【文章內(nèi)容簡(jiǎn)介】 ady helped millions of seniorsand billions of dollars in savings. Rebatesfor people who see insurance panies who are not spendingenough on actual care, more onadministrative costs or profits, theyamp。rsquo。re gettingrebates. They may not know itamp。rsquo。s theAffordableCare Act thatamp。rsquo。s giving them rebates, but itamp。rsquo。s happening. So there were a number of things thatwerealready in place over the last three years that got implemented effectively.
　　The other thing that hasnamp。rsquo。t beentalked about a lot is cost. There was a lot of skepticismwhen we passed theAffordable Care Act that we were going to be giving a lot of people care butwewerenamp。rsquo。t doing anything about the underlying costs. And, in fact, over the last three years,weamp。rsquo。veseen health care costs grow at the slowest pace in 50 years. And that affects the bottomlines ofeverybody here.
　　And there are a lot of smartdelivery system reforms that slowly across the system are beingimplemented andtheyamp。rsquo。re making a big difference. Andthatamp。rsquo。s saving us money. Thatamp。rsquo。s why, bytheway, some of the projections that in terms of what the Affordable Care Actwould do to deficitshave actually proved even better than we had originallyexpected.
　　What I have learned, though, withrespect to setting up these marketplaces which areessentially mechanismswhere people who are currently in the individual market or donamp。rsquo。t havehealthinsurance at all can join together, shop, and insurance panies will petefor theirbusiness setting those things up is very challenging justmechanically.
　　The good news is that choice andpetition has actually worked and insurers came in withbids that were evenlower than people expected about 16 percent lower than had originallybeenprojected.
　　The challenge has been justmaking sure that consumers are actually able to get on awebsite, see thosechoices, and shop. And I think that weprobably underestimated theplexities of building out a website that neededto work the way it should.
　　There is a larger problem that Iprobably speak personally, but also as theadministration could haveidentified earlier, and that is the way the federal government doesprocurementand does IT is just generally not very efficient. In fact, thereamp。rsquo。s probably no biggergapbetween the private sector and the public sector than IT.
　　And weamp。rsquo。ve seen that in, forexample, the VA and the Department of Defense trying to dealwith electronicmedical records for our servicemen as they move into civilian life. Most of thatstuff is still done on paper. Weamp。rsquo。ve spent billions of dollars Iamp。rsquo。m notsaying “。we”。 as in myadministration, I mean weamp。rsquo。ve now had about a decade ofexperimentation, spent billions ofdollars and itamp。rsquo。s still not working the wayit should.
　　So what we probably needed to doon the front end was to blow up how we procure for IT,especially on a systemthis plicated. We did not do thatsuccessfully. Now, we are gettingitfixed, but it would have been better to do it on the front end rather than theback end.
　　And the last point Iamp。rsquo。ll make isthat in terms of expectation setting, thereamp。rsquo。s no doubt that inan environmentin which we had to fight tooth and nail to get this passed, it ended upbeingpassed on a partisan basis not for lack of trying, because I met with anawful lot ofRepublicans to try to get them to go along but because therewas just ideological resistanceto the idea of dealing with the uninsured andpeople with preexisting conditions. There was aprice to that, and it was that what was already going to behard was operating within a verydifficult political environment. And we should have anticipated that thatwould create arockier rollout than if Democrats and Republicans were bothinvested in success.
　　One of the problems weamp。rsquo。ve had isone side of Capitol Hill is invested in failure, and thatmakes, I think, thekind of iterative process of fixing glitches as they e up and finetuningthe law more challenging. But Iamp。rsquo。moptimistic that we can get it fixed.
　　Well, thatamp。rsquo。s the question I was going toask next. Is it possible youamp。rsquo。ve lostenough time hereand enough potential customers in the exchanges that youamp。rsquo。renot going to reach the criticalmass of signups that you need to make themarketplace work? Is that a danger thatyou have toworry about right now?
　　THE PRESIDENT: Well, itamp。rsquo。s something that we have to payattention to. But keep in mindthat thismodel of marketplaces was based on what was done in Massachusetts, andtheexperience in Massachusetts was that in the first month, 153 or 163 people signedup out ofan ultimate 36,000. It wasless than 1 percent signed up in that first month partly becausebuyinginsurance is a plicated process for a lot of people. When they have more choices, itmeans thattheyamp。rsquo。re going to take more time.
　　Thereamp。rsquo。s no doubt that weamp。rsquo。ve lostsome time, but the website is getting better each week. Bythe end of this month, it will befunctioning for the majority of people who are using it. Theyamp。rsquo。llbe able to shop, see what theirchoices are. The prices are good. The prices are not changingduring the openenrollment period that goes out until March. And so I think that weamp。rsquo。re going tohave time to catch up.
　　Whatamp。rsquo。s also been expressed as aconcern is the mix of people that sign up. So we mightend up having millions of people sign up。 theyamp。rsquo。re happy withtheir new coverage, but weamp。rsquo。ve gotmore people who are older, more likely to getsick than younger and healthier. Weamp。rsquo。vegot tomonitor that carefully. We alwaysanticipated, though, that younger folks would be the last folksin, justbecause itamp。rsquo。s been a while since you and I were young but as I recall, youdonamp。rsquo。t thinkthat youamp。rsquo。re going to get sick at that time.
　　So, look, I am confident that themodel that weamp。rsquo。ve built, which works off of the existingprivate insurancesystem, is one that will succeed. We aregoin