Friday, November 8, 2013

Your Parrot Is Dead

There is a small silver lining to the problems that have plagued the rollout of America’s new healthcare exchanges. It has made me feel somewhat better about the Irish healthcare system.

Granted this silver lining is pretty limited and doesn’t apply to the vast majority of Americans, but it’s something.

As someone who wanted to see the U.S. healthcare system reformed to be more affordable and universal but who saw Obamacare as making the problems worse, I could probably be expected to be saying, I told you so. But I can’t. My problem with the Affordable Care Act was that it nearly seemed deliberately designed to make health care more expensive without necessarily expanding it to that many additional people. It never seriously occurred to me that the federal government, with well over half a billion dollars at its disposal, would be incapable of building a viable web portal.

The whole rollout of seems like a classically wicked Monty Python sketch. The chronic political kibitzing, the vendors with no incentive to be efficient because they bill by the hour and the reflexive CYA among various levels of management all bring back vivid memories of my days in the software industry. This kind of mess is endemic in all kinds of large enterprises without clear and strong management—not just the government. But nowhere is it more pervasive than in the federal government, where no one ever seems to be responsible for anything when things go pear-shaped—the pending resignation of the CIO of CMS notwithstanding.

That doesn’t mean that government cannot do anything competently. I have been annoyed at various people comparing the healthcare exchanges to “the DMV.” Personally, I have no complaints about my acquisitions and renewals of driver’s licenses over many years in the states of California and Washington or even in Ireland. And I have done business for years with all kinds of government websites that have worked perfectly well.

In a strange way, the brouhaha over the website—and even the stories about people having policies canceled—may actually be good news for the Affordable Care Act. As long as people are talking about those things, nobody is talking about the real problems with the law, which will become apparent much more gradually than a botched website launch or anecdotes about policyholders being dropped. Those problems can, and probably will be, fixed. What will be more entrenched is the fact that the new healthcare system will have a lot of inefficiencies and waste built in.

The Affordable Health Care Act is perversely named because, as currently devised, it cannot help but raise the cost of health care. This will probably show up over time in higher premiums for everyone and, the more the government tries to combat this with subsidies and Medicaid coverage, the more the costs will be converted into long queues for care and, ultimately, rationing. Maybe fewer people will show up at emergency rooms because of not having coverage, but more are likely to show up because they don’t want to deal with the hassle of getting in to see a GP or scheduling time in a hospital.

There are some ironies in the way things have played out so far. One is hearing Democrats defend the law by noting that the exchanges in least some of the states are working much better than the federal one. Doesn’t that vindicate failed presidential candidate Mitt Romney, who said that this kind of system should be run by states and not by the federal government?

Another irony is that Democrats up for reelection next year are reportedly pressuring the administration to agree to delay the individual mandate for a year. Isn’t that the very same offer Republicans made to Democrats to avoid the government shutdown—after their initial demand to defund Obamacare went nowhere? If the individual mandate does get delayed, it will mean in hindsight that Democrats could have avoided the shutdown by admitting to Obamacare’s problems just a bit earlier. Now, for Democrats to get the delay they may well have to deal with Republican demands for other concessions to go along with it.

Things could still turn around on this issue for the Democrats, at least in the short to medium term. If the administration can get its website working reasonably well, the media narrative could go from debacle to turn-around. Stories about low-income people getting subsidies could eclipse those of middle-class people getting saddled with higher premiums—at least for a while.

Barring that, the president’s party will have little choice but to double down on its fallback strategy, i.e. heap as much blame as possible on the insurance companies and on “sabotage” by Republicans who, voters will surely remember, opposed the law unanimously and consistently from the very beginning.

No comments:

Post a Comment