A congressional hearing Wednesday on the botched rollout of HealthCare.gov was largely a forum for Republican critics of U.S. government involvement in the health-care industry and other large social programs.
The website malfunctions were a glaring example of how the U.S. government often fails to deliver on huge projects, some lawmakers and representatives of conservative groups said during a hearing of the U.S. House of Representatives Oversight and Government Reform Committee.
An unfriendly audience
The committee, controlled by politicians largely hostile to U.S. President Barack Obama’s agenda, billed the hearing as a forum for criticism of HealthCare.gov and the limitations of big government. The hearing, though, often veered away from the website into broader criticisms of the underlying Affordable Care Act, the health insurance reform bill passed in 2010, and of government social programs in general.
The HealthCare.gov rollout has “undeniably been, inarguably, a disaster,” said Representative Darrell Issa, a California Republican and committee chairman. “It is not a disaster of the making of one man or any one person. In fact, in many ways, it is a sign of a failed system that is often seen in the federal government.”
Parts of the website’s back-end functionality are not yet completed, and there continue to be concerns about users’ data being transferred accurately to insurance carriers, Issa said. Despite promises from Obama that HealthCare.gov would allow health-insurance shopping to be as simple as using an e-commerce site, “nothing has been more different” than HealthCare.gov and well-run e-commerce sites, he said.
A well-run e-commerce site wouldn’t use the customer queuing system HealthCare.gov has implemented, Issa said, nor would it tell a customer, “leave your personal email, and we’ll call you back in eight or 10 hours … in order to tell you now is a better time to log on,” he said.
Issa said the committee has the responsibility of making sure HealthCare.gov works properly, but he repeated his long-standing criticisms of the need for the Affordable Care Act, often called Obamacare.
”By its very design, the federal government may never be efficient or effective or innovative enough to carry out big initiatives like Obamacare,” he said. “Nor should it be. Government should not be picking winners and losers precisely because it has proven to be so bad at it.”
But Representative Elijah Cummings, a Maryland Democrat, pointed to several large and successful government programs, including Social Security, Medicaid and most recently, a 2005 prescription drug benefit under Medicare. Each of those programs had many critics when they were first launched, only to gain widespread acceptance from the U.S. public, he said.
The Affordable Care Act was needed because private health insurance coverage had evaded tens of millions of U.S. residents, he said.
Republicans want to use HealthCare.gov’s troubles to “make a broader argument that the federal government cannot administer large-scale programs, and that we are all better off leaving it to the private sector,” he said. “We have tried that, and it simply does not work.”
Suggestions from Republicans and some witnesses that the U.S. government should stay out of the health-care industry also ignore its long-time involvement, added Karen Kruse Thomas, a medical historian at the Johns Hopkins Bloomberg School of Public Health. Beyond the Medicare and Medicaid programs, federal agencies have invested in medical research for decades, she noted.
The federal government has been heavily involved in health care since 1935, and the medical industry before that time is a “disturbing picture,” she said.
Critics who say health care should be left to the private market don’t recognize the unique set of issues in the industry, she said. “They misapply the same economic principles to all types of markets, whether the product is houses, handbags or heart surgery,” she said.
Many doctors have “fiercely” defended private pay systems, but have relied on government-funded research to treat their patients, Thomas added. “Without publicly funded medical education, research, service delivery systems and other government-sponsored aspects of medical care, the medical profession would still be the small and struggling band of individualists who began the 20th century with little scientific understanding of how disease spreads, much less how to cure it,” she said.
But government programs are often inefficient and distort the private market, countered Veronique de Rugy, a senior research fellow at the Mercatus Center at George Mason University. “In government, intentions do not equal results,” she said.