an awful federal procurement system, and, last but not least, partly to a lack of adequate management capability in the administration.
“Wanting to create competition in insurance markets is all well and good, but it requires more than just throwing money at the problem.”
Not to undersell everything else that went wrong, but former Obama advisor and Harvard health economist David Cutler made it clear in a letter to the administration, noting that "[t]he person newly appointed to head the insurance oversight office has a reputation as an insurance bulldog, not a skilled facilitator." And an investigation by the Department of Health and Human Services' inspector general concluded that "the absence of clear leadership … caused delays in decision-making, lack of clarity in project tasks, and the inability of CMS to recognize the magnitude of problems as the project deteriorated."
Second lesson: Establishing an insurance company is more than just paying claims. The failure of more than half of all co-op insurers around the country — non-profit insurers that were given federal grants to compete in the exchanges — underscores this immensely well. Of course, these companies failed for a variety of reasons, including Republicans pulling the rug out from under them by changing the rules of the road for an important federal backstop. The point here is that wanting to create competition in insurance markets is all well and good, but it requires more than just throwing money at the problem.
The last lesson is perhaps the most relevant: People don't want to spend a lot of money on insurance...
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This piece originally appeared in Washington Examiner