It would be an understatement to say that this month’s rollout of the Affordable Care Act, U.S. President Barack Obama’s initiative to ensure that all Americans have access to health insurance, has not gone according to plan. On October 1, the online insurance marketplaces that are the lynchpin of Obamacare (as the law has colloquially become known) were opened for business -- but it quickly became clear that they are not functioning properly. Computer malfunctions have prevented enrollment, consumers are frustrated, and politicians and pundits are attacking Obama for the resultant “train wreck.” The problems are all the more embarrassing given that publicly funded health-insurance programs are commonplace in most other countries.
But the fact that the White House is having trouble implementing Obamacare also should not come as a particular surprise. It is not that the Obama administration is especially incompetent. Rather, the program it is charged with executing is a complex public-private hybrid that has no real precedent elsewhere in the world. The blend is purely American: Policymakers in the United States have a history of jerry-rigging complicated programs of this sort precisely because they have little faith in government. The result is a self-fulfilling prophecy that fuels only deeper public cynicism about the welfare state.
Among the advanced industrialized countries there is no real parallel to Obamacare. In part, that is because most countries established universal health insurance long ago, some fairly gradually. By contrast, the United States is abruptly expanding coverage to millions -- probably around seven million people will be purchasing insurance coverage through the new exchanges by 2014. Even the closest precedents fall far short of this. In the mid-1990s, Switzerland boosted health-insurance coverage to try to reach the four percent of the population that was not yet covered. But that was in a country whose entire population was seven million. In 2006, the Netherlands adopted a health-care system in which individuals could choose their coverage from competing health plans. Yet, unlike in the