It's hard to admit you were wrong. Democrats are going to need some help with that.
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.
Barack Obama, Nancy Pelosi, and Harry Reid (wherever he is) ought to fess up: They blew it. They got this one wrong. They may have meant well, their hearts may have been in the right place, and they may have given it their best, but they did not achieve their intended outcomes, their heads were . . . somewhere heads don't belong . . . and their best wasn't good enough. They were warned, in these pages and elsewhere, but they refused to listen. They should just admit it — doing so would help to clear the way for fixing up what they fouled up.
Instead, they are sticking their fingers in their ears and shouting "La-la-la! Can't hear you!" as critics point to imploding health-insurance markets and skyrocketing premiums.
Emotionally mature people and highly effective institutions are quick to admit error. The best of them in fact embrace periodic failure as a necessary part of experimentation, learning, and institutional evolution. (Megan McArdle covers this ground brilliantly in The Up Side of Down.) McDonald's, you may have noticed, rolls out a lot of new products, most of which do not end up staying on the menu. You cannot predict what products will succeed in a brutally competitive marketplace like the one McDonald's plays in: That information cannot be calculated in advance — it can only be discovered. Discovery, not efficiency, is what competitive markets are really good at — organizing capital is secondary to the real function of free markets, which is organizing knowledge. But you can't do that discovery work in the boardroom or in a laboratory: You have to go out into the pitiless real world and see what actually happens. Nobody walking the Earth knows as much about consumers' soft-drink preferences than the beverage geniuses laboring away at the Coca-Cola Company, but they got it wrong big time with New Coke. The ACA was put together in part by some very smart people who have spent their lives studying health care and health insurance. It still stinks. They messed up.
There are better and worse ways to fail, and it pays to be conservative when trying out new products, most of which fail, or investing in a new business, most of which fail. Learning to do that well is what makes a wise venture capitalist successful and an innovative executive effective. It's also why conservatives like federalism, using the states as 50 "laboratories of democracy," as Louis Brandeis put it. Trying it out in Utah and failing costs less than trying it out coast to coast and failing — and what works in Utah may not work in New Jersey. The more robust and immediate feedback mechanism of local democracy is also why conservatives like subsidiarity, mitigating problems at the lowest effective level of government rather than treating everything as a national question.