KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Viewpoints: Whether Americans Will Like Health Law Is Open Question; GOP Has ‘Nothing To Show’ For Shutdown; Sebelius Says Demand Derailed Marketplace’s Debut

The New York Times: Nazis, Lynching And Obamacare
How absolutely bonkers. And yet how unsurprising. We're awash these days in metaphors as overworked as our political debate is overwrought, and it's impossible not to wonder how much one contributes to the other. When nuance and perspective exit the language, do they exit the conversation as well? When you speak in ludicrous extremes, do you think that way, too? Obamacare has proved to be not just ideologically divisive but linguistically fertile. There's seemingly no event or passage in American history to which it can't be compared (Frank Bruni, 10/7).

Los Angeles Times: Obamacare's Next Round
Many conservatives and liberals talk about the entitlement ratchet as if it's an iron law of the universe. But there's precedent for bad ideas — even entitlements — being modified or undone. In the 1990s, for example, Washington reformed welfare. In the 1980s, Congress dropped catastrophic health insurance like a hot rock. And we shouldn't assume that a majority of Americans will like Obamacare once they get to know it. Its list of unintended consequences is already long and still growing (just ask the administration officials listening to complaints from organized labor). If the program lives down to the promise of its website — already arguably the biggest IT disaster in American history — then you can be sure it won't be popular (Jonah Goldberg, 10/8).

Los Angeles Times: In Shutdown War, Democrats May Be Losing The PR Battle
Republicans continued to criticize President Obama and Senate Democrats on Monday for refusing to negotiate over the partial government shutdown that the House GOP instigated last week. And so far, Senate Majority Leader Harry Reid (D-Nev.) has also refused to entertain any of the rifle-shot continuing resolutions that Republicans have pushed through the House, which would have reopened such popular programs as the Federal Emergency Management Agency and the National Institutes of Health. The question is, how long can Democrats ignore the GOP's calls for deal-cutting before the public stops blaming Republicans for picking the fight and starts blaming Democrats for prolonging it? (Jon Healey, 10/7).

The Washington Post: Obamacare Is Here. Get Used To It.
While Republicans were throwing their silly tantrum, Obamacare became a fact. There is no turning back. The point of no return was reached when millions of people crashed the Web sites of the new Affordable Care Act exchanges while trying to buy health insurance. Republicans can fight rear-guard battles if they want, but last Tuesday they lost the war. All they can do at this point is harm the nation — and their political prospects (Eugene Robinson, 10/7).

The Washington Post: A Face-Saving Plan To End The Obamacare Shutdown Statement
Even the president has acknowledged that there are bound to be glitches in implementing an initiative as large and complicated as Obamacare. So why not agree now to a thorough review of the program once we have some experience with it? The process could begin after two years with a rigorous evaluation by a respected group of independent experts such as the Institute of Medicine. By the end of 2015, the institute could forward its findings to a special joint committee of Congress, reflecting the partisan makeup of the new Congress. The panel would have the authority to propose any legislative changes it deems necessary, including outright repeal, within 90 days of receiving the advisory group’s report. The committee’s proposal would be filed with both houses of Congress, which under an expedited procedure could either accept or reject it without amendment. If approved by both House and Senate, the legislation would go to President Obama for his signature or veto (Steven Pearlstein, 10/7).

The Washington Post: The House GOP Has Nothing To Show For Its Government Shutdown
Derail the hated Obamacare? ... That was the GOP's ostensible purpose for this travesty of misgovernment, but the online insurance markets created by that law opened on schedule last week and continue to operate. In fact, the Republicans managed only to distract attention from the computer glitches that would have gobbled up all the news attention if the government weren't shut. In a revealing moment Sunday on ABC's "This Week," host George Stephanopoulos replayed a clip from last year in which House Speaker John A. Boehner (R-Ohio) explained the foolishness of the tactic that he is now, a year later, pursuing (10/7). 

Politico: Fact Checkers Can Help Keep ACA Debate Honest
Although the federal government is currently shut down as a result of Republican efforts to defund the Affordable Care Act, many important debates over health policy going forward will take place at the state level. Unfortunately, continuing public confusion over the law is likely to be exploited by opportunistic politicians if they aren't fact-checked aggressively by the press (Brendan Nyhan and Jason Reifler, 10/7).

Bloomberg: Boehner's Mess and Democrats' Obligations
At this point, arguing over whether this situation is of Boehner’s own making is counterproductive. The priority now is getting out of it. Obama cannot afford to allow the debt ceiling to be ransomed as he did in 2011, and his desire to appease an opponent in free fall is unlikely to be acute. Nonetheless, there are modest concessions -- rhetorical and real, such as agreeing to rescind the $3 billion a year tax on medical devices that was part of the health-care law -- that he can offer. Boehner should then promptly bring legislation to the House floor to fund the government and lift the debt ceiling to cover spending already authorized by Congress (10/7).

The San Francisco Chronicle: Obama Sold Voters Bill Of Goods On Health Care
Now that the Affordable Care Act exchanges are open for business, voters are finding that the biggest problem with Obamacare isn't that some Web sites crashed last week but that the Obama promise of big savings for the average family was too good to be true. Now that the exchanges are open for business, people who already have individual coverage have something new to not like: sticker shock. The Affordable Care Act isn't affordable after all (Debra J. Saunders, 10/7). 

USA Today: Kathleen Sebelius: HealthCare.Gov Simple, User- Friendly
When the Health Insurance Marketplace opened last week, demand was so high, it exceeded even optimists' expectations. On the first day alone, HealthCare.gov had nearly eight times more concurrent users than Medicare's site (one of the federal government's most highly trafficked) during open enrollment peak levels (Kathleen Sebelius, 10/7).

USA Today: Exchange Launch Turns Into Inexcusable Mess: Our View
Over the first four days the new online health insurance exchanges were open last week, more than 8 million people visited them, according to the Obama administration. At the very least, this casts doubt on the Republican claim that Americans hate Obamacare and want it repealed. It seems millions of people desperately want the coverage the law will allow them to get, regardless of their medical histories. Alas, the administration managed to turn the experience for most of those visitors into a nightmare. Websites crashed, refused to load, or offered bizarre and incomprehensible choices. Even though the system was shut down for repairs over the weekend, Monday's early reports continued to suggest an epic screw-up. Why have things gone so wrong? (10/7).

The Kansas City Star: Maybe Obamacare Exchanges Are Asking Too Many Questions
News accounts about the problems with the federal health care exchange are saying that people who manage to get into the site at all are getting hung up at the point where they are asked to provide information and register. But state-designed exchanges, which are working much better, allow consumers to browse among the sites without providing information (Barbara Shelly, 10/7). 

The Milwaukee Journal Sentinel: Obamacare: Not Quite Open For Business
A week on, the exchanges are working a little better, but still don't work nearly well enough. The government planned to take healthcare.gov offline again to do more work on the site after a crush of visitors overwhelmed its servers since the federal site was launched a week ago. The government said about 8.6 million people had tried to log in during the first four days the site was open. Democrats, who conceived and saw that Obamacare became law, would have you believe that these problems are good news. The traffic illustrates the vast interest in the program, they say. And yes, there is broad interest in Obamacare; millions of Americans don't have insurance. But the problem with the online marketplaces may be more complicated than unexpected demand (which should have been expected) (10/7).

And on other topics --

Los Angeles Times: '60 Minutes' Shameful Attack On The Disabled
Is it possible for a major news organization to produce a story about the Social Security disability program without interviewing a single disabled person or disability advocate? That's the experiment "60 Minutes" conducted Sunday. The result was predictably ghastly. The news program's theme was that disability recipients are ripping off the taxpayer. Anchor Steve Kroft called the program "a secret welfare system ... ravaged by waste and fraud." His chief source was Sen. Tom Coburn, an Oklahoma Republican with a documented hostility to Social Security. Coburn has a report on the disability program's purported flaws due out Monday. Good of "60 Minutes" to give him some free publicity (Michael Hiltzik, 10/7).

Bloomberg: Are Hospitals More Efficient Than They Seem?
Hospitals have been criticized, including by me, as wildly inefficient. Yet two new pieces of evidence suggest that the hospital market may be more efficient than conventional wisdom suggests. Hospitals practice medicine in drastically different ways, and the higher-spending ones don't seem to generate any better results than those that spend less. Because of third-party insurance and other distortions, though, the market doesn't punish the inefficient hospitals. That has been the traditional critique (Peter Orszag, 10/7).

The Seattle Times: Washington Must Treat The Mentally Ill
A compelling fiscal and moral case can be made that the chronic neglect of Washington's mental-health system has reached "epidemic" proportions. That word leaps out of recent stories by Seattle Times reporter Brian M. Rosenthal about the inhumane "boarding" of psychiatric patients in hospital emergency rooms (10/7).

JAMA: Using Detection Of Postsurgical Blood Clots As A Quality Measure May Be Misguided
Sometimes good intentions have unintended consequences. Take, for example, using rates of blood clots ... after surgery as a quality measure, with higher rates theoretically pointing to suboptimal preventive measures (Mike Mitka, 10/7).

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