Paul Krugman has long been touting the success of Obamacare, so he is just as concerned as everyone else that premiums for people using the exchanges are set to spike by more than 20 percent. He devotes his Friday column to putting this bad, but in his view not catastrophic, news in perspective and concludes that the problems with the affordable care are fixable if only we had a Congress that was interested in such a thing.

The current problems should in no way erase the very real accomplishments of health reform, Krugman points out. "Health reform had two big goals: to cover the uninsured and to rein in the overall growth of health care costs — to “bend the curve,” in the jargon of health policy wonks," he writes. "Sure enough, the fraction of Americans without health insurance has declined to its lowest level in history, while health cost growth has plunged: Since Obamacare passed Congress, private insurance costs have risen less than half as fast as they did in the previous decade, and Medicare costs have risen less than a fifth as fast."

With that rosy picture of slowed cost increases, why are premiums for those on the exchanges going up so sharply? Krugman answers:

The way the exchanges were supposed to work was that both healthy and less-healthy people would sign up, providing insurers with a good mix of risks that let them offer reasonably priced policies. Broad participation was supposed to happen because the law requires everyone to have insurance — the “mandate” — or face a penalty. Buying insurance was supposed to remain affordable because the law provides subsidies for middle- and lower-income families, ensuring that health costs don’t become too large a share of income. Many insurers entered the market in the belief that the system would work as advertised. After all, conceptually similar systems work in other countries, like Switzerland; Massachusetts has had a system along the same lines since 2006 (which is why some of us call it ObamaRomneycare); and even now it’s working O.K. in California, which has managed the program well.

In many states, however, not enough healthy people signed up — and now insurers are either pulling out or hiking their premiums to reflect the not-so-good risk pool. Since premiums have until now been well below projections, this only brings them back up to expected levels. But it’s clearly not good news.

Only people who are not covered by employers or Medicare or Medicaid, and are not low enough income (under about $100,000 for a family of four) are affected. Still, that's a lot of people, though Krugman points out it is mostly people with pre-existing conditions, who would not be insured at all but for Obamacare.

In any case, Krugman makes the case that the bad news hardly means Obamacare will die though it has admittedly fallen short of its goal to insure just about everyone. And the problems are fixable: "Strengthen the mandate; expand the subsidies; close the loopholes that have allowed some insurers to bypass the exchanges; take a more active role in setting standards and reaching out to families to make them aware of their options. Some states are doing much better than others, and it wouldn’t take a lot of money to expand best practices to the nation as a whole," Krugman writes for starters.

This would, alas, take a Congress willing to spend some money to solve problems, and that is not the Congress we currently have. Another reason to vote as if your life depended on it..