One of the President’s errors was in not knowing the difference between defining the goal versus implementing the methods of attaining the goal. These are not the same tasks and they do not require nor depend upon skills, capabilities and talents that are shared in common. Implementation is not a political act. It is not a committee process nor is it an endeavor that can be performed by individuals who are unwilling to force decisions on how to adapt the goal to the reality of the environment in which the implementation will or must take place. The President should not be apologizing that unforeseen and undesired consequences have resulted from the ACA’s impacts, but he should be apologizing for allowing the implementation to proceed without anyone understanding the consequences that the law would cause or would allow to be used by healthcare industry players who saw opportunities use the law to their benefit at someone else’s expense. The President should have realized that there should have been a “devil’s” advocate focus looking at how unintended consequences would produce undesired results.
But the President isn’t alone in being responsible for problems with the law, the Healthcare Exchange or the plethora of future unintended consequences that will bleed out over time. Congress (Republicans and Democrats alike) is actually more responsible and more involved in creating the healthcare mess that their efforts have produced through their ineffective, inefficient, and incompetent understanding of the issues, situations, and environments in which the ACA would have to function and exist. Instead of focusing on how to craft a Healthcare program and national policy Congress spent its time and efforts in rank bickering, seeking to obstruct the other side from winning some ideological item, playing to political campaign strategies, and believing that they actually knew what the interests of the American people were.
Congress should have been spending its time on crafting the law so that the law would have the anticipated objectives codified into its structure and so that there were defined responsibilities and requirements on achieving performance, cost and quality improvements; and on rewards and penalties for over-performs versus under-performers. Congress failed to see that their responsibility was not to know how to make the healthcare program or system work but to require that it perform, improve and advance the healthcare for Americans. Congress failed in legislating the law, in defining an effective funding mechanism for the law, in providing an oversight of its implementation, and in affecting no changes to the law to improve it since it was passed.The President’s apology should have been an all-inclusive, government-wide and bipartisan admission that the Government once again failed the American people. Those who love the law failed to deliver, those who hate it failed to show how to make it work, and those who didn’t pay attention failed to remember that without the attention of someone who cares about the results the results you get are assured to be different than the ones you wanted.