The technical problems with the new insurance exchanges established by the Affordable Care Act, which according to Yuval Levin are serious and could potentially have non-technical, very real and lasting consequences, support an argument that liberals have been making for a long time. I don’t mean neoliberals or progressives — the people in the Obama administration who thought the whole individual mandate thing was a good idea. I mean real liberals, who believe that requiring everyone to buy medical insurance on their own is needlessly complicated, and a better policy would simply be to create a system with a single payer.
To use Steven Teles’s preferred term, our new health care system is a kludge, meaning it is an inelegant, improvised, and complex solution to a problem that could be solved better and more simply. Teles points out that our government, which is far more complicated and probably less competent than most comparable governments around the world, can basically be described as a kludgey kludge of kludges.
There are two conclusions to draw from this observation. One can argue that government should be as limited as possible to avoid kludges. Or, one can argue that when government is necessary, government needs the authority and the resources to do what must be done.
Kludges are a result, Matt Steinglass notes, of this country’s essential conservatism. We hesitate to take actions that would disrupt the existing state of affairs, and so we design elaborate solutions to achieve our goals without violating anyone’s established privileges. Obamacare is a perfect example: if we hadn’t been so concerned about protecting hospitals and insurers, we might have found our way to a simpler system with a better chance of success.
No less a conservative than Ross Douthat acknowledges (guardedly) that Obamacare is close to a “right-of-center vision.” He goes on to argue that conservatives should hope for its success, because if the current system fails, “they would have to explain how their plan to build an effective, exchange-based marketplace differed from the Obama White House’s exchange fiasco.”
They won’t be able to. It’s far too early to give up on the exchanges, but if they do fail, it seems most likely that they will fail because of their conservatism — because Congress and the president weren’t willing to go far enough in 2010 in expanding the government presence in the health care system.