You know you're having a bad day when Jon Stewart ridicules your greatest achievement.
Barack Obama has been having that kind of a day this week. On Monday night, the Daily Show host tore into Obamacare, which had a shaky launch, to say the least. Hundreds of thousands of people tried to log on to the new insurance exchanges, only to find that the computer systems didn't work.
"We're gonna do a challenge," Mr. Stewart told Kathleen Sibelius, the Secretary of Health and Human Services, who had come on his show to shill for it. "I'm gonna try and download every movie ever made, and you're gonna try and sign up for Obamacare – and we'll see which happens first."
It went downhill from there. How many people had signed up? (She didn't know.) Why don't the computers work? Why do big businesses get to delay it for a year when individuals don't? What about the businesses that are cutting people's hours to avoid facing the law? What about the people who will have to pay a penalty if they don't want it? Can people really be smart consumers when the choices they will have to make are so complicated? Can you guys run it okay? Why is all of this so hard?
Then he summed up the problem in a nutshell. "So this is a system that has been jerry-rigged to deal with the crazy people."
Obamacare was jerry-rigged in a country where single-payer health care is not an option. It was jerry-rigged to deal not only with the crazy people, but with the doctors' lobby, the pharma lobby and a thousand other interest groups. It was arguably the best shot Mr. Obama had at bringing decent health care to everyone. But even its supporters admit that it's a big, ugly hairball. And, as Mr. Stewart said, fighting off the crazy people is frustrating when you have to defend something so flawed.
In the long run, the biggest threat to Obamacare isn't from Tea Party Republicans, who seem perfectly happy to bring the world financial system to its knees to stop it. It's from people who liked the idea, but are discovering that the reality is different. It's from people who truly believe in universal coverage and the collective good, but now find that they're the ones who'll be paying for it.
That wasn't the way it was supposed to work. Mr. Obama sold people on the Affordable Care Act by promising that it would "cut the costs of a typical family's premium by up to $2,500 a year." He promised they could keep their doctors and their insurance plans. And indeed, the good news is that costs for the poor and for many of the formerly uninsured will be very low, because of the subsidies they'll receive.
The bad news is that some middle- and upper-middle-class families are getting whacked. Nobody knows how many of these people there are, but it isn't hard to find them. Debra Saunders, a columnist with the San Francisco Chronicle, cites the 60-something San Francisco couple who will now be paying $13,000 for a bare-bones plan, and the healthy 55-year-old single woman whose premiums will go up $250 a month, among many others. In North Carolina, Blue Cross customers are getting renewal letters telling them their premiums will go up by $10,000 a year.
The idea that Obamacare could offer more coverage to more people and sicker people, while also cutting costs, never did make sense. As Ms. Saunders writes, "It was too good to be true."
The success of Obamacare depends on everybody signing up. It desperately needs the young and healthy to subsidize the old and sick. But will they? Maybe they'll just decide to pay the penalty instead. What about the healthy middle-aged who are facing newly hefty premiums? They'll soon be voting – with their wallets.
In Canada, most of us believe that passing the Affordable Care Act was a moral imperative. No advanced nation can allow so many people to be shut out of health care. Better a flawed bill than no bill at all, we argued. Besides, it can be fixed up later.
But most Americans don't agree. A Pew Research poll last month found that 53 per cent of them disapprove of the law. And even if it can be fixed up, Obamacare doesn't address the bloated costs that are larded through the system like the fat on a Berkshire pig. A hip replacement costs two or four or six times what it does in Canada (it's impossible to be exact, because every U.S. hospital system has its own pricing scheme and charges whatever it can get away with). Insurers don't bargain very hard because they can just pass the costs along to consumers, who are in no position to bargain because insurers pay the bills.
I've seen some of these bills – they're insane. An ordinary birth with mild complications in Chicago: $85,000. (The stunned Canadian mother took a picture of the bill and sent it to all her friends.) A routine pacemaker replacement for an 83-year-old in Massachusetts: $100,100. A recurrent outpatient treatment for my sister's chronic illness: $4,500 a pop.
Overtreatment is a problem, too. Last week, my sister went to see a doctor for warts on her finger, and he sent her for an MRI – to rule out cancer. If the U.S. system were as cost-effective as ours is, they'd get twice as much value for their money. As it is, soaring health-care costs are the single biggest threat to America's finances, and no one has a clue how to rein them in.
Princeton economist Uwe Reinhardt probably has the best description of Obamacare. He calls it "a complex and somewhat ugly patch on a complex and somewhat ugly system." Which is better than a "train wreck," I guess. Maybe Americans will warm up to it in time. But it will always be a hairball.