President Obama acknowledged reality when he said Tuesday that the rollout of the health reform law next year is going to be interrupted by “glitches and bumps.” But if the past is any indication, an initial spate of difficulties or bad headlines won't alone spell failure.
“There will still be stories that will say this will not be working the way it’s supposed to,” Obama said during a 45-minute press conference. “That’s basically been true of every government program that’s ever been set up.”
In health care, recent history underscores his point. The most recent big government program that was built—the Medicare Part D prescription-drug benefit—is now beloved by Democrats and Republicans, industry, and consumers. When it launched in 2006, it was a nightmare.
The program was beset by a multitude of “glitches and bumps.” Information failed to transfer on new computer systems. Social Security checks were miscalculated. Frail seniors and people with disabilities lost their previous drug coverage, while their new coverage failed to show up at the pharmacy. Seniors were overwhelmed by the many choices of drug plans, and—for many with limited computer literacy—by the challenge of navigating an online enrollment system.
In a recent National Journal magazine story, former Bush administration officials recalled the trials and triumphs of building Part D. They are uniformly proud of the product, but they also remember months of problems and frustrations—accompanied by a litany of bad press. (The story includes links to a few particularly salient headlines.)
Those involved in Medicare Part D predict more of the same next year, when many of the health reform’s major provisions kick in. As Obama noted, the law will create few major disruptions for people who are already insured through their employer or a government program. But for the uninsured who hope to access new coverage options—and the government officials who must manage the programs—the first months of 2014 may be frustrating and confusing.
The health reform law is more ambitious and more complex than Part D. It must reach people not yet enrolled in government programs; it relies on more-complex information-technology systems working; it requires the cooperation of state governments, not all of whom are enthusiastic. Several Part D veterans, many of whom oppose Obama’s health law, said, whatever the ultimate success of 'Obamacare,' an imperfect rollout is an inevitability.
The two most serious problems in Part D affected a few thousand seniors each—out of about 40 million enrolled in the program. But they resulted in negative headlines about how the program was failing.
Critics were spelling the doom of President Johnson’s legacy when Medicare rolled out, too. Like Sen. Max Baucus, D-Mont.,—who recently warned Health and Human Services Secretary Kathleen Sebelius that he worries inadequate planning will turn health reform implementation into a “huge train wreck”—a group of top Republican lawmakers told Johnson that he had “failed tragically” to prepare for the Medicare launch, according to a New York Times report.
Obama was correct that implementation hiccups don’t mean a program will always be viewed as a failure—both the original Medicare program and the newer Part D are politically popular and deliver on their major promises of health coverage for the elderly and disabled.
“LBJ is remembered for a lot of things, but one of those things is not the failure of the Medicare program,” said Larry Kocot, the deputy director of the Engleberg Center for Health Care Reform at the Brookings Institution, and the former senior adviser to the administrator of the Centers for Medicare and Medicaid Services during the Part D launch.
But the health law’s early difficulties will emerge in a difficult political environment—just before the 2014 midterm elections, and with a Republican Party that is close to unified in its opposition to the law. Those circumstances may mean the public and the political process will have less patience as officials wrestle with inevitable glitches.