I wrote earlier this week about Paul Krugman’s claims that the health insurance market in New York is evidence that the Affordable Care Act is a “huge success.” Somewhere in that post I made the point that success is probably going to be hard to define for the ACA, and it’s going to vary a lot from beholder to beholder.
Ross Douthat wrote a blog post yesterday that captures this on a more nuanced level, and I think it’s really worth reading. Click the link and check out the whole thing, but here’s a little taste.
Ezra Klein, in his new capacity as one of the impresarios behind Vox, has written a pair of attention-grabbing posts — here , and then here — defending the proposition that Obamacare has, in some sense, “won,” and that conservatives who can’t come to terms with that victory can’t come to terms with reality itself. Reading them, it struck me that this argument would benefit from laying down some specific markers for the near future, because Klein seems to move back and forth between two definitions of success. At times, as when he writes that Obamacare “has won its survival” and allows that that “there are still many good critiques to make” of the law, he seems to be using a narrow definition, with which I mostly agree — the law won’t collapse under its own weight, the enrollment levels are high enough to make a return to the coverage status quo ante unlikely, etc. But when he uses language like “the individual mandate … is working” and “the law is back on its expected track,” and concludes that ”[Kathleen Sebelius] can leave with the law she helped build looking, shockingly, like a success,” it implies a stronger definition of victory, in which Obamacare isn’t just continuing, isn’t just unlikely to be swiftly repealed, but is clearly succeeding as a policy in basically the way its advocates predicted that it would.
So I think it would be useful for the law’s supporters to specify the metrics/numbers/outcomes that would vindicate the latter claim.
Douthat goes on to recommend some specific ways that we could go about nailing down whether or not the ACA is successful. Like I said, worth reading in its entirety.
As a brief note, I scrolled through the comments section and it looks like a couple readers have responded to Douthat with some variation of the idea that even a net increase of one beneficiary would constitute a success for the ACA. I think what they mean is that, if after all of this everything–budget, premiums, outcomes, etc–totally evened out but one more person than before was enrolled in a health insurance plan, that would be a success. I can see where they are coming from, I suppose, but that seems like quite a stretch. After all, for such a limited bump in enrollment, it would have been far easier and less intrusive to simply levy a modest tax and use that to finance premiums for a small percentage of the population. These obviously aren’t particularly realistic ways of thinking about the ACA, but the point I’m trying to make–the point I’ve been trying to make for months and even years when it comes to the health care reform–is that this is about trade-offs.