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Obamacare and oversight

Affordable Care Act (Obamacare)MedicineU.S. CongressMedicaidFitnessMedicare

We don't know what kind of TV ratings the House Energy and Commerce Committee might have drummed up during its more than four hours on C-SPAN today, but we suspect they couldn't have been high. Surely, only a few minutes of testimony about the Obamacare website was all the average viewer could tolerate without leaving in disgust.

Bad enough that the panel of private contractors working for the federal Centers for Medicare and Medicaid Services (CMS) didn't have particularly good answers for many of the website's initial woes, but it was difficult to even determine who was responsible for what. Who knew, for instance, the difference between a website's "front door" versus its "face?"

Making matters worse, of course, was that once again anything involving the Affordable Care Act got the usual treatment by members of Congress, which is to say Republicans got highly outraged and many Democrats (although not all, mercifully) got highly defensive. We won't say we're shocked that a Congressional hearing generated more heat than light, but the theatrics were particularly difficult to bear given the importance of the topic.

It is not Congressional oversight for some people to pose stilted, grandstanding and often obscure questions (some involving patient confidentiality of all things) that are clearly aimed at playing to their political base and not actually investigating anything. Those Democrats who used their time as apologists and sought only to defend the goals of the ACA and trumpet its successes are not really any better.

Can't we all agree on one thing — that the website, HealthCare.gov, has been an embarrassing failure so far and the federal government ought to be focused on fixing it? President Barack Obama has already admitted that mistakes were made, so why can't we have a productive conversation on Capitol Hill about what went wrong with the computer programming aspect of Obamacare and what should be done about it?

We don't recall hearing such flapdoodle when there were problems with the initial rollout of Medicare Part D prescription drug benefit in 2005. People were leery of that government program, too, and there were even technical problems (although they involved call centers, the Neanderthals) but there was also bipartisan support for getting it to work right. Today, that benefit is greatly appreciated by seniors, and it's difficult to imagine, given the cost of some prescription drugs, how millions would have managed without it.

This looks to be fixable. States like Kentucky appear to have done fine with their websites. Indeed, if more states had opted for state-based insurance marketplaces (not to mention the federally-funded expansion of Medicaid eligibility), the situation would be better.

But we can't say we know, at least based on what was said during the hearing, exactly what needs to be done. Maryland's own Rep. John Sarbanes came close when he reminded witnesses that "we have problems here that need to be addressed," but he fell short of investigating whether the contractors or CMS are going about these fixes in the correct way.

Perhaps that's something a congressional committee is simply incapable of doing. These are highly technical issues involving a highly ambitious undertaking, and layering politics on top of it makes it all the more difficult to comprehend. The only thing that's clear is that the website — and only the website — isn't working well, and if it's not fixed soon, certain deadlines for signing up for private insurance under Obamacare may need to be pushed back.

Eventually, it would be nice to know exactly what went wrong. It could well be this will someday serve as a case study for the failings of government contracting in general (which tends to reward companies for understanding the complexities of government procurement rather than being leaders in their field), but even evidence of that seems muddled.

In the meantime, the few Americans who might actually have watched this exercise can only conclude that Congress, or at least one House committee, is wholly incapable of conducting a fair and impartial oversight of Obamacare. Either one party is shutting down the government and risking default over it or the other is showing relative indifference to its obvious failings. All of which only lends credence to H.L. Mencken's observation that Congress is composed idiots and scoundrels but mostly cowards.

Copyright © 2014, The Baltimore Sun
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