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If the ACA Rollout Seems Rough, Wait Until the Right "Reforms" Medicare

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The Republican health care exchange.

Yes, the government should have seen these problems coming. And I'm baffled by the fact that nobody has introduced to me what seems like a very quick fix, by allowing people to submit their demographic information in a quick and easy front-end screen which could then be "batch processed" in a day or two. They wouldn't be kept online, bottlenecks would be relieved, and a system like that is easy to design, relatively speaking. If the government had gotten on it as soon as the problems began, it could've been in place by now.

But the real cautionary tale of "healthcare.gov" is one that should disturb Republicans more than anyone else. The Ryan budget -- that is to say, the Republican budget -- has proposed that all Americans will become eligible for Medicare after the year 2023 and will purchase that program from private insurers.

Rep. Paul Ryan and the Republicans have a system which seniors can use to purchase health insurance once they've eliminated Medicare as we know it. As Ryan's website points out, they call it a "Medicare Exchange." Republicans had a similar plan for Social Security back in 2005. They intended to dismantle this popular and successful program and replace it with a series of private offerings.

Neoliberalism made complicated.

The neoliberal agenda -- which includes the "bipartisan" consensus behind that ever-elusive "Grand Bargain" -- believes that Medicare should be means-tested. Means-testing is the process which has caused so much difficulty with the ACA website.

And it is the insistence that we purchase health insurance from private entities which is creating all these problems in the first place. Medicare enrollment, by contrast, is quick and relatively simple. It will remain so as long as it doesn't have means-testing or other neoliberal/conservative restrictions imposed upon it.

This leads us into the category of what Konczal calls "Category A" social insurance programs, conservative/neoliberal inventions which are based on means-testing and complex public/private hybrids. Although neoliberals love to present themselves as "technocrats," let's be perfectly clear: these types of programs are ideologically-driven, at least as much as today's Social Security and Medicare -- and perhaps even more so.

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Programs like Social Security and Medicare, unlike the neoliberal contraptions which serve as their equivalent, have a long track record of success.

Private sector, public failure.

Lastly, Republicans have used this as an opportunity to rail about the ineptness of the government in administering large-scale programs. That's where I agree with Scher. Some of the liberal critiques come close to drawing the same conclusion. In fact, government has proven extraordinarily effective at delivering certain types of programs, even in the face of increased spending cuts.

The problem is, government successes are largely invisible to the American people. The processing of Social Security applications, the issuance of Medicare payments, this is the sophisticated analyses of medical costs, fraud, and billing practices that constitute the back end of governments health care processing systems -- all of these remain hidden from public view.

But conservatives or neoliberals who trumpet the private sector's supposedly efficiency in these areas need to explain to the American public why they have so much difficulty with private insurance's administrative processes.

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How many of the people who are attacking the ACA website tried to call their health insurance company recently in order to get a simple question answered? Nowadays that task can involve many minutes or even hours on hold and an endless series of baffling and frustrating voice response menus, which are eventually followed by an unsatisfying interaction with an uncooperative employee.

We won't even talk about what it takes to get a claim paid.

Neoliberals, beware. You need to think less about placating corporate sponsors and reflect more on that old adage: If it ain't broke, don't fix it.

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Host of 'The Breakdown,' Writer, and Senior Fellow, Campaign for America's Future

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