I don’t post here much now that I am on Forbes Apothecary site. But I did want to take note of one development. At long last, and after years of denial and shameless cheerleading, the New York Times has run a lead story acknowledging that the ACA is in deep trouble. Longtime ACA proponents such as Sara Rosenbaum, a professor of health law and policy at George Washington University, have come to the realization that the law is in deep trouble.
“Even the most ardent proponents of the law would say that it has structural and technical problems that need to be addressed,” she said. “The subsidies were not generous enough. The penalties for not getting insurance were not stiff enough. And we don’t have enough young healthy people in the exchanges.”
Frankly, although I take no pleasure in the millions of people who are going to be hurt as a result of the ACA’s implosion, I do have a sense of vindication. I warned from the outset that, well-motivated or not, the ACA was not designed properly and that it was extremely vulnerable to a death spiral. I discussed early signs of trouble. And yet people accused me of Chicken Little “The Sky is Falling” syndrome or of not understanding all the brilliant stabilization methods built into the ACA that would let its community rating scheme succeed where so many predecessors had failed.
So, the good news is that people can start to focus on ACA 2.0 rather than pretending that ACA 1.0 is working. It will be a huge fight — already the battle lines are being drawn. My one plea is for discussion to be based on reality and transparency. No more magical models that predict whatever the politicians want. No more things like the CLASS Act — remember that — which miraculously let the ACA appear to cost little even when it had zero chance of ever working. Instead, and perhaps this is the part that is sadly naive in today’s American, let’s have a discussion where we actually listen to each other.