Viewpoints: 'Elementary errors' in insurance exchange; problems could lead insurance pool imbalance; recalcitrant govs could have made Obamacare launch better

Oct 24 2013

The New York Times' Taking Note: Did Basic Errors Create The Health Insurance Mess?
Clearly, the government picked the wrong people to manage this project and it was a terrible decision to fragment it among so many contractors. Anyone who's ever been involved in creating a new computer application knows that you don't just assemble the thing and then see if it works. You're supposed to test the components, obsessively, along the way (Andrew Rosenthal, 10/22).

The New York Times: How To Fix The Glitches
What went wrong? My diagnosis is that there were three big mistakes. First, the Obama administration acted too slowly. It waited too long to release specific regulations and guidance on how the exchange would work. It also waited too long to begin building the physical Web site (Dr. Ezekiel J. Emanuel, 10/22). 

Los Angeles Times: Saving Obamacare From The Website Disaster: A Smart Proposal
With dire reports of the Obamacare website's dysfunction rising by the hour--and the deadlines for signing up for insurance moving nearer by the day--the question on everyone's lips is: Has the time come to delay the individual mandate? Health economists Nicholas Bagley and Austin Frakt say no. But they do have a workable plan for saving Obamacare from the website's meltdown. Here's the best news: It doesn't require action by Congress (Michael Hiltzik, 10/22).

The Wall Street Journal: The ObamaCare Con Job
With enough time and unlimited resources, the government can invent the atom bomb or deliver men to the moon with 1960s technology. Fixing the exchange websites, though, won't fix the fact that ObamaCare depends on noneconomic enthusiasm to drive enlistment of people for whom ObamaCare is an objectively bad deal-;the "marks" in grifter terminology. The mandate is too weak (Holman W. Jenkins Jr., 10/22). 

Bloomberg: Press 4 If You're Madder Than Obama About Obamacare
Please listen carefully as our menu options have changed. Press 1 if failure is not an option. President Barack Obama pressed the wrong button. He got the Affordable Care Act passed and then rested on his laurels. How sad to see our tech-savvy commander in chief, who blew billions on a website that is worse than any state's DMV, direct frustrated consumers to a 1-800 number, like an infomercial host on late-night cable (Margaret Carlson, 10/22).

The Fiscal Times: How To Know If Obamacare Has Failed
Let's take the president at his word and assume the website problems get sorted out, and fairly soon. How will Americans know if Obamacare is a success or failure? Here are four benchmarks (John F. Wasik, 10/23).

The Seattle Times: No Excuses, Make Affordable Care Act Sign-Up Work
The successful launch of the Washington Health Benefit Exchange in Olympia stands in sharp contrast to the high-tech turmoil in the other Washington. ... The launch of our state's system had the support of lawmakers and the governor. All that helps. But the Healthplanfinder website was also designed to be easy to use, with access and review like a familiar online-shopping experience.The federal system needs to be mindful of its customers and match consumer expectations (10/22).

The Milwaukee Journal Sentinel: Gov. Scott Walker's Obamacare Mistake 
Republican governors who oppose Obamacare, such as [Gov. Scott] Walker, didn't do their constituents any favors by shoving them onto the federal system (and then complaining loudly when it was overwhelmed). Wisconsin officials could have created a state exchange every bit as good as Kentucky's, where the governor says things are running smoothly. Instead, thanks in part to Walker's intransigence, Wisconsinites are stuck in the same line as the rest of the country. (10/22).

The Milwaukee Journal Sentinel: The Obamacare Rollout 'Glitch' Is Really A Disaster
Even Obama has called the rollout of the program -; which passed Congress three years ago -; "unacceptable." But Obamacare's supporters still say that this website fiasco shouldn't reflect poorly on other aspects of the program, which will aid people in getting health care. Apparently they believe that when literally the most important part of the program goes belly up, we should not look upon the remaining aspects of Obamacare with suspicion (Christian Schneider, 10/22).

The Wall Street Journal: ObamaCare 2016? Happy Yet?
Three years after the disastrous launch of the Affordable Care Act, most of the website troubles finally have been ironed out. People are now able to log on to the government's ACA website and to most of the state health-insurance exchanges. The public has grudgingly come to accept higher insurance premiums, new taxes and increases in part-time workers who were formerly full-time. But Americans are irate anyway-;because now they're seeing the health-care law's destructive effect on the fundamental nature of the way their care is delivered (Bradley Allen, 10/22).

The New York Times' Economix: The Power Of The Individual Mandate
The Affordable Care Act has at least two provisions to make insurance cheaper to workers who have so far been uninsured, compared with what employer insurance would have cost them in previous years. ... The first provision is the "individual mandate penalty" for being uninsured, which will eventually reach the greater of 2.5 percent of husband-and-wife income, or $695 per uninsured family member (up to three, with uninsured children counting half, and the $695 indexed to inflation). ... The law's premium assistance tax credits are another provision that makes insurance cheaper (Casey B. Mulligan, 10/23).

Los Angeles Times: Judge Allows Attack On Obamacare To Continue
[I]n addition to an attack on the employer mandate (which the administration has delayed until 2015), the case is a clever attempt to re-litigate the individual mandate. If the plaintiffs prevail, though, they wouldn't actually eliminate the requirement that adult Americans carry insurance. Instead, they would leave millions of lower-income Americans struggling to afford the coverage they have to buy -- and that they may need (Jon Healey, 10/22).

The Washington Post: Democrats Own Health Care
Fox News's Sean Hannity, that paragon of journalistic integrity, hosted six "average Americans" on his show this month who were "feeling the pain" of Obamacare. One was Paul Cox, who runs a North Carolina construction business and complained that the new law prevented him from hiring full-time employees because he would have to provide health insurance to anybody working more than 30 hours a week. ... Salon's Eric Stern called Cox, and he found that Cox's business has only four employees -; and therefore is not affected by the new requirement, which applies to businesses with 50 or more workers (Dana Milbank, 10/22).

USA Today: Technology Could Save Us From Obamacare
While we're a long way from the "autodocs" featured in some science fiction stories, the proliferation of devices that can do extensive blood tests and diagnostic workups doesn't seem that far away. Neither does the creation of freestanding gadgets that can diagnose things such as strep throat and other staples of doc-in-a-box or nurse-in-a-box practices now. While such devices will be expensive at first, they're likely to get steadily cheaper and more capable because, as electronic gadgets, they'll benefit from Moore's Law, the steady increase in computing power (Glenn Harlan Reynolds, 10/22). 

The New York Times' Evaluations: Why Not Medicaid For All?
My Sunday column on the potential consequences of Obamacare's botched rollout ended by sketching a scenario in which the program's Medicaid expansion is deemed a success while its reform of the individual market leads to much-higher-than-expected costs and much-lower-than-expected participation rates. ... This wouldn't amount to the full-on push for single payer that some people expect from the left if Obamacare fails or gets repealed, but it would move the U.S. toward the closest thing to single payer that we're ever likely to get  (Ross Douthat, 10/22). 

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  (10/22).

The New York Times' Economic Scene: New Front In The Fight With Infant Mortality 
Pregnant women, across the country and anywhere along the income spectrum, will for the first time [under the health law] have guaranteed access to health insurance offering a minimum standard of care that will help keep their babies alive. The benefit may seem narrow. But it offers the best opportunity in a generation to tackle one of the United States' most notorious stigmas: an intractably high infant mortality rate that hardly fits one of the richest, most technologically advanced nations on earth (Eduardo Porter, 10/22). 

And on other issues --

Bloomberg: The Ozone Treaty That Banned Your Asthma Inhaler
The Food and Drug Administration has outlawed the only over-the-counter asthma medicine in the U.S. It has also banned a number of other asthma medicines that patients like and that doctors have prescribed for them. ... Why does it ban asthma medicines? The answer lies in the Montreal Protocol, a treaty the U.S. ratified in 1988. Strongly supported by President Ronald Reagan, the Montreal Protocol was designed to phase out chlorofluorocarbons and other substances that deplete the ozone layer (and thus increase the risk of skin cancer and cataracts) (Cass R. Sunstein, 10/22).

Journal of the American Medical Association: Eliminating Prevention Counseling To Improve HIV Screening
In an era of shrinking resources, clinicians and policymakers cannot ignore data that inform efficient clinical practice. Maximizing identification of individuals with undiagnosed HIV infection and reducing viral transmission will require consistent and extensive HIV testing with emphasis, for those identified with HIV infection, on linkage to care, treatment, and adherence. ... prevention counseling in conjunction with HIV testing is not effective and should not be included as a routine part of practice (Drs. Jason S. Haukoos and Mark W. Thrun, 10/22).