Obamacare is on a Different Path from Medicare Part D

Thursday Ezra Klein once again compared Obamacare’s unpopular rollout to Medicare part D. While it’s true that part D was unpopular and that Obamacare could one day surmount its image problems, Klein continues to gloss over the significant differences in the enrollment response to the two programs. Klein writes:

Obamacare could take a different path. But we won’t know that until the
individual mandate actually begins to bite in 2014. Past experience with
these kinds of programs suggests people say they won’t sign up until
the penalty looms and they do.

Klein has actually written this entire post once before. Back on Dec. 9th he wrote a piece with the same polling results and the same quote from Marc McClellan. Back then, Klein claimed, “with these kinds of laws…enrollment begins as a trickle and spikes at the end.”

That wasn’t true as I explained here and here in some detail. Medicare part D enrollment started strong (over 1 million in the first 28 days) and remained fairly steady over the entire enrollment period.

The revised claim (block quoted above) is more carefully worded but suggests the same thing, i.e. people don’t sign up for “these kinds of programs” until the deadline. So once again let me point out that was not the case with part D. Here’s how it looked (dashed red line). Note this is a trajectory based on percentages, not a graph of raw numbers.

The solid yellow line at the bottom is Obamacare. It’s already clear that Obamacare is not taking the same path as Medicare part D. People are not signing up at anywhere near the expected numbers, much less surpassing the goals as part D did.

Yes, Medicare part D did become more popular over time. Yes, Obamacare might also. But at this moment using one as reassurance for the other is based on nothing. There’s no connection between the actual behavior of the two policies at this point. On the contrary, the graph shows a clear disconnect in their performance, something Klein would surely be pointing out himself under other circumstances.

It really is possible Obamacare will have a happy ending. Klein is right that nothing very significant is likely to change before 2016. That’s a lot of time to keep tweaking things until just enough people are happy. But if Obamacare succeeds it won’t be because it behaved just like part D. It certainly hasn’t done so thus far.