Reflecting on Health Reform: Holiday Reading and the Affordable Care Act
According to Mark Twain, "history doesn’t repeat itself, but it does rhyme." I was reminded of this Twainism over the holidays as I read The Guns at Last Light, the third in Rick Atkinson's three-volume history of the Second World War in Europe. Atkinson's account of D-Day—the June 6, 1944, Allied invasion of Normandy that turned the tide on the Western Front—particularly grabbed me. I’ve read several histories of what is now remembered as one of the great military feats of all times. But I saw D-Day differently this time, in part because of the rollout of the Affordable Care Act (ACA), with its website problems, missed and changed deadlines, and policy detours, all recounted in real time for the American public.
Quite simply, if we had subjected D-Day to 21st century levels of scrutiny and accountability, its “rollout” might have had uncomfortable parallels to the ACA's. Here is a sampling of the things that went terribly wrong in the first hours, days, and weeks of the Normandy invasion.
- A paratroop drop behind German lines early on D-Day failed to account for the low cloud cover common (and totally predictable) over Normandy during the early morning hours. Most troops missed their drop zones. They and their equipment were scattered over the Normandy peninsula.
- The huge Allied naval armada bombarded the Germans for only 30 minutes before the landing, though experience in the Pacific had demonstrated that many hours or even days of shelling were required to reduce entrenched defenses prior to an amphibious assault.
- At Omaha Beach, where Americans took horrific casualties, landing craft were dispatched 11 miles offshore instead of the planned seven. This exposed defenseless infantry in tossing, rolling boats to enemy fire far longer than expected.
- At Omaha Beach, 27 of 34 tanks sank as they were unloaded short of the beach, despite inflated skirts intended to keep them afloat. Their crews died, as did many infantry who desperately needed their protection on the beach from enemy fire.
- Many of the amphibious DUKW boats (the Duck boats now commonly used for tours in Boston and other American cities) carrying artillery and troops capsized after launch because they were overloaded and, in any case, totally unseaworthy. Both the artillery and the infantry were lost.
Individual and small-group improvisation and heroism averted disaster for the Allies on the morning of June 6, 1944, and in the weeks that followed. On that first day, the Allies established a small beachhead, but fell miles short of their D-Day objectives. Only in late July did they finally overcome German resistance to break out of Normandy and head into greater France. However, during bombing that preceded the breakout thrust, Allied aircraft inflicted hundreds of casualties on friendly forces when they mistakenly dropped payloads short of enemy lines.
History doesn’t repeat itself; it only rhymes. There are big differences in the circumstances and the tasks that faced the leaders of D-Day and the challenges confronting officials now implementing the ACA.
But the larger point is this: when scrutinized in real time, complex human endeavors are mosaics of success and failure whose outcomes are difficult to predict from early returns, and whose ultimate success depends on the ingenuity and will of leaders and their far-flung staffs. From the perspective of D-Day, the twists and turns that have come to characterize the ACA rollout may be the inevitable and necessary equivalent of the kind of small-unit improvisation and tactical flexibility that ultimately turned the tide of history on June 6, 1944.