Talking about the Emperor’s Clothes: Causes and Consequences of Healthcare.gov’s Problems

Healthcare.gov’s disastrous launch has left me, as an Obamacare supporter, feeling dismayed and even betrayed. Sure I expected problems at the start. What new IT system doesn’t have problems? And the task involved—coordinating data from the IRS, a slew of private insurers, state Medicaid programs, and so on—was known to be no small feat, much more than private e-exchanges have to do.

But after last Thursday’s Congressional testimony, we know that it’s much worse. The main contractor for the back-end said, “our portion of the contract worked as designed.” All the contractors said their job started and finished with contract specs. Whether it works with the other parts was someone else’s problem. The government, the Center for Medicare and Medicaid Services, ostensibly in charge of putting the whole thing together, did not test the whole system until two weeks before the Oct. 1 launch. Anyone (or at least anyone who ever tried to get their iTunes purchases onto a non-Apple device or vice versa) could have seen the need for that test much earlier. Such seemingly willful incompetence shocked me, because it was so unlike my own knowledge and experience of the competence of the legislation and its implementation. As I taught about the legislation last Spring, I kept being impressed that various fixes and features dealt with potential problems.

What explains the chasm between the IT and the reform design? Much alludes me, but it is clear that Obamacare’s IT had nothing like the time or talent that that the reform design had. That is bad news for the website—long term as well as short term. But it is good news for the consequences of the disastrous web site launch. As Adriana McIntyre explained, various features will protect us from death spirals and other potential disasters.

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Republicans for Government Subsidized Insurance

Congressman Steven Palazzo, Republican of Mississippi, has proposed an amendment supporting Federal government subsidies to insurance: “We have one common goal—to make sure that insurance remains available and affordable to everyone.

No, the ardent Obamacare opponent has not been bewitched by a Democratic spell. I left out of his statement one key word: “flood.” It is flood insurance that Palazzo considers essential and worthy of government subsidies, not health insurance. In fact, he finds it so essential that neither likely-to-balloon expenditures nor damaging distortions to insurance and real estate markets dissuade him.

Flood insurance subsidies are now being reduced—sharp premium increases began on Oct. 1. Palazzo’s and other Republicans’ opposition shows that they are not the anti-government ideologues they claim—and perhaps aspire—to be. And if they only cared to look, their support for flood insurance could provide a window of understanding into the reasons for Obamacare. Continue reading

If My Health Plan Died, Did Obama Lie? Sort Of, But It Died For a Good Cause

Right-wing pundit Michelle Malkin’s insurer has canceled her health insurance plan, due, they say, to the Affordable Care Act (aka Obamacare). She quotes Obama, “If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.” Malkin concludes, “Obama lied. My health plan died.”

Did Obama lie? Yes—and no—and yes. But Malkin fails to admit that her plan died so that people like her could be protected for life. Period. No matter what medical tragedy might occur.

In some sense, what Obama promised was obviously impossible. Millions of Americans have experienced the end of their health plan—or major changes in it—even without health care reform. Insurers (and employers) change their plans because of recessions, rising medical care costs, hospital mergers, and such. In a market, companies react to market forces. Continue reading

You can’t have it both ways: Taking from the rich to buy health care

Three and a half years after Obamacare passed, three weeks before the Exchanges go live, and coinciding with their 42nd attempt to destroy the law, House Republicans have an official alternative to Obamacare. In fact, Republican Congressman Tom Price, already had a proposal. But a key change from that proposal—eliminating tax credits in favor of only tax deductions—is revealing. It shows that House Republicans are unwilling to take from the rich and therefore unwilling to ensure that all Americans get modern healthcare.

Our biggest problems with health insurance come from something really good—the great stuff health care can do. Continue reading