I think whether or not "Obamacare" is working depends upon what you believe the reform was designed to do. At its heart, Obamacare was designed to expand access to millions of people who did not have it. It's too soon to tell but everything that I know about Obamacare, and I know quite a lot, tells me that it will accomplish that goal. You can quibble with exactly how many people it will end up covering, but it will be millions of people. The only reason that it won't cover more millions of people is because the Supreme Court made expansion of Medicaid optional for the states, which was the main mechanism by which the poor would have reliably gained coverage.
At it's heart, Obamacare was about redistributing resources from those who currently have care to those who do not. Whether that is a good or a bad thing depends on whether you believe that it is a moral imperative that everyone in this country obtain affordable healthcare coverage. I do, Yoda and others do not. Obamacare was also about regulating insurance companies so that more of what they do centers around providing care rather than protecting their profits. Obamcare also appears to be on the road to accomplishing that goal Do you like no exclusions of coverage for pre-existing conditions, no lifetime or annual limits on coverage, mandating that insurance companies have to spend 85% of the dollars they collect providing care, instead of lining their pockets? Do you like that health insurance companies have to cover preventive services with no copays or deductibles? Do you like that everyone who makes under 400% of the federal poverty level will get a little help with premiums that are currently more expensive than you are able to afford? If you do, than you'll love Obamacare, because it does all of these things, and none of these things existed before it was passed into law. If these are the things you are using to judge whether or not it is a success, I think you'll be happy.
If, however, you believe the goal of Obamacare was to control costs, I don't think Obamacare is going to do that as effectively as the proponents of it led people to believe. If your goal is that your healthcare is going to remain exactly the same and that you as an individual will not have to pay a dollar more than you were paying before the reform was passed, I think you're going to be disappointed. But the ironic part about this whole discussion is that the time horizon for these conversations is totally wrong.
Conservatives are going crazy that Obamacare has not controlled costs, and has in fact increased them for many, but these judgments are totally inappropriate at the present time. The true test of Obamacare will be what happens in twenty or thirty years, not what happens today or next month or next year. Those who have an agenda, on both sides of the aisle, are seeking to gloss over this incredibly important point, and it is this: Whether Obamacare works or not will depend on how much it increases access, and how much it controls costs, but that can't possibly be known now, so fair judgments cannot be made now one way or the other. This is not an attempt to dodge the disastrous implementation of the Exchange websites, or to kick the can down the road to avoid having to wrestle with these issues. It's an honest reflection about how long these utilization patterns take to change.
If millions more get coverage, and those millions because of having access to timely preventive care become less likely to develop chronic diseases, that will save the nation trillions of dollars over the next few decades. If the incentives in Obamacare lead to better coordination of care, that will reduce medical errors, and provide better healthcare for patients, in addition to saving money. If, on the other hand, Obamacare explodes costs and doesn't raise enough revenue to fund the program, the unsustainable nature of our healthcare system will get worse rather than better. If the individual mandate ends up resulting in younger, healthier people becoming insured who would have otherwise opted out, the risk pool will become diversified and costs will come down as a result. If, on the other hand, the individual mandate ends up being ineffectual due to its low cost relative to the cost of purchasing insurance, costs will increase.
Reforming our healthcare system is so much more complex, and takes a much longer period of time, than most of the people casually debating about this have any capacity to understand. These are not things that can be evaluated in the short-term. The effects of these policies can only be analyzed long-term. It's only by taking a long-term vision, and by a long-term vision I mean something on the order of thirty years, that any of us will be able to answer the following questions: Does Obamacare work, does Obamacare lower costs, and is Obamacare a good or a bad thing for our healthcare system and our broader society?
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