It's easy to blame a White House that focuses on the big picture but is notoriously lousy at managing the details (think Iraq or Katrina), but Jacob Weisberg says that's only the half of it in a Slate commentary:
It's tempting to conclude that "Medicare D" has flopped because of Republican disdain for government. And that is indeed part of the problem.. . . But in fact, there's an even more basic problem with the Medicare prescription-drug plan that cannot be laid solely at the doorstep of Republicans. Over the past quarter-century, governments the world over have evolved away from statist solutions and toward programs that rely to a greater degree on markets and incentives. This has been, by and large, a positive evolution. In much of the public sector, privatization and regulated markets work well. But the mixed public-private programs now in vogue have a big disadvantage. They are inherently more complex, sometimes so much so that they simply won't take. Whatever the advantages of Medicare D in theory, it has an overwhelming drawback common to all recent presidential proposals for health-care reform: It's too damn complicated.