U.S. President Barack Obama meets with health insurance chief executives at the White House in Washington.KEVIN LAMARQUE/Reuters
President Barack Obama has run into deep trouble with the Affordable Care Act because of his moderation. He didn't revolutionize America's health-care institutions at one fell swoop. Instead, he tried to preserve much of what Americans are used to, and which many of them are quite happy with, while also enabling millions of the previously uninsured to get health insurance – on its face, quite a reasonable idea.
The consequence is that Mr. Obama has fallen between two stools. His program is a hybrid of a public, government-run system and a private, market-driven insurance industry. It's a bewilderingly complicated scheme that perhaps no one fully understands.
The flaws with the government website HealthCare.gov, on which citizens are invited to enroll, are likely to be overcome comparatively quickly. It's just a website glitch. It can be fixed.
However, there is a bigger problem for Mr. Obama's credibility, and that of his signature domestic policy. He led Americans to believe that those who already had health insurance would be able to keep the policies they already had, at the same price. It turns out that, for a great many people, that may not be the case.
Americans covered by employer-sponsored health-insurance plans were generally doing quite well in the past. An employer could hardly exclude its less healthy employees from the plan, which means that the risks to the insurer were greater, and the whole plan was more expensive. Obamacare is in effect trying to insure all Americans by replicating employer-sponsored health insurance for the whole country.
Many people who have "pre-existing conditions" – who are, in plain English, sick – and have no insurance, must now be offered coverage. That's a new cost to private insurers, and they have to be able to charge for it. But the system doesn't work if young, healthy Americans are allowed to opt out of insuring themselves. It also doesn't work if they can choose to buy cheap, subpar coverage – as many now do.
The Obama administration doesn't seem to have fully appreciated this basic fact of a universal health care system. Ditto for many voters.