Hurricane Katrina killed more than 1,800. Obamacare’s Web site doesn’t work yet. Stop comparing them.

November 18, 2013

Hurricane Katrina killed at least 1,833 people and damaged more than $80 billion worth of property. It was one of the deadliest, costliest storms ever to hit the United States.

Meanwhile, the Affordable Care Act's Web site isn't working very well yet. So of course the media is asking whether "this is Obama's Hurricane Katrina." I look forward to future coverage in this vein: "Is the failure of immigration reform Obama's 1906 San Francisco Earthquake?" "Are the 2014 sequestration cuts Obama's 1918 Influenza?"


Does Obamacare flood cities? No, right? (David Phillip/AP)

The interest in comparing HealthCare.Gov to a lethal natural disaster is all the odder because the Bush years actually offer a ready analogue to Obamacare: Medicare Part D.

Like Obamacare, Medicare Part D was a massive health-care expansion. Like Obamacare, it was administratively complex. Like Obamacare, the Web site didn't work on launch. Like Obamacare, people who were supposed to be benefitting from the law found their plans upended and the supposedly superior alternatives inaccessible. Like Obamacare, the early months were, in the words of then-Majority Leader John Boehner, "horrendous."

Obamacare has been live for about six weeks. At this point in Medicare Part D's life, here's what the coverage looked like. Let's start with NPR:

Many health care professional and policy experts have complained about how complicated the Medicare Part D maze is for millions of elderly and disabled people. That may explain why many people still haven't signed up for the benefits. Out of the 43 million people in Medicare, only about 10 percent have signed up on their own. About 10 million people were automatically enrolled. They could be dually eligible for Medicaid and Medicare, and may even be receiving coverage from a former employer. Still the latest report from the Kaiser Family Foundation, says enrollment numbers are 15 million people below government predictions.

The Washington Post also focused on the mounting enrollment disaster:

A $400 million campaign by the Bush administration to enroll low-income seniors in prescription drug coverage that would cost them just a few dollars per prescription has signed up 1.4 million people, a fraction of the 8 million eligible for the new coverage.

At this rate, by some calculations, the government is on track to spend about $250 for each person it enrolls, and even then it would have only 2 million poor senior citizens taking advantage of what is perhaps the most generous government benefit available today.

The New York Times reported that the new law might cost the GOP support among the elderly:

Older voters, a critical component of Republican Congressional victories for more than a decade, could end up being a major vulnerability for the party in this year's midterm elections, according to strategists in both parties. Paradoxically, one reason is the new Medicare drug benefit, which was intended to cement their loyalty.

During next week's Congressional recess, Democrats are set to begin a major new campaign to highlight what Representative Nancy Pelosi of California, the Democratic leader, describes as "this disastrous Republican Medicare prescription drug plan."

This zoom-out from the NYT will sound familiar to anyone following the coverage around Obamacare:

The Medicare Prescription Drug, Improvement, and Modernization Act ... was an effort to blend a classic big government program from the Great Society with the conservative, market-oriented philosophy of the Republicans in power.

It was supposed to be one of the great domestic policy achievements of the Bush presidency.

But today, as state and federal officials struggle to carry out the program, they face widespread complaints from beneficiaries, advocates, pharmacists, lawmakers and others that it is too complex, too cumbersome, too hard to navigate. Congressional committees are holding hearings on problems in the rollout of the plan, which began Jan. 1, and debate has already begun over how to change it.

Michael Kinsley was unsparing in The Washington Post:

The hideous complexity of President Bush's prescription drug program has reduced elderly Americans — and their children — to tears of bewildered frustration. The multiple options when you sign up, each with its own multiple ceilings and co-payments; the second round of red tape when you actually want to acquire some pills; the ludicrously complex and arbitrary standards of eligibility, which play a cruel and pointless game of hide-and-seek as they lurch up and down the graph paper like drunks. Suddenly a mystery is solved: So this must be what he means by "compassionate conservatism."

Thus Bush's only major domestic accomplishment in six years as president has not achieved its intended purpose of cementing the affection of senior citizens for the Republican Party. Many Republicans are sobbing with frustration, too. It is one thing to put aside your principles and spend hundreds of billions of taxpayer dollars on the largest expansion of the welfare state since the Great Society if it is going to help you win elections (so you can pursue your dream of smaller government). It is another to sell your soul and not get anything for it. No one looks more foolish than a failed cynic.

Paul Krugman:

We are ruled by bunglers. Every major venture by the Bush administration, from the occupation of Iraq to the Medicare drug program, has turned into an epic saga of incompetence. In retrospect, the Clinton years look like a golden era of good government.

Medicare Part D eventually found its footing and today it's a popular and successful program. Which is, perhaps, the reason the media is more interested in the Hurricane Katrina comparison: "The glitches get fixed and, after a year or two, the program fades into an efficient obscurity" is a less interesting story line then "failure that defines a presidency."

But that's exactly why the Part D comparison makes so much more sense, and the Katrina comparison is so misguided — and so offensive. The reason the Bush administration could never wipe away the stain of Katrina was that the victims were dead. There was only one chance to get the response right, and the consequences of failure were irreparable. The Affordable Care Act, by contrast, might fail in November, but if it works come December, or January, it can go on to be a hugely successful, popular program.

There's no guarantee, of course, that that'll happen. But the underlying dynamics between the two programs are very similar. The underlying dynamics between Obamacare and a category 3 hurricane are not.

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Dylan Matthews · November 18, 2013