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“Yikes,” went the public outcry throughout the fall.
The computers were glitching! The Affordable Care Act was stalled! Progress was technologically too hard.
We must rethink, reconfigure, retreat, according to a large segment of the public. Either our government is too inept to program this act correctly, or the act is unprogrammable.
After this period of technological lamentations – from the right, people screaming that Uncle Sam should step back – from the left, people wondering why Uncle Sam didn’t initially reach out to Google to run this shebang – let me hazard some historical perspective. Yes, social change is hard. Yes, more glitches will arise: From the cup to the lips is a long trek, with unforeseen blips. But think back to 1965 with the launch of Medicare, to see some real roadblocks.
In 1965, Congress granted hospital insurance – Medicare Part A – to everybody with a Social Security card. Since Uncle Sam was paying for those hospital stays, Uncle Sam exacted some minimal standards. It was too easy to have fly-by-night “hospitals” springing up. Besides, the architects of Medicare wanted patients to go to “quality” hospitals.
At the time the hospitals had a national accrediting association, as they do today. But in 1965 roughly half the nation’s hospitals, many small ones, didn’t meet those standards (“full compliance”). In 1965, the year of the Voting Rights Act, America’s South was divided into “white” and “colored” facilities. Those patently unequal facilities – schools as well as hospitals – were patently substandard.
But the government could not simply reject all substandard hospitals. Too many patients would have found that their newly issued Medicare cards were useless. The challenge was to prod all hospitals that wanted reimbursement from Medicare to improve. The government allowed a loophole: “substantial” compliance. Eventually, hospitals either closed or improved. And Medicare overrode that roadblock.