In response to:

The Flop from the December 19, 2013 issue

To the Editors:

Sue Halpern is correct about the appalling lack of competence in setting up the website [“The Flop,” NYR, December 19, 2013]. But I am doubtful that anyone could make it work, not for reasons of technological competence, but because of the Rube Goldberg–like nature of the law itself. All the ostensibly interlocking parts will not connect, either on the website or in practice. If the website is fixed, then the substantive problems will reveal themselves. Because the law left the for-profit private insurance industry in place and promised it millions of new customers, it will simply be too costly to implement fully, and too inflationary to sustain. And as premiums rise, coverage will inevitably shrink. Regulations to require companies to insure all comers, regardless of health, can probably be circumvented fairly easily.

It’s time to begin extending Medicare to everyone, by dropping the qualifying age a decade at a time.

Marcia Angell, M.D.
Harvard Medical School
Boston, Massachusetts

Sue Halpern replies:

I agree with Dr. Angell. One cannot try to untangle the mess of the website without appreciating the mess of the Affordable Care Act itself. But no one should have known this better than President Obama, and thus it was incumbent upon him to take every measure possible to get the rollout right, and when that looked unlikely—as early as last March—it was his responsibility to pass that information along to the public. His failure to do so goes much further, now, than this one law in particular, or health care more generally, giving precious ammunition to those who maintain that government is not the solution, it’s the problem.