In my last post I echoed most pro-health-reform observers in counseling patience with the initial enrollment (and data transmittal) problems associated with the federally-run Obamacare exchanges. But there is one big reason the problems need to be resolved as quickly as possible even though the actual “go-date” for coverage is ten weeks off, and even though enrollment will continue for three months after that. National Review‘s Yuval Levin–obviously an Obamacare opponent–identified it in a reasonably fair-minded assessment of the technology snafus today based on conversations with federal and insurance-company personnel:
One key worry is based on the fact that what they’re facing is not a situation where it is impossible to buy coverage but one where it is possible but very difficult to buy coverage. That’s much worse from their point of view, because it means that only highly motivated consumers are getting coverage. People who are highly motivated to get coverage in a community-rated insurance system are very likely to be in bad health. The healthy young man who sees an ad for his state exchange during a baseball game and loads up the site to get coverage—the dream consumer so essential to the design of the exchange system—will not keep trying 25 times over a week if the site is not working. The person with high health costs and no insurance will. The exchange system is designed to enable that sick person to get coverage, of course, but it can only do that if the healthy person does too. The insurers don’t yet have a clear overall sense of the risk profile of the people who are signing up, but the circumstantial evidence they have is very distressing to them. The danger of a rapid adverse selection spiral is much more serious than they believed possible this summer.
I’m in no position to judge the accuracy of Levin’s assessment–he actually mentions in passing the analogy of Katrina where accurate and inaccurate reports, all of them scary, coming into Washington were hard to sort out initially. But he’s right that people who really need health insurance are more likely to push through technological obstacles to get coverage than people who don’t, and that an “adverse selection spiral” would be bad news for the whole system. So it’s important the administration light as many fires as possible beneath the folks struggling to resolve the initial problems.