Pretend you were a government bureaucrat and you designed a government program authorized by Congress that effectively forced people to participate because Congress levied a substantial tax on you (this is allowed by the Supreme Court based on many test cases on many programs). The program also used much of your income tax payment to pay for its wasteful activities and some outright abuse.
(See June 2014 MedPAC Data Book for latest splits, released in late July 2014, which are basically the same as illustrated above but more in favor of capitated plans than the illustration)
But within years of starting your government progam, many of the people you intended to help made other - mostly private non-governmental -- arrangements to get the financial protection and/or services that you supposedly provided with their tax money. Still the program continued over the years because -- hey, you are a government bureaucracy. But at least you recognized its problems and made changes almost every year of the program's existence to try to fix its problems. Yet after almost 50 years, the problems are worse. Now over 95% of the people who are in the program decide they have to make other - mostly private and mostly paid for out of their own pockets -- arrangements to get the service your government program is supposed to provide.
Would you call yourself successful? Yes, you would lie to yourself and call yourself successful if your program was United States Medicare.
Comments