Megan McArdle recounts her formal debate of the viability of the PPACA, she and Scott Gottlieb taking the affirmative (that the PPACA is not viable) and Jonathan Chait and Douglas Kamerow taking the negative. The affirmative prevailed even before what was probably an unsympathetic audience:
What was the winning argument? We argued that the Patient Protection and Affordable Care Act is an unstable program that doesn’t deliver what was expected. For a lot of people, that hardly needs proving, given all the recent technical and legal gyrations. But for others, it does, and because most of them weren’t at the debate, let me elaborate. Scott spoke eloquently about the ways in which narrow networks and the focus on Medicaid are going to deliver an unacceptable quality of care. I talked about why this, among other things, makes the system so unstable.
In a nutshell, Obamacare has so far fallen dramatically short of what was expected — technically, and in almost every other way. Enrollment is below expectations: According to the data we have so far, more than half of the much-touted Medicaid expansion came from people who were already eligible before the health-care law passed, and this weekend, the Wall Street Journal reported that the overwhelming majority of people buying insurance through the exchanges seem to be folks who already had insurance. Coverage is less generous than many people expected, with narrower provider networks and higher deductibles. The promised $2,500 that the average family was told they could save on premiums has predictably failed to materialize. And of course, we now know that if you like your doctor and plan, there is no reason to think you can keep them. Which is one reason the law has not gotten any more popular since it passed.
The merits no longer matter. It no longer matters if it ever did that only a few hundred thousand people previously without healthcare insurance now have it under the PPACA or that could have been accomplished at lower expense and disruption. It no longer matters whether the plan is actuarially sound or financially stable without increasingly large infusions of cash from the general fund. It no longer matters whether the plan is popular in its entirety or in detail.
That’s what I meant the other day when I wondered whether the PPACA had become a “vanity project”. Like a single-celled organism it now exists in order to exist.