Apple has a long track record making technology products. What’s more, lots of people—most people in fact—don’t buy Apple’s technology products. So Apple’s customer base consists of a self-selected minority of people who based on Apple’s long track record in the industry choose to buy its phones, tablets, and computers.
The health care marketplaces, by contrast, will need to gain the trust of customers who may be skeptical or hostile about the underlying project. They’re also launching into a highly politicized partisan crossfire in which many people have a huge vested interested in blowing problems out of proportion.
Assuming that the glitches work themselves out without creating any lasting drag on the law, however, the next major test will be the January 1st deadline, when the individual mandate will go into effect and the coverage will officially start. At that time, the big question for Obamacare care will be whether enough young people sign up for coverage to keep premiums low. The latest Gallup poll on coverage found that 65 percent of uninsured Americans currently plan to sign up for insurance under the ACA, while only 25 percent definitely stated they will instead pay the fine. Those seem like pretty good numbers for Obamacare, but a lot rides on the age breakdown. If young people are highly overrepresented in the 25 percent, we could still see premium rates rise.Past January 1st, one possible outcome is that support for the ACA will continue to drop, in which case serious reforms to the law may become practically unavoidable. A leading candidate for reform would be dropping the employer mandate permanently, something some on the left already favor. If this happens, the law would probably function better on some key metrics (for instance, it will depress wages and job growth less), but it will cost tax payers a lot more.If tinkering with law in this way isn’t enough to build public confidence in it, the conversation could shift in one of two directions: toward a repeal and a Republican alternative, or toward further consolidation and a single payer-still system, under the logic that the ACA only failed because it didn’t go far enough. Of course, if support climbs after January 1st, we’ll be in a totally different place. Politically, the GOP will have suffered a defeat that will weaken it for many years to come, and any serious alterations to the law will be unlikely.Whether public opinion continues to plummet or starts to rise will largely hinge on one issue: cost. Expanding access is an essential piece of health care reform, but if in the end you’ve expanded access to a system that’s going bankrupt, even the newest initiates are likely to think they got a raw deal. If premiums continue to climb—or climb at higher rates—expect the movement for serious reform or repeal to gain even more steam.Ultimately, however, either the ACA’s success or its failure could be used as a rationale for the single payer system. If it succeeds, we need more of it; if we fail, it’s because it didn’t go far enough. This is all the more reason for Republicans to be at the ready with a serious health care plan that their wonks, party leaders and public intellectuals can support. With such a plan (and with some success in the 2014 midterm elections), the GOP could make a plausible push for repeal if, as seem likely, the continuing cost crisis erodes support for the ACA. Without it, they’ve essentially ceded the field to the single-payer advocates.