Editor's note: Aaron E. Carroll is a professor of pediatrics at the Indiana University School of Medicine and the director of its Center for Health Policy and Professionalism Research. He has supported a single-payer health system during the reform debate. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.
(CNN) -- Last spring, the Senate Finance Committee held a hearing on implementation of the Affordable Care Act, otherwise known as Obamacare. Sen. Max Baucus, a Montana Democrat and the chairman of the committee, was not pleased with how things were going.
The Obama administration originally had asked for more than half a billion dollars to spend on public relations and outreach for the law. House Republicans had returned with an offer of nothing. That's right: zero dollars. Without necessary funds, the Department of Health and Human Services worried it would not have the necessary money to pay for navigators to help people enroll in health care, for the technology needed to implement the exchanges and for the public relations campaign that was required to inform citizens about what the law actually did.
HHS Secretary Kathleen Sebelius made the controversial move of asking insurance companies and nonprofit organizations to donate money and help. Republicans were outraged. She asked for more money. She was refused.
Then, when she tried to move some money from the PR budget to replace cuts to other areas, Baucus became quite upset. He was concerned that if the administration did not do more to inform people about the law and get implementation going, there would be problems:
"A lot of people have no idea about all of this," he said. "People just don't know a lot about it, and the Kaiser poll pointed that out. I understand you've hired a contractor. I'm just worried that that's gonna be money down the drain because contractors like to make money. ... I just tell ya, I just see a huge train wreck coming down."
As I've said before, it's important to note that the "train wreck" Baucus was describing was a botched implementation because not enough was being done to make things go smoothly.
It wasn't a description of the law itself but of what might occur if the government did not devote enough resources to making it work. Sebelius' response was not surprising to those who were paying attention. She said that she was "incredibly disappointed" that all her requests for resources were being denied by Republicans.
That was then. Today, implementation has arrived, and if it's not a train wreck, then it's certainly close. The administration is still under fire because people cannot get the insurance they want through the exchanges. But while I will continue to point out the problems with implementation and fault the administration for mistakes they've made, how does one ignore the apparent hypocrisy from many politicians who are now "outraged" about the very problems they've helped to create.
Republicans refused to appropriate money needed to implement Obamacare. When Sebelius tried to shift money from other areas to help do what needed to be done, she was attacked by Senate Republicans. At every step, Republicans fought measures to get money to put towards implementation.
Is it really a surprise then that implementation hasn't gone smoothly?
Federal legislators aren't the only ones to blame. Let's remember that original versions of the bill called for one big national exchange. This would have been much easier to implement. But conservatives declared that insurance should be left to the states and kept out of the hands of the federal government. So as a compromise (yes, those did occur), exchanges were made state-based instead of national.
As a precaution, the law stipulated that if states failed to do their duty and enact exchanges, the federal government would step in and pick up the slack. This was to prevent obstructionism from killing the law. Surprisingly, it was many of the same conservative states that demanded local control that refused to implement state-based exchanges, leaving the federal government to do it for them.
That made implementation much harder.
There have been books, webinars and meetings explaining how to sabotage the implementation of Obamacare. There have been campaigns trying to persuade young adults not to use the exchanges. It is, therefore, somewhat ironic that many of the same people who have been part of all of this obstructionism seem so "upset" by the fact that people can't easily use the exchanges.
For goodness sake, the government was shut down just a few weeks ago because some of the same people who are now bemoaning poorly functioning websites were determined to see that not one dime went to Obamacare.
Lest you think I'm defending this month's rollout, I encourage you to review my last article here. I still maintain that the administration has had a failure in management in overseeing and reporting on progress towards October 1. But I'm also sympathetic that they've had a hard job to do. I would like to see this go better. I'd like to see millions more get insurance. I'd like to see the law of the land function as well as it can, and if it doesn't, I'd like to see Congress continue to amend it to make it work better. I'd like a better health care system.
What I cannot ignore, however, are the many people who actively worked to see implementation fail now get the vapors over its poor start. The truth is, they got what they wanted. A victory lap is somewhat warranted, not concern-trolling.
If, on the other hand, their concern is real, then I'm sure the administration would welcome their help in making things right.
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The opinions expressed in this commentary are solely those of Aaron Carroll.