Underlying all the talk about healthcare.gov is the presumption that its technical failures explain why people are not signing up for Obama's health insurance. The inference is, "If the website just worked right, millions would be clamoring for what Washington is selling." Not true. Not even close.
Maybe the real reason for slow signups is how confusing PPAHCA (Patient Protection and Affordable Health Care Act) is. Few have read the 2,400-page Law. Fewer understand it. No one, and I do mean no one, could possibly comprehend more than 10,000 pages of Obamacare's rules and regulations in the Federal Register, with more still to come.
Maybe it is PPAHCA's outright contradictions. First, President Obama proudly announced that the people would pay less by $2,500 per year. Then he said we should all pay more to cover the costs of care for those less fortunate.
Maybe the broken promises have turned people away. No doubt you know that the president's "If you like your health plan, you can keep it," achieved the dubious distinction of becoming Politifact's Lie of the Year for 2013. Similarly, he promised that you could keep your doctor. You know this to be another falsehood. With the government's new reimbursement schedule, your doctor cannot keep you. Seventy percent of California doctors say they cannot afford to accept patients who will sign up with Covered California, the Golden State's Obamacare Health Exchange.
The website woes, the confusion, the contradictions, not even the broken promises can adequately explain the paltry number of people who have signed up.
Millions of insurance cancellations, even with PPAHCA's legal requirement for all citizens to purchase insurance, have induced less than half a million to sign up. Thus, the number of the uninsured is going up, not down. Recall that reducing the number of uninsured Americans was a major justification for pushing through the president's namesake Law.
The rising price of insurance might be your explanation for low signups, but that does not hold water. Firstly, the real price is hidden: healthcare.gov grossly underestimates the price people will have to pay for Obama insurance. Secondly, the cost of carrier premiums does not include all the additional costs (taxes) imposed by Obamacare that you will have to pay. Finally and most important, none of this cost escalation is real, yet. People have not seen it in their paychecks or their tax bills. They will, starting in 2014 and escalating dramatically in subsequent years. Since it hasn't directly hurt them in the "pocket nerve," price cannot explain the small number of signups.
Coverage (benefits) under Obamacare will increase compared to pre-2014 policies. Perversely, this begins to explain the low number of signups. It is quite simple: people don't want it. Men do not want to buy insurance with guaranteed mammograms. My 67-year-old wife does not want insurance that includes maternity benefits. More generally, Americans resist (see postscript below) being forced to buy anything, especially what they don't want.
Every single poll taken since March 23, 2013 has shown that a majority of Americans dislike the president's signature domestic reform act. We resent it when he condescendingly tells us he knows what's good for us, better than we do.
This poor showing for Obamacare signups has happened despite Washington's aggressive marketing efforts using professional athletes, Hollywood celebrities, cajoling (even threatening) CEOs of big business, and most recently the First Lady's ludicrous entreaty that Americans should, "Make it a Christmas treat around the table to talk about a little health care." This is the same federally mandated product -- Obamacare insurance -- from which Congress and the White House granted themselves waivers.
At our Health Insurance Exchange in New Mexico, we have avoided most of healthcare.gov's technical problems. Our website is easy to use. You do not have to give us all your personal information before you can compare prices. We do not have lax informational security. Our Call Center gets you a human within two minutes. Our prices are only minimally higher than pre-Obama rates. We have extensive educational outreach as well as marketing programs in the several languages of our multicultural State. With all this effort and tens of millions of dollars already expended, the number of individual New Mexicans who have signed up is... 291.
Yesterday, three separate colleagues asked me, "Why?" My answer is simple. I wrote it above in italics. All the patches applied to healthcare.gov; the massive government subsidies for insurance; multiple deferred deadlines; slick marketing campaigns; even apparent course reversals by the president, none of this will force the American people to buy something they don't want: Obamacare.
Postscript: Just as some cultures, viz. Japanese, tend to defer to authority, Americans are culturally programmed to resist it. The harder a central authority figure pushes us, the harder we push back.
Deane Waldman MD MBA ("Dr. Deane") is the author of newly released "The Cancer in Healthcare;" Host of the free newsletter, The Hidden Enemy; a member of the Board of Directors of the New Mexico Health Insurance Exchange; Adjunct Scholar for the Rio Grande Foundation; and Emeritus Professor of Pediatrics, Pathology, and Decision Science at University of New Mexico.