KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Viewpoints: Marketplace Snags Spook Democrats; Government Seldom Gets Tech Initiatives Right; New Revenue Is ‘Fair Trade’ For Entitlement Changes

The Wall Street Journal: Democrats Run For ObamaCare Cover
Jeanne Shaheen doesn't sound like a Democrat who just won a government-shutdown "victory." Ms. Shaheen sounds like a Democrat who thinks she's going to lose her job. The New Hampshire senator fundamentally altered the health-care fight on Tuesday with a letter to the White House demanding it both extend the ObamaCare enrollment deadline and waive tax penalties for those unable to enroll. Within nanoseconds, Arkansas Sen. Mark Pryor had endorsed her "common-sense idea." By Wednesday night, five Senate Democrats were on board, pushing for . . . what's that dirty GOP word? Oh, right. "Delay" (Kimberley A. Strassel, 10/24).

USA Today: Obama's Y2K Moment
While the website mess will certainly go down as one of the great case studies on how not to launch an Internet service, it will not dictate the legacy of the Affordable Care Act. Indeed, several of the state websites are doing just fine, and once the political grandstanding on is over -- it's not by a long shot -- we'll be able to finally begin assessing just how well the Affordable Care Act works and whether it indeed helps reduce costs. The inevitable calls for a delay in the mandate, beyond the penalty assessments, may still be a matter of hot debate for both practical and political reasons. But even a small delay will not affect how this initiative will ultimately be judged. Democracy is a messy business. Plenty of major government programs are still argued about decades later. Yet the politics behind their implementation is seldom remembered (David Callaway, 10/25). 

The New York Times’ Economix: The Midterm Grade For HealthCare. Gov
President Obama taught constitutional law at the University of Chicago Law School. How would he have graded a student's performance on, say, a term paper or test that the professor viewed as "unacceptable," especially when there was "no excuse" for the paper’s deficiencies? One would hope that the grade would have been F, even under modern grade inflation. I certainly would affix that grade to such inexcusably deficient work. But who exactly should be assigned the F for the troubled rollout of (Uwe E. Reinhardt, 10/25). 

The New York Times: Why The Government Never Gets Tech Right
Millions of Americans negotiating America's health care system know all too well what the waiting room of a doctor's office looks like. Now, thanks to, they know what a "virtual waiting room" looks like, too. Nearly 20 million Americans, in fact, have visited the Web site since it opened three weeks ago, but only about 500,000 managed to complete applications for insurance coverage. And an even smaller subset of those applicants actually obtained coverage. ... But is only the latest episode in a string of information technology debacles by the federal government. Indeed, according to the research firm the Standish Group, 94 percent of large federal information technology projects over the past 10 years were unsuccessful  (Clay Johnson and Harper Reed, 10/24).

The New York Times' Taking Note: GOP Roots For Failure
In theory, lawmakers hope that government programs work well, and if they don’t, try to fix them. In theory, our representatives hope that government agencies carry out their missions smoothly, and if something goes wrong, try to figure out what happened to avoid making the same mistake in the future. Obviously that's not how things work in the United States, where one of the two parties doesn't even believe in government (Juliet Lapidos, 10/24). 

Los Angeles Times: Wrong Rx For Healthcare Website
The problems at the federal government's new health insurance website are so severe that even Democrats are starting to talk about neutering a key provision of the 2010 healthcare law: the requirement that adult Americans obtain coverage next year. But now is not the time to take such a drastic step, which could lead to sharper increases in premiums for individuals. It is true that the federal government hasn't yet fixed its website's problems, but there is still time to do so before Jan. 1, the first day coverage is supposed to go into effect. The focus should remain on fixing the site quickly and signing up more people for insurance (10/25).

Los Angeles Times: What FDR Would Say About Obamacare's Botched Launch
Yes, Obamacare's website debacle is a problem for the healthcare reform program and for many customers still unable to apply for and secure health insurance. But no, it's not the first time a big government program experienced birth pangs. The go-to source on how to manage the launch of a major federal undertaking, of course, is Franklin D. Roosevelt, who launched dozens of such programs during the New Deal--several of them every bit as revolutionary as the Affordable Care Act (Michael Hiltzik, 10/24).

The Washington Post: GOP: Stop Being So Negative
The American political class is facing a perfect storm of public contempt. Congressional Republicans have proved themselves divided and incapable of adopting a coherent strategy, with a significant minority determined to light the way with an auto-da-fé. Meanwhile, an administration that seeks to transform U.S. health care cannot run a Web site — a breathtaking gap between ambition and competence. And its responses to failure — denial, defensiveness and secrecy — have been as discrediting to Obamacare as any technical breakdown (Michael Gerson, 10/24).

The Washington Post: How Uncle Sam Can Avoid Another was launched Oct. 1 with bugs that made it impossible for many Americans to purchase insurance. Although these problems are the focus of many tirades and jokes , it's not a disaster — in a few months the site will work as expected. Moreover, in the range of federal IT debacles, doesn't come anywhere close to the worst. Over the past five years, agencies including the Justice Department have had to scrap software projects that cost far more than the $70 million to $125 million (at least) reportedly spent on ... But's issues remain troubling, and the government can still learn from the site’s failures (Evan Burfield, 10/24).

The Wall Street Journal: ObamaCare Takes On Water
The ObamaCare rollout is a disaster for the White House, not a problem or a challenge or an embarrassment, not a gaffe or a bad few weeks. It is a political disaster, and the only question is whether it is partially recoverable, meaning the system can be made to work in a generally satisfactory way in the next few weeks. But—it has to be repeated—they had 3½ years after passage of the Affordable Care Act to make the program into something the American people could register for and feel they were benefiting from. Three and a half years! (Peggy Noonan, 10/24). 

Bloomberg: Obamacare’s Virtual Fantasy Couldn't Handle Messy Reality
So why didn’t the administration realize that integrating a bunch of incompatible government databases into a seamless system with an interface just about anyone could understand was a really, really hard problem? Why was even the president seemingly taken by surprise when the system didn't work like it might in the movies? We have become seduced by computer glamour (Virginia Postrel, 10/24).

The Wall Street Journal: ObamaCare's Political Choices
It's been another lousy week for the Affordable Care Act, as hundreds of thousands of Americans learned they're losing their current coverage and new details emerged about the 36 federal insurance exchanges that are still as useful as a cement wall. But the truth is that these and other events aren't "glitches." They're the intentional or inevitable results of political control of the health economy (10/24). 

The Wall Street Journal: Another 'Affordable Care' Sticker Shock Looms
President Obama and supporters of his health-care law have defended it by saying that the Affordable Care Act is "the law of the land." However, the spending reductions in the 2011 Budget Control Act—the so-called sequester—also remain "the law of the land." ... Some have claimed that the sequester "exempts" ObamaCare's subsidies from spending reductions. That is only half true. The Budget Control Act does exempt from sequestration the premium subsidies for households with incomes up to 400% of the federal poverty level ($94,200 for a family of four) and that meet other eligibility criteria. But other ObamaCare subsidies, paid directly to insurance providers on behalf of eligible beneficiaries, are subject to the sequester—namely "cost-sharing subsidies." These include subsidies for households with incomes below 250% of the federal poverty level ($58,875 for a family of four) to reduce copayments and deductibles (Chris Jacobs, 10/24).

Charlotte Observer: Another McCrory Mistake On Medicaid
If only Pat McCrory were right this week when he told a conservative group in Washington that a new federal regulation might force North Carolina to expand its Medicaid program. If that were true, hundreds of thousands more N.C. residents could get medical coverage, and the state could see some economic benefits, too. But the governor, once again, got it wrong on Medicaid (10/25).

And on other health issues -

The Washington Post: A Fair Trade For Entitlement Reform Includes Increased Revenue
The Post’s Oct. 20 editorial on the budget challenge ["A fiscal quid pro quo"] made important points but was way off-base on the issue of revenue. It suggested that a fair trade would be reductions to the "sequester" budget cuts in exchange for reforms to Medicare and Social Security and said that Democrats should not insist on additional revenue because that's a non-starter with many Republicans. Democrats would make a serious mistake by following that advice. Our country needs more revenue to help us get back on track (Kent Conrad, 10/24).

The New York Times: Raising The Medicare Age, Revisited
Back in 2011, we almost had a "grand bargain" whose centerpiece would have been a rise in the Medicare eligibility age. Liberals were horrified, but it actually would have happened if Republicans hadn't balked at the idea of any revenue increases at all. Now we learn that it would have been not just cruel and a betrayal of promises, but bone-stupid too (Paul Krugman, 10/25).

Los Angeles Times: Antibiotics For People, Not Animals
Antibiotics are modern medical miracles that rendered lethal infections minor nuisances. But that 20th century success story is turning into a 21st century parable about shortsightedness and denial. The president and Congress have more than enough scientific justification to curb antibiotic overuse in food animal production. It is time for them to act (Gail Hansen, 10/23).

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.