Once the prescription benefit law took effect, attention suddenly shifted from a general philosophical debate over government's role in subsiding health care to a discussion of costs and benefits of the new program, said Mark McClellan, who ran the Medicare program in the Bush administration and oversaw the prescription-drug rollout.
Despite the rocky start, most problems were ironed out during the first year, McClellan said in an interview. Obama's program, with far greater scope and more moving parts, "is going to take at least a few years, not just one. There are still bumps in the road," he said.
Any advice for the Obama team? "I think the most important thing is to make this as practical and easy for people, put in direct terms that matter to them," McClellan said, adding that despite its shortcomings, Obama's plan offers "more opportunity for people to get into coverage that actually works for them."
"Big change is unnerving, it's troubling. And it gets almost as big as it can be when you get into health, which virtually affects everybody," said presidential scholar and historian Stephen Hess, who's worked for four presidents and has seen many shaky program debuts up close.
Despite rough beginnings for such programs, he said, they mostly "got improved over time, either legislatively or in terms of regulation or simply knowing how to organize a program." Obama should realize that "this too shall pass. Wait it out and correct things as you can," Hess said.
Of course, success stories from Social Security to Medicare prescription drugs represent the survivors -- not the failures.
One that completely blew up is the Medicare Catastrophic Coverage Act, which had broad bipartisan support when it was enacted in 1988 and signed into law by President Ronald Reagan.
Intended to provide new medical benefits for the elderly, including expanded payments for nursing-home care, the program also imposed staggering new costs on those it sought to help -- an extra monthly Medicare premium and a surtax for people over 65 with incomes above $35,000. The law was repealed a year after its passage, after angry seniors launched nationwide protests.
Several other ambitious health-care overhaul proposals never became law. President Bill Clinton's big 1993 effort -- the work of a study group headed by his wife, Hillary Rodham Clinton, and dubbed "Hillarycare" by foes -- failed to win congressional support. Same with Bush's 2004 re-election proposal to allow younger workers to invest part of their Social Security tax payments in stocks or other investments.
Many big social programs have rocky rollouts because the government is basically not good at setting up such complicated enterprises, suggests Paul C. Light, professor of public service at New York University.
Washington "designs these complex programs and doesn't ask about delivery, how they will be carried out," Light said. "Obama is keeping his fingers crossed that he can get through the next two years and bequeath implementation to somebody else."
White House spokesman Josh Earnest acknowledges a need "to iron out the kinks" but insists that the new program's "trajectory is moving in the right direction."
As of Dec. 21, more than 1 million people had signed up for private health plans in the exchanges created by the law -- a long way from the 7 million the administration projects by April 1.