An emerging theme from Democrats struggling to explain the Obamacare fiasco is that stubborn Republican opposition has hobbled the administration's efforts to implement President Obama's complex national health care scheme. If you want the particulars, just glance at " The Obamacare sabotage campaign" by Politico's Todd Purdum.

But a memo revealed in a new Washington Post examination of the rollout shows the administration was already on a disastrous path in May 2010, just two months after Obamacare was signed into law -- and six months before Republicans won control of the House and more Senate seats in the November 2010 elections. At the time the memo was written, Democrats still had the huge majorities in the House and Senate with which they had passed Obamacare on party-line votes.

In the memo, dated May 11, 2010 and sent to top administration economic official Larry Summers, Harvard professor and health care expert David Cutler, a supporter of the administration's efforts, wrote that "the early implementation efforts are far short of what it will take to implement reform successfully." Cutler continued: "For health reform to be successful, the relevant people need a vision about health system transformation and the managerial ability to carry out that vision. The President has sketched out such a vision. However, I do not believe the relevant members of the Administration understand the President's vision or have the capability to carry it out."

Cutler laid out a set of problems: 1) poor leadership at the Centers for Medicare and Medicaid Services, a key organization in creating Obamacare; 2) clueless management at the Department of Health and Human Services on the subject of setting up exchanges; 3) an ineffective effort to work with insurers in implementing reform; and 4) general incompetence. "The overall head of implementation inside HHS, Jeanne Lambrew, is known for her knowledge of Congress, her commitment to the poor, and her mistrust of insurance companies," Cutler wrote. "She is not known for operational ability, knowledge of delivery systems, or facilitating widespread change."

All that was at a time when the administration had control of Congress. Although the election of Scott Brown had ended the Democrats' filibuster-proof control of the Senate, the fact is, Republicans had no control of anything. Later, after their landslide victory in the 2010 midterms, House Republicans could block funding increases the administration needed to pay for Obamacare's inevitable cost overruns. And Republican governors could make use of a feature Democrats wrote into the law that allowed states to decline to create their own exchanges, leaving the job to the federal government. But Cutler's memo shows the administration was well on the road to a disastrous debut of Obamacare long before Republicans could do anything to make the job harder.





<a href="http://s3.documentcloud.org/documents/814532/181039999-memo-from-david-cutler-on-health.pdf">181039999 Memo From David Cutler on Health Reform Implementation (PDF)</a><br /> <a href="http://s3.documentcloud.org/documents/814532/181039999-memo-from-david-cutler-on-health.txt">181039999 Memo From David Cutler on Health Reform Implementation (Text)</a>