“Humming Along Today”: Despite Rocky Beginnings, 5 Other Government Programs Suggests Glitches Get Fixed And Forgotten
The Obama administration’s struggle with debugging the HealthCare.gov website is causing critics to ask whether ObamaCare is “Obama’s Iraq war,” and to dismiss Obama’s signature policy achievement a “quagmire.”
Media coverage is becoming increasingly hysterical, meaning some historical perspective is in order. Many large-scale government programs that are now embedded in American society also began with rough rollouts that are now mostly forgotten.
Here are five programs that are humming along today, despite their rocky beginnings:
1. Social Security
In the program’s early days, many employers failed to include worker names and their new Social Security numbers in their earnings report, leaving the government without the basic information needed to calculate benefits and cut checks. Syndicated columnist Drew Pearson turned the “John Doe” problem into a crusade, writing about the snafu once a week for two months and stoking panic that the government would be unable to pay out the promised benefits to millions. But new procedures were established to follow up with delinquent employers, and within a year the number of John Does was slashed. Today, the crisis is dismissed as a blip, while Social Security historians view the effort to build a nationwide social insurance system from scratch before the age of computers as “Herculean” and “amazing.”
2. Medicare
Last week, historian and Bloomberg columnist Stephen Mihm chronicled the myriad problems that beset the 1966 Medicare rollout. More than 700,000 eligible seniors initially refused to sign up because they mistakenly believed it meant giving up Social Security. Some Southern cities were left without any participating hospitals because the Medicare law required hospitals to comply with the new Civil Rights Act, yet many in the South remained segregated. It was more commonplace at the time for doctors to bill patients directly, and excessively long waits for Medicare reimbursement checks frustrated seniors. But as Mihm notes, “The government and the private insurers worked out most of the kinks, and by the late 1960s the system was working reasonably well.”
3. Medicare’s Prescription Drug Benefit
It wasn’t all that long ago that another presidential health care initiative ran into an online buzzsaw. In 2005, the Bush administration rolled out its new Medicare Part D program, providing seniors coverage for prescription drugs. But the debut was bedeviled by website problems. The Washington Post noted at the time that the launch was delayed twice over the course of a month. Then on the day it actually launched, “Visitors to the site could not access it for most of the first two hours. When it finally did come up around 5 p.m., it operated awfully slowly.” The glitches continued throughout the open enrollment period, but as Jack Hoadley of the Georgetown Health Policy Institute reminded in a blog post this month, “The program added both phone lines and customer service representatives and implemented other upgrades over the weeks. The website — both its functionality and the accuracy of its information — was the source of ongoing frustration for its users, but it did get better over time. By the end of open enrollment in May 2006, over 16 million successfully enrolled for drug benefits in Part D … And today, Part D enjoys widespread popularity.”
4. The Peace Corps
President John F. Kennedy established the Peace Corps by executive order shortly after taking office in 1961. Skeptics worried that the program would be overrun with immature draft-dodgers. And that concern was seemingly confirmed when one of the first volunteers mistakenly dropped a postcard before it could be mailed, telling her stateside boyfriend that her host country of Nigeria suffered from widespread “squalor and absolutely primitive living conditions.” A horrified Nigerian student discovered the postcard, made copies, and distributed it widely. It sparked an international incident. Riots ensued, and the volunteer had to be sent home “cloak and dagger” for her safety. Still Kennedy forged ahead, shrugging off the setback by joking to a new batch of volunteers, “Keep in touch, but not by postcard!” And two years later, the Christian Science Monitor reported that foreign governments were “so pleased with [the Peace Corps’] work they have called again and again for more … Although the ‘postcard incident’ in Nigeria seemed to confirm some fears that the program might do more harm than good, that has been far from the case…”
5. The income tax
It was 100 years ago this month when President Woodrow Wilson first enacted the progressive income tax that finances much of our government today. Now, few Americans would claim to be fans of our current tax system — but many of them are fans of what the income tax system helps pay for. In the early days of the rollout, however, plenty of people were sent over the edge because of the forms’ perceived complexity. As tax historian Joseph Thorndike noted, one lawyer made headlines in 1915 by saying of the forms, “It is so complicated that it is utterly impossible to understand its meaning save by consulting a palmist.”A 1915 The New York Times headline characterized the forms as “Income Tax Riddles.”
Now, some may say the tax forms have only gotten worse over the last 100 years. But by and large, the public has accepted the nature of tax forms as a governing necessity, and no politician has gotten very far in the past century campaigning against the progressive income tax. As Thorndike noted in Barron’s, “The income tax has survived because it does two things reasonably well: It raises money, and it satisfies popular notions of economic fairness.”
The lesson? History suggests that glitches get fixed and forgotten, people get acclimated to new programs, and policies rise and fall on their merits. If past is prologue, ObamaCare will be judged on the quality of the coverage, not on the first incarnation of the website.
By: Bill Scher, The Week, October 23, 2013
“Health Reform Turns Real”: Even The “Bad News” On Obamacare Start-Up Is Really Good News For The Program’s Future
At this point, the crisis in American governance has taken on a life of its own. Some Republicans are now saying openly that they want concessions in return for reopening the government and avoiding default, not because they have any specific policy goals in mind, but simply because they don’t want to feel “disrespected.” And no endgame is in sight.
But this confrontation did start with a real issue: Republican efforts to stop Obamacare from going into effect. It’s long been clear that the great fear of the Republican Party was not that health reform would fail, but that it would succeed. And developments since Tuesday, when the exchanges on which individuals will buy health insurance opened for business, strongly suggest that their worst fears will indeed be realized: This thing is going to work.
Wait a minute, some readers are saying. Haven’t many stories so far been of computer glitches, of people confronting screens telling them that servers are busy and that they should try again later? Indeed, they have. But everyone knowledgeable about the process always expected some teething problems, and the nature of this week’s problems has actually been hugely encouraging for supporters of the program.
First, let me say a word about the underlying irrelevance of start-up troubles for new government programs.
Political reporting in America, especially but not only on TV, tends to be focused on the play-by-play. Who won today’s news cycle? And, to be fair, this sort of thing may matter during the final days of an election.
But Obamacare isn’t up for a popular referendum, or a revote of any kind. It’s the law, and it’s going into effect. Its future will depend on how it works over the next few years, not the next few weeks.
To illustrate the point, consider Medicare Part D, the drug benefit, which went into effect in 2006. It had what was widely considered a disastrous start, with seniors unclear on their benefits, pharmacies often refusing to honor valid claims, computer problems, and more. In the end, however, the program delivered lasting benefits, and woe unto any politician proposing that it be rolled back.
So the glitches of October won’t matter in the long run. But why are they actually encouraging? Because they appear, for the most part, to be the result of the sheer volume of traffic, which has been much heavier than expected. And this means that one big worry of Obamacare supporters — that not enough people knew about the program, so that many eligible Americans would fail to sign up — is receding fast.
Of course, it’s important that people who want to sign up can actually do so. But the computer problems can and will be fixed. So, by March 31, when enrollment for 2014 closes, we can be reasonably sure that millions of Americans who were previously uninsured will have coverage under the Affordable Care Act. Obamacare will have become a reality, something people depend on, rather than some fuzzy notion Republicans could demonize. And it will be very hard to take that coverage away.
What we still don’t know, and is crucial for the program’s longer-term success, is who will sign up. Will there be enough young, healthy enrollees to provide a favorable risk pool and keep premiums relatively low? Bear in mind that conservative groups have been spending heavily — and making some seriously creepy ads — in an effort to dissuade young people from signing up for insurance. Nonetheless, insurance companies are betting that young people will, in fact, sign up, as shown by the unexpectedly low premiums they’re offering for next year.
And the insurers are probably right. To see why anti-Obamacare messaging is probably doomed to fail, think about whom we’re talking about here. That is, who are the healthy uninsured individuals the program needs to reach? Well, they’re by and large not affluent, because affluent young people tend to get jobs with health coverage. And they’re disproportionately nonwhite.
In other words, to get a description of the typical person Obamacare needs to enroll, just take the description of a typical Tea Party member or Fox News viewer — older, affluent, white — and put a “not” in front of each characteristic. These are people the right-wing message machine is not set up to talk to, but who can be reached through many of the same channels, from ads on Spanish-language media to celebrity tweets, that turned out Obama voters last year. I have to admit, I find the image of hard-line conservatives defeated by an army of tweeting celebrities highly attractive; but it’s also realistic. Enrollment is probably going to be just fine.
So Obamacare is off to a good start, with even the bad news being really good news for the program’s future. We’re not quite there yet, but more and more, it looks as if health reform is here to stay.
By: Paul Krugman, Op-Ed Columnist, The New York Times, October 3, 2013
“A Very Sweet Deal”: Prescription Drug Price-Gouging Enabled By Congress
Republicans and Democrats don’t agree on much. But one thing they would agree on if they knew the facts is that because of the cozy relationship big drug companies have with our lawmakers in Washington, Americans pay far more for their medications than people anywhere else on the planet.
As a consequence, our health insurance premiums are much higher than they should be. And our Medicare program is costing both taxpayers and beneficiaries billions of dollars more than necessary.
Americans who are uninsured are at an even greater disadvantage: many of them have no choice but to put their health at risk because they can’t afford the medications their doctors prescribe for them.
Drug makers have so much influence in Washington that they’ve been able to kill numerous proposals over the years that would enable the U.S. government to regulate drug prices like most other countries do. Between 1988 and 2012, the pharmaceutical industry spent more on lobbying than any other special interest, forking over a total of $2.6 billion on lobbying activities, according to OpenSecrets.org. That’s far more than even banks and oil and gas companies spent.
That money helped them get a very sweet deal when members of Congress were drafting legislation that would eventually be the Medicare Part D prescription drug program. Drug makers were able to get their friends in Congress to insert language in the Part D legislation that prohibits the federal government from seeking the best prices from pharmaceutical companies.
According to a recent analysis by Health Care for America Now (HCAN), an advocacy group, the 11 largest drug companies reported $711.4 billion in profits over the 10 years ending in 2012, much of it coming from the Medicare program. They reaped $76.3 billion in profits in 2006 alone, 34 percent more than in 2005, the year before the Part D program went into effect.
“Americans pay significantly more than any other country for the exact same drugs,” said HCAN Executive Director Ethan Rome.
How much more do we pay than residents of other countries? Here are a few examples of what we pay on average for six brand name drugs compared to what residents of other countries pay, according to the International Federation of Health Plans:
— Celebrex (for pain) – U.S.: $162; Canada: $53
— Cymbalta (for depression and anxiety) – U.S: $176; France: $47
— Lipitor (for high cholesterol) – U.S.: $124; New Zealand: $6
— Nasonex (for nasal allergies) – U.S: $108; U.K.: $12
— Vytorin (for high cholesterol) – U.S: $123; Argentina: $31
— Nexium (for acid reflux) – U.S.: $123; Spain: $18
The Congressional Budget Office says that if Medicare could get the same bulk purchasing discounts on prescription drugs as state Medicaid programs already get, the federal government would save at least $137 billion over 10 years.
In his proposed budget for 2014, President Obama is asking Congress to require drug companies to sell their medications to Medicare at the best price they offer private insurance companies, which is what they are required to do for Medicaid.
On April 16, several members of Congress, led by Sen. Jay Rockefeller (D-W.Va.) and Rep. Henry Waxman (D-Calif.), introduced legislation to require drug companies to provide rebates to the federal government on drugs used by people who are eligible for both Medicare and Medicaid. One of the cosponsors was Independent Sen. Angus King, the former governor of Maine. The lawmakers noted that with the exception of Medicare Part D, all large purchasers of prescription drugs negotiate better prices. Their bill, they say, would correct excessive payments to drug companies, while saving taxpayers and the federal government billions of dollars.
As you can imagine, the drug companies don’t like what President Obama and the lawmakers are proposing. You can expect them to mount a multi-million dollar PR and lobbying campaign over the coming months to protect both their sweet deal with Medicare and their Wall Street-pleasing profits.
By: Wendell Potter, Guest Contributor, Politix, April 23, 2013
Affordable Care Act Delivers Big Savings For Seniors
Most of the Affordable Care Act won’t take effect for a few years — and if court rulings and the 2012 elections go a certain way, it may not take effect at all — but there’s already evidence that the reform law is working.
It’s making a big difference in providing coverage for young adults; it’s providing treatment options for women like Spike Dolomite Ward; and it’s slowing the growth in Medicare spending.
It’s also, as Jonathan Cohn explained, saving seniors quite a bit of money on prescription medication.
Under the terms of the Affordable Care Act — yes, Obamacare — pharmaceutical companies provide a 50 percent discount on name-brand drugs for seniors who hit the “donut hole.” The donut hole is the gap in coverage that begins once an individual Medicare beneficiary has purchased $2,840 in drugs over the course of a year. At that point, the beneficiary becomes completely responsible for prescription costs — in other words, he or she has to pay for them out of his pocket — until he or she has spent another $3,600.
It may not sound like a lot of money. But the seniors who hit the donut hole are, by definition, the ones with the most medical problems. Saving a few hundred dollars, on average, makes a real difference. And that’s precisely what’s happening, according to data the administration released today. According to its calculations, 2.65 million seniors hit the donut hole — and then saved an average of $569 each. The data runs through October. More seniors will hit the donut hole through year’s end, so the total number of beneficiaries who take advantage of the discount in 2012 should end up higher.
In an interview with USA Today, Jonathan Blum, director of the Center for Medicare, added, “We’re very pleased with the numbers. We found the Part D premiums have also stayed constant, despite predictions that they would go up in 2012.”
Seniors have been some of the biggest skeptics of the Affordable Care Act, but they’ve also seen some of the most direct benefits. Indeed, USAT’s report went on to note that as of the end of November, “more than 24 million people, or about half of those with traditional Medicare, have gone in for a free annual physical or other screening exam since the rules changed this year because of the health care law.”
If Republicans repeal the law, all of these benefits will simply disappear. It’s something voters may want to keep in mind.
By: Steve Benen, Contributing Writer, Washington Monthly Political Animal, December 7, 2011
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 