From National Review Kevin Williamson writes McHealthcare Deluxe- The Affordable Care Act is a failed political product.

What’s too often lost in the Sturm und Drang of recent Republican efforts to reform the insurance reforms enacted by Democrats in 2009 is this: The Affordable Care Act has not worked as advertised. That is the fundamental fact around which the debate should be organized. The ACA did not result in lower premiums but in the opposite; it did not result in more competitive insurance markets but in the opposite; it did not result in superior health-insurance plans but, at least in many cases, the opposite; it has not resulted in universal coverage. Among the major promises made on behalf of the ACA, only one of any significance has been delivered on: It is the case that more Americans have health insurance today than they did in 2009. But the ACA has underdelivered on that point, too: Only about 16.5 million people — barely 5 percent of the population — gained health coverage from the passage of the ACA through 2016, and the vast majority of those, 81 percent, were new Medicaid beneficiaries.


The health care debates is so contentious because it focuses the differences in political and economic philosophies into a single issue. Does this require a central government solution or is it better served  by solving it locally in the 50 laboratories we call states?

One of the greatest advantages of market solutions is not that it always picks better solutions, but that it recognizes failures quicker and better. The opposite happens in government. Self serving bureaucracies institutionalize failures.  Instead of admitting failure and redeploying assets into better and different solutions we institutionalize failures and increase their funding.

Trying to agree on component solutions is so arduous that we think that systemic solutions is the preferred path. But these solutions are so plagued with compromise that it has become impossible to make them effective. One side wants to build a bridge, the other side does not. We compromise by building half a bridge, spending 90% of the money and failing to provide the perceived need to cross the river.

The unwillingness to admit failure and implement corrective action is a big reason to be skeptical of expensive central solutions.