Obamacare Implementation

At The New York Times, Joseph Nocera quotes my dissertation adviser:

An insurance executive friend says that the systems Obamacare required were an order of magnitude more complex than even the most complicated insurance company systems. That complexity, says Drew Altman, the president of the Kaiser Family Foundation, was necessitated by the many compromises that were required to pass the bill into law. Ted Marmor, a former Yale professor and an expert on entitlement programs, says that it has to coexist within the extraordinarily complicated “patchwork” that is the American health care system.

Marmor was a young special assistant in the old Department of Health, Education and Welfare when Medicare rolled out in 1966 — a rollout that was as smooth as Obamacare’s has been rocky. (“Our biggest worry was getting Southern hospitals to treat black people,” Marmor told me.) Partly that was because Medicare was a relatively straightforward program. But Marmor also believes that it was because the men in charge of the new Medicare program were seasoned pros who knew how to get the job done.

Thus the second reason the Obamacare rollout has been so awful. “They put amateurs in charge,” says Marmor. Obama would have been much better served if, for instance, he had called upon his friend Jeffrey Immelt, the chief executive of General Electric, to choose a team of specialists to lead the effort.