KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Viewpoints: Republicans’ New-Found Interest In The Workings Of The Health Website; Fixing The Problem Crucial To Obama’s Presidency

The New York Times: Web Sites And Grave Sites
Republicans are apoplectic about Healthcare.gov, the official Web site for the Affordable Care Act. They are trying desperately to change the subject from their disastrous government shutdown by ranting about the failures of a government Web site that cost a tiny fraction of what was lost as a result of the shutdown. Republicans are pretending that they care about the problems encountered in signing up for a system that many of them are bent on destroying (Charles M. Blow, 10/23).

Los Angeles Times: Why The Website Meltdown Won't Crash Obamacare
The crash of the Obamacare federal website, which is preventing many people in three dozen states from signing up for health insurance, has turned the outright hate some conservatives have for the program all of a sudden into sympathy and solicitude (Michael Hiltzik, 10/23).

Politico: Heckuva Job, Sebelius
Little did they know it, but Republicans fighting to defund or delay Obamacare had an ally in spirit in Health and Human Services Secretary Kathleen Sebelius. Her explanation for why the Obamacare website doesn't work is that she couldn't possibly have been expected to make it work in the mere 3½ years since the law passed. She told The Wall Street Journal the website ideally needed five years of construction and one year of testing and instead had only two years of construction and almost no testing (Rich Lowry, 10/23).

Bloomberg: Obama's Presidency Depends On 'Just A Website'
The flip side of the conservative desire to believe Obamacare's problems are much worse than they actually are is the liberal desire to believe they're much less severe than they actually are. One refrain that's become particularly popular, perhaps because President Barack Obama uses it, is "Obamacare is more than just a website." This has the advantage of being true: The Patient Protection and Affordable Care Act is a vast and complex effort that includes drastic changes to how health care is delivered, a huge expansion of Medicaid (welcome, Ohio!), and an array of regulations meant to protect consumers from the worst predations of insurers. But Obamacare’s website is much more crucial to the law's success than the website for your average government program (Ezra Klein, 10/23).

Roll Call: Sebelius' Tenure As Obamacare Overseer Hangs With Vulnerable Democrats
Will the star witness who isn't there become the sacrificial secretary? ... It will be little surprise if the corporate executives, taking advantage of her absence as a rebuttal witness, push as much blame as possible for the online morass toward their government customers. What will be more newsworthy is if the wall of Democratic support for Sebelius starts to crumble (David Hawkings, 10/23).

The Fiscal Times: Obama And Sebelius: The Dog Ate My Homework
In short, the ACA was the Obama administration's own bid to prove that activist, large-scale government was superior in innovation and competency. Instead, it has become a signature example of the lack of accountability, incompetence, and rank dishonesty that activist, large-scale government creates and protects.  And that was just on performance.  Despite the 42 months lead time and the outlay of $400 million, the web portal failed immediately, and two successive weekends of repair couldn't make it work.  When the media demanded to know what happened, the White House responded with a battalion of Ida Knows (Edward Morrissey, 10/24).

The Washington Post: Don't Give Up On The Uninsured
Obamacare is working. True, that sentence comes with a large asterisk. It is working in states that have followed the essential design of the Affordable Care Act, particularly in Kentucky, Connecticut, Washington and California. The law was written with states' rights and state responsibilities in mind. States that created their own health-care exchanges — and especially those that did this while also expanding Medicaid coverage — are providing insurance to tens of thousands of happy customers, in many cases for the first time (E.J. Dionne Jr., 10/23).

The Washington Post: Obamacare Backfires – On Everyone
The Affordable Care Act ("Obamacare") turns out to represent dreadful miscalculations by both the president and his Republican adversaries. Doubtlessly, Barack Obama imagined that achieving something close to "universal" health insurance would guarantee his legacy. It would make him the liberal heir to Franklin Roosevelt and Lyndon Johnson. Forget it. Even if Obamacare worked flawlessly — that's now a joke — it's too small to rank with the New Deal or the Great Society. Meanwhile, Republicans say Obamacare threatens liberty and would lead to a federal "takeover" of health care. This fiction, pursued fanatically with policies risking anarchy, has earned the GOP a deserved public backlash (Robert J. Samuelson, 10/23).

The Wall Street Journal: Has He Got A Health-Care Deal For You
He sounded every bit the pitchman—repeating a 1-800 number, promising that "call centers are available" and reassuring viewers "you can get your questions answered by real people, 24 hours a day." And boy was he selling: "The product is good. . . . It's high quality and it's affordable. People can save money, significant money . . . . And we know the demand is there. People are rushing to see what's available" (Karl Rove, 10/23). 

Fox News: Mocking Obamacare: Jon Stewart Leading The Media Charge
Naturally, the Obamacare debacle was ripe for mockery by the "Daily Show," which usually has more fun skewering the Republicans (and cable news networks). It's no secret that Stewart, who has interviewed President Obama, is more sympathetic to the liberal side, so this was telling—especially when he ridiculed the administration’s planned tech "surge" to the same strategy used to salvage the Iraq war. When your political program becomes a punchline, you've got problems (Howard Kurtz, 10/23).

The New York Times: Could Obamacare Discredit Neoliberalism?
As a kind of companion piece to my last post on the liberal and conservative visions for health insurance, I strongly recommend reading this post by Mike Konczal, which strikes a note that you can expect to hear sounded more often on the left if the Obamacare rollout continues to go badly. Contra conservatives suggesting that HealthCare.gov represents some kind of discrediting moment for liberalism, Konczal argues that the potential policy problems associated with a nonfunctional web portal really just point to the problems with neoliberalism — a much-debated term of art, but defined for his purposes as the post-1970s idea that social insurance should be "heavy on private provisioning and means-testing," that it should preserve as much "choice and competition" as possible, and that it should be delivered at the state level or through state-and-federal coordination rather than by the federal government alone (Ross Douthat, 10/23).

The Wall Street Journal: Medicaid And The Apostle Kasich
Believe it or not, there are still a few disciples with faith in an Obamacare higher power, and one of them happens to run Ohio. Governor John Kasich is so fervent a believer that he is even abusing his executive power to join the Affordable Care Act's Medicaid expansion. Not to be sacrilegious, but the Republican used to know better. Now Mr. Kasich seems to view signing up for this part of Obamacare as an act of Christian charity and has literally all but claimed that God told him to do so (10/22).

Tampa Bay Times: A Medicaid Tale Of Two GOP Governors
This is a tale of two Republican governors who oppose the Affordable Care Act. ... Florida would receive $51 billion in federal money over 10 years to cover 1 million uninsured residents if the Legislature would vote to accept the Medicaid expansion money under the Affordable Care Act. ... Now low-income Floridians who would be covered by the expansion fall into a gap: They don't qualify for Medicaid, and they make too little money to qualify for subsidies to buy insurance in the new federal marketplace. So they will continue to show up in hospital emergency rooms for expensive charity care, and the costs are paid by taxpayers at public hospitals and by paying patients through higher insurance premiums. [Gov. Rick] Scott said Florida should take the Medicaid expansion money, but unlike [Ohio Gov. John] Kasich, he hasn't lifted a finger to force the issue (10/22).

Fox News: Obamacare And America's Journey Into The Third World
In Europe, national health care systems deliver coverage for everyone, at remarkably lower cost, and in countries with per capita income comparable to the United States, a lot better care. The United States spends 18 percent of GDP on health care; Germany and Holland spend about 12 with better results. One only need look behind the rollout of the federal health insurance exchanges to see why. President Obama sees every decision -- from the timing for sending his mother-in-law a birthday card to those required for the rollout of the exchange -- as a political calculation (Peter Morici, 10/23).

Health Policy Solutions (a Colo. news service): Making The Most Of Open Enrollment Season
In many cases, consumers who spend time reviewing their health plan options can find ways to save money on their health care costs, whether it's through selecting a plan that will cover more of their expected health costs for a major event in the coming year (such as having a baby or surgery), reviewing which doctors participate in the health plan's care provider network or evaluating prescription drug coverage. Unfortunately, just 14 percent of Americans understand basic health insurance concepts such as deductible, co-pay, co-insurance and out-of-pocket maximum, according to a recent study published in the Journal of Health Economics (Dr. Robert Beauchamp, 10/23).

Health Policy Solutions (a Colo. news service): Despite Good Intentions, Women Not Achieving Good Health
While 14 percent of Colorado women are in fair or poor health overall, around 40 percent are having days of poor mental or physical health every month. That’s a substantial portion of the population that is facing physical and mental health challenges, and a larger percentage than that of men reporting similar health challenges (Sarah Mapes, 10/23).

WBUR: The Last Bill JFK Signed – And The Mental Health Work Still Undone
The Community Mental Health Act reflected a bold new vision for the treatment of mental illness, but much remains to be done to fulfill that promise. While the legislation did usher in positive and hopeful changes for millions of people with serious illnesses such as schizophrenia, progress stalled because of funding challenges and continuing stigma. Only half of the proposed community mental health centers were ever built, and those were never fully funded. Drastic cuts were made to the remaining community mental health centers at the beginning of the Reagan administration (Vic DiGravio, 10/23).

Politico: Children Need Good Start In Life
America needs a grand bargain for babies. ... It's this simple: Our youngest children need to develop into healthy adults if America's economy is to have a healthy future. Our earliest life experiences shape the foundation of the brain architecture, which serves as the basis for all later learning and functioning. ... When babies and toddlers do not have engaging relationships with their parents and caregivers, it can rob them of the secure connections they need to thrive. When young children encounter adverse experiences, their early brain development can affect their health and ability to function as adults. These detrimental experiences can include poverty and its accompanying deprivations, depression, substance abuse and maltreatment. One in four babies in the United States starts life in poverty. Having this many babies who lack the ingredients to be mentally and emotionally healthy for school, work and life will be hugely detrimental to the future of this country if we don't prioritize putting our children on the right track (Denny Rehberg, 10/22).

The New England Journal of Medicine: Dead Man Walking
We met Tommy Davis in our hospital's clinic for indigent persons in March 2013 (the name and date have been changed to protect the patient's privacy). He and his wife had been chronically uninsured despite working full-time jobs and were now facing disastrous consequences. The week before this appointment, Mr. Davis had come to our emergency department with abdominal pain and obstipation. His examination, laboratory tests, and CT scan had cost him $10,000 (his entire life savings), and at evening's end he'd been sent home with a diagnosis of metastatic colon cancer. ... The year before, he'd had similar symptoms and visited a primary care physician, who had taken a cursory history, told Mr. Davis he'd need insurance to be adequately evaluated, and billed him $200 for the appointment. ... We find it terribly and tragically inhumane that Mr. Davis and tens of thousands of other citizens of this wealthy country will die this year for lack of insurance (Drs. Michael Stillman and Monalisa Tailor, 10/23).

The New England Journal of Medicine: Smoothing The Way To High Quality, Safety, And Economy
In recent years, health care institutions have awakened to the need to provide safe, high-quality care at lower cost. The Centers for Medicare and Medicaid Services is implementing multiple incentives and penalties intended to help realize this goal. ... We believe that greater attention to a frequently overlooked parameter in health service design — patient load and flow — would accelerate progress toward reliable, safe, efficient care. ... Direct and indirect savings from smoother patient flow could give Medicare a new lease on life, underwrite biomedical research, reduce the national debt, support schools, and serve many other private and public purposes (Eugene Litvak, and Dr. Harvey V. Fineberg, 10/23). 

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