海角大神

Whatever happened to American can-do optimism? 聽Even before the Affordable Care Act covers its first beneficiary, the nattering nabobs of negativism are out in full force.

鈥淭ens of millions more Americans will lose their coverage and find that new ObamaCare plans have higher premiums, larger deductibles, and fewer doctors,鈥澛爌redicts聽Republican operative Karl Rove. 鈥淓nrollment numbers will be smaller than projected and budget outlays will be higher.鈥�

Rove is joined by a chorus of conservative Cassandra鈥檚, from Fox News to the editorial pages of the Wall Street Journal, all warning that the new law will be a disaster.聽

Robert Laszewski, president of Health Policy and Strategy Associates,聽anticipates聽a shortage of doctors. 鈥淭here just aren鈥檛 going to be enough of them.鈥�

Professor John Cochrane of the University of Chicago聽predicts聽the individual mandate will 鈥渦nravel鈥� when 鈥渨e see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance.鈥澛�

The round-the-clock nay-saying is having an effect. Support for the law has plummeted to 35 percent of those questioned in a recent聽CNN poll, a 5-point drop in less than a month. Sixty-two percent now say they oppose the law, up four points from November.聽

Even liberal-leaning commentators are openly worrying. On ABC鈥檚 鈥淭his Week,鈥� Cokie Roberts聽responded聽to my view that the law eventually would prove popular by warning of 鈥渁 whole other wave of reaction against it鈥� if employers start dropping their insurance.聽

Some congressional Democrats are getting cold feet. West Virginia Senator Joe Manchin recently聽fretted聽that 鈥渋f it鈥檚 so much more expensive than what we anticipated and if the coverage is not as good as what we had, you鈥檝e got a complete meltdown.鈥澛�
Get a grip.

If the past is any guide, some fixes will probably be necessary 鈥� but so what? Our current healthcare system is the real disaster 鈥� the most expensive and least effective among all developed countries, according to聽Bloomberg鈥檚聽recent ranking. We鈥檇 be collectively insane if we didn鈥檛 try to overhaul it.

But we won鈥檛 get it perfect immediately. What needs fixing can be fixed. And over time we can learn how to do it better.

If enrollments are lower than anticipated, the proper response is to keep at it until larger numbers are enrolled. CHIP, the Children鈥檚 Health Insurance Program, got off to a slow start in 1998. The Congressional Research Service聽reported聽鈥済eneral disappointment 鈥� with low enrollment rates early in the program.鈥� CHIP didn鈥檛 reach its target level of enrollment for five years. Now it enrolls nearly ninety percent of all eligible children.聽

Richard Nixon鈥檚 Supplemental Security Income program of 1974 鈥� designed to standardize welfare benefits to the poor 鈥� was widely scorned at the time, and many states were reluctant to sign up. Even two years after its launch, only about half of eligible recipients had enrolled. Today,聽more than 8 million聽Americans are covered.聽

If mistakes are made implementing the Affordable Care Act, the appropriate response is to fix them. When George W. Bush鈥檚 Medicare Part D drug benefit was launched, large numbers of low-income seniors had to be switched from Medicaid. Many needed their prescriptions filled before the switch had been completed, causing loud complaints. The website for the plan initially malfunctioned. Pharmacies got the wrong information. Other complications led even Republican Representative John Boehner to call it 鈥渉orrendous.鈥� But聽the transition was managed, and Medicare Part D is now a firm fixture in the Medicare firmament.

If young people don鈥檛 sign up for the Affordable Care Act in sufficient numbers and costs rise too fast, other ways can be found to encourage their enrollment and control costs. If there aren鈥檛 enough doctors initially, medical staffs can be utilized more efficiently. If employers begin to drop their own insurance, incentives can be altered so they don鈥檛.

Why be defeatist before we begin? Even Social Security 鈥� the most popular of all government programs 鈥� had problems when it was launched in 1935. A full year later, Alf Landon, the Republican presidential candidate,聽called it聽鈥渁 fraud on the workingman.鈥� Former President Herbert Hoover said it would imprison the elderly in the equivalent of 鈥渁 national zoo.鈥� Americans were slow to sign up. Not until the 1970s did Social Security cover most working-age Americans.

As聽Alexis de Tocqueville聽recognized as early as the 1830s, what distinguishes America is our pragmatism, resilience, and optimism. We invent, experiment, and fix what has to be fixed.

Of course there will be problems implementing the Affordable Care Act. But if we鈥檙e determined to create a system that鈥檚 cheaper and more effective at keeping Americans healthy than the one we have now 鈥� and, in truth, we have no choice 鈥� we have every chance of succeeding.