Australia

When officials describe the weaknesses of current Australian programs for people with disabilities, they sound as if they could be describing the U.S. system. Officials note, for example, that "even within a jurisdiction, people deal with a multitude of programs and agencies, few of which coordinate or share information," and that "funding for service providers uses outdated models and comes with unnecessary compliance burdens, stifling innovation."

The floweriness of the predictions about how the NDIS will affect Australians' lives is also striking. Once the NDIS is up and running, "people with disability and their carers will have peace of mind that the individualised care and support they receive will change as their needs change," program managers promise.

But, at least for me, an American, figuring out what benefits the NDIS managers are really promising is more difficult than figuring out what the PPACA implementers are promising.

I don't know if states and the U.S. Department and Health and Human Services (HHS) can deliver on the PPACA promises, but I can make up a list of what agencies think PPACA will provide. I'm cribbing some of my description of what I think the NDIS is supposed to provide from Australian media accounts, I'm not sure, from the NDIS site, what the program is ultimately supposed to provide, other than endless, personalized peace of mind.

John Walsh, a consultant, told the Australian Financial Services Council in July 2011 that he thinks the NDIS will not crowd out private insurance arrangements, because private disability insurance programs usually replace income. The NDIS will not be an income replacement program.

Regardless: It might be interesting to watch to see what goes right, and wrong, with implementation of the NDIS, to see if any of the lessons learned there could lead to ideas about what to do and not to do in the U.S. disability, health and long-term care insurance markets.

Today, we get into endless, bitter, partisan fights over policy because we're trying to predict what the future will look like.

Wanting to know how a big policy change will affect a country with 300 million people is understandable but not very realistic. It's hard to know how a 5-line Microsoft Word macro will work in real life, let alone a 2,000-page law.

If only we could just hire Australia, New Zealand or, say, a really brave Canadian province to test all of our big new policy ideas before we try them in the United States, just to get a reality check.