President Barack Obama has often said that his proudest domestic achievement is the passage of the Patient Protection and Affordable Care Act (commonly known as the ACA or Obamacare). The sprawling law, pushed through Congress in 2010 in the face of fierce Republican resistance, made numerous important changes to the U.S. health-care system -- a system so big that, on its own, it represents an economy about the size of France’s.
Thanks to the ACA, which took effect on January 1 of this year, the U.S. government has finally joined most other industrialized nations in offering its citizens health security. The reform, by many estimates, will save tens of thousands of lives as Americans reap the benefits of such provisions as greatly expanded preventive medicine and a prohibition on insurance companies’ discriminating against those with preexisting conditions. The era when millions of Americans were bankrupted by medical expenses will end. If the law works as planned, it will also contain health-care costs, reducing the U.S. budget deficit. And by freeing employees from the perpetual fear of losing their health insurance, the ACA should, in theory at least, make it easier for them to leave their jobs to start new businesses, boosting domestic and global growth.
Given such stakes, and the intense Republican opposition Obamacare still faces, the disastrous manner in which the White House allowed its signature program to be rolled out last fall presents a great mystery: Why didn’t the administration pay more attention? For the debut of the plan and its website, HealthCare.gov, was nothing short of a fiasco. In early 2013, the Congressional Budget Office had estimated that once the ACA got going, seven million Americans would enroll in the new national health exchange in the first six months. Yet in the six weeks following the ACA’s October 1 launch, only a few thousand managed to do so. More than a quarter of a million more, meanwhile, were prevented from even beginning to enroll by