Republicans have short........memories.

Let’s play a quick game: who made this statement?  "This is a huge undertaking and there are going to be glitches. My goal is the same as yours: Get rid of the glitches."    I know, I know, it’s one of those whining Democrats trying to gain some breathing space on the difficulties with the healthcare site, right?  No, Sarah, it wasn’t.  Actually, it was Rep. Joe Barton, a Texas Republican who chaired the House Energy and Commerce Committee, and he was referring to Medicare Part D in 2006!

     There are strikingly eerie similarities between the two health care programs, both of which were heralded as the signature domestic achievements of the presidents who signed them into law and both of which have been criticized by (surprise!) the drug and insurance lobbies as well as members of the opposition parties.  Supporters of the laws asked for time and promised a quick fix. Critics did not mince their words. Even the catch phrases  -- words like "glitches" -- have been recycled.

     Earlier this year, a report documenting the history of Medicare Part D was released by a panel of Healthy Policy experts  at the Center on Health Insurance Reform at Georgetown University. It highlighted several areas where Medicare Part D struggled in its implementation that sound extremely familiar.
     Like The Affordable Care Act, the Bush administration faced a difficult political battle to get the bill passed in 2003. That damaged public opinion of the law, making it a challenge to educate 43 million seniors on its nuances. A majority of seniors were very vocal about what they believed (having been fed a huge dose of bullshit by special interest groups. lobbyists and  media) would be a law detrimental to their (seniors') interests.  

     Enrollment in the law was set to begin in late 2005. In April of that year, a Kaiser Family Foundation poll found that only 27 percent of respondents understood the law, while only 21 percent favored it. (In a comparable Kaiser poll in April 2013, 35 percent viewed the Affordable Care Act favorably and less than half felt they were well-informed of its details.) You will, of course,  remember that Republicans in general and Tea Partiers in particular constantly touted those numbers while condemning the Affordable care Act, but had been strangely silent when “W’s”  drug plan (also a good plan, credit where due) had far lower popularity ratings.  

      The Medicare site, meant to help seniors pick benefit plans, was supposed to debut Oct. 13, 2005, but it didn’t go live until weeks later in November. Even then, "the tool itself appeared to be in need of fixing," the Washington Post reported at the time.

    "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 Post reported. (Sensing a pattern?)

          Once seniors began to try to enroll, problems persisted. According to the report, the online tools had "accuracy problems," and local organizations designated with assisting seniors "reported problems getting necessary and accurate information." Call centers provided by the Center for Medicare and Medicaid Services underestimated "the needed capacity to ensure that reliable answers could be provided" and "service representatives were not knowledgeable or failed to provide accurate information."

     The Georgetown experts anticipated similar hiccups with the Affordable Care Act, noting that the country’s experience with Medicare Part D suggested "the experience will be far from perfect" and "problems were not always addressed as quickly or as thoroughly as critics would have liked, but fixes were usually found."

        So; Medicare part D was a miserable failure, right? Hardly!  These days, nine in 10 seniors who utilize the program report they are satisfied. I defy you to find any other government mandated and run program with higher customer satisfaction.

     But there are still some important differences between Medicare Part D and the Affordable Care Act that make the challenges facing the exchanges different and even more daunting. Because it was aimed at seniors and e-commerce was still relatively young, Medicare.gov was not intended to be the main hub for people to purchase and review plans, said David Brailer, the first National Coordinator for Health Information Technology under Bush.

     "The issue with Medicare Part D is there were choices of 70 to 100 plans," Brailer said. "People were overwhelmed with the choices, with the options available and didn't know how to navigate and pick one.This was about how do you really navigate through all these choices. Also, prescription drugs are a relatively small and easy-to-understand part of health care. Shopping for an insurance plan is more complicated.  In the exchange world you have a full health care benefit to buy," Jack Hoadley of the Georgetown group pointed out, "Drug costs are relatively predictable, certainly a lot more predictable than overall health costs. The challenge for this website (healthcare.gov) was and is a lot greater, probably by a significant amount of magnitude."

       And don’t forget the  political climate. . When Medicare Part D passed, Democrats were not happy with the final bill and were critical of its botched rollout. But even then, they were generally supportive of its intended outcome and worked with constituents who had difficulty signing up or utilizing their new benefits. When Medicare Part D faced early troubles, many blue states came to its rescue. The New York Times reported in 2006 that "about 20 states, including California, Illinois, Ohio, Pennsylvania and all of New England (almost all Democratic), have announced that they will help low-income people by paying drug claims that should have been paid by the federal Medicare program."

         In the starkest contrast, not a single Republican voted for the Affordable Care Act, and in the years since it passed, the party has made its repeal a top priority. In the states, many Republican governors have bucked the Medicaid expansion and rejected offers to build their own insurance marketplaces, putting greater pressure on the federal government.

Henry Aaron, a health policy expert at the Brookings Institute, said the opposition from Republicans has forced the Obama administration into a "two-front war" Bush did not have to fight.

"On the one hand, one must and should address the administrative problems that no one denies is plaguing the problem," he said. "But you’re also waging a war of public opinion against the hysterics of its critics."

       So, in summary, we have a much more complex program running via healthcare.gov with issues similar to the startup of the far less complex, yet even more unpopular Medicare part D.  Another similarity is that both laws are aimed at helping provide affordable healthcare for more Americans. Where they differ  radically is that while many Democrats opposed Medicare part D  (as did, many Republicans), Democrats set aside the partisan differences and even stepped up to cover drug expenses in several large Democratically controlled states until part D was up and running at the federal level.

     Compare that to the obstructionist carping of Republicans regarding the present similar problems with implementation of the Affordable care Act. Shame on them!