Known as "Mr. Social Security" and "The Man Who Built Medicare," Wilbur J. Cohen defined good policy as "1% inspiration and 99% implementation."
That will be true of the Affordable Care Act as well.
The health exchange marketplaces, where uninsured people can shop for coverage that begins on Jan. 1, opened up for business on Oct. 1. Sixteen states, including California, run their own exchanges. Thirty-four states, whose leaders oppose Obamacare, rely on a federal exchange. The online rollout has been less than smooth, with numerous technical problems.
That is not totally unexpected. The Center on Health Insurance Reforms, based at Georgetown University, provides perspective on the launch of the prescription drug benefit for the elderly in 2005 and lessons for the Obamacare exchanges. As its new report notes, although the Medicare Part D program in 2005 "encountered significant technical, educational, and coordination difficulties at first, eight years later, many of the initial difficulties have been forgotten."
The websites for Covered California and the federal exchange work well as places to find out options and to window shop before the Dec. 15 deadline for Jan. 1 coverage. And for uninsured people who have no idea what might be best for them, the websites do a good job of pointing people to help. Type in your city or ZIP code and you can get a list of "certified enrollment counselors," insurance agents and county offices that can help you understand the different options, assess eligibility for subsidies and help you with an application.
The Kaiser Family Foundation sees California, which has 15% of the nation's uninsured, as a laboratory of how Obamacare will work. The foundation did a baseline survey of the nearly 6 million uninsured Californians on this "once-in-a-lifetime policy shift that will put health insurance within many of their grasps." California's uninsured here are more positive about Obamacare than nationally but feel they don't have enough information yet about how it will work for them.
Now that we're in Cohen's "99% implementation" phase, perseverance and a commitment to working out glitches -- as Americans did with Social Security and Medicare -- is essential.