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Posted by on Nov 1, 2013 in Featured, Health, Politics | 15 comments

Plenty of time to fix Obamacare

Daryl Cagle,

Daryl Cagle,

WASHINGTON — It takes chutzpah, or perhaps just an extraordinary lack of self-awareness, to argue vehemently that a program should never be implemented — and then complain it isn’t being implemented well enough.

But that seems to be the new Republican position: We want the Affordable Care Act, and we want it now.

Given that House Republicans have voted dozens of times to repeal Obamacare, you’d think more of them would be cheering the “debacle” of a barely functioning website that keeps people from signing up. Instead, they demand to know who is responsible and insist that heads should roll.

The sense of urgency surrounding the program is palpable — and largely artificial. The Obama administration royally screwed up the launch, no question about it. But there’s time to get it right. Plenty of time.

The real deadline for creating a sleek, seamless, customer-friendly website allowing people to buy insurance through the federal exchanges isn’t three weeks or even three months. It’s three years and change — the time President Obama has left in office.

The Affordable Care Act will remain the law unless its opponents win veto-proof majorities in both houses of Congress. With the GOP’s approval numbers essentially down to friends and family, a landslide victory in next year’s midterm election seems unlikely, to say the least. This means that as long as Obama is around, his eponymous health care reforms will be around, too.

So everyone can take a deep breath and calm down. The state exchanges are working fine. The first task with the federal website is to make sure the flow of information to and from insurance companies is reliable and accurate. This whole scheme doesn’t work unless insurers know whom they are insuring.

As far as the user experience is concerned, the goal right now should be to make it easier for people to do comparison shopping before the system insists on trying to verify their life stories. By the time applicants have made their decisions and are ready to buy, the website will probably still be clumsy and aggravating. But engineers should have applied enough duct tape and baling wire to make it at least functional.

Meanwhile, there ought to be a separate team working on a whole new website with different architecture. I say this as a non-techie who has only a vague notion of what “architecture” means regarding computer systems, but who knows a total lemon when he sees one.

“Hold me accountable for the debacle. I’m responsible,” said Health and Human Services Secretary Kathleen Sebelius as she faced House inquisitors Wednesday in the first of what surely will be many investigative hearings.

Indeed, Sebelius must shoulder most of the responsibility for the late-night punch line that is It’s shocking that the website was made operational — or, in this case, non-operational — with so little testing. It’s even more shocking that the little testing that was done indicated there would be problems, yet the whole administration seemed unprepared when the predicted problems appeared.

But there is plenty of blame to go around. Some of it must fall to Obama, who hurt his own cause by making categorical statements about the program that were not categorically true.

He said many times that Americans who are happy with their current health insurance can keep it. This is true for almost all the insured — almost, but not quite. Of the 19 million people in the individual-insurance marketplace, estimates are that at least half will not be able to keep their policies because they do not meet the Affordable Care Act’s standards.

There are good reasons why. Many of these policies offer little coverage and impose substantial out-of-pocket costs that discourage regular doctor visits. The Affordable Care Act exchanges and subsidies will offer many people better insurance at a lower cost.

Still, it was careless, at best, for Obama to make that unqualified keep-your-insurance promise — and make it so many times — without explaining the fine print. So now, he not only has to convince people that the website will eventually work. He also must counter his opponents’ allegations that he was less than honest about the true impact of his signature domestic accomplishment.

The word debacle does fit the rollout. But the policy itself is sound, and eventually all the noise will fade. The first weeks of Obamacare will be forgotten. The first months will become a footnote. The first years are what will matter.

Eugene Robinson’s email address is [email protected] (c) 2013, Washington Post Writers Group

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Copyright 2013 The Moderate Voice
  • lilbear68

    never enough time to do it right, always plenty of time to fix and re-fix it

  • sheknows

    If these software companies were conducting a nationwide roll out for say, Donald Trump, they would be sued out of existence by him I’m sure.

    As for those who cannot keep their insurance, Obama should have been very specific about that, telling them that if their policies did not meet coverage standards, they would not be allowed to keep them…..oh wait, I seem to remember someone saying exactly that months ago, but not the president. I believe it was a panel discussion on MSNBC. The reason I remember it is because it would affect my friends daughter.
    Obama blew it. He either didn’t read his notes correctly, or didn’t have the correct notes to read at the podiums.
    At any rate, panic inducing articles aimed at those who were coverage deficient and have lost their insurance are designed only to create more disapproval and fear.
    Funny thing about healthcare systems lilbear68, there is ALWAYS room for improvement in this country, so fixing and ref-fixing is welcomed.

  • DaGoat

    Obama blew it. He either didn’t read his notes correctly, or didn’t have the correct notes to read at the podiums.

    SK, watch the video below, it’s only a minute and a half. Obama’s trouble isn’t that he doesn’t read the notes correctly, it’s that he does. Maybe if he’d used some judgment about what he was saying he’d have been more honest.

  • DORIAN DE WIND, Military Affairs Columnist

    Nevertheless: Obama did knowingly make an overly simplistic guarantee to the American people that Obamacare wouldn’t affect their current plans. And as this video compilation shows, he made this guarantee over and over again.

    I like this verdict — “making an overly simplistic guarantee” better –(from the same linked story) than “he’d been more honest.” The latter smacks too much of “lying” which I do not believe is the case.

  • sheknows

    Thanks for the link DG, but the implication is one of deliberate deception as opposed to misinformation for the people.
    I grant you, he blew it. If the panel on MSNBC had researched it before their discussion, I think he could have appointed people in his office to do at the the same.
    ( I guess it’s too much for us to expect that he memorized all 600 pages) 🙂

  • brcarthey

    Let me apologize if I get snarky at all during this post. My reason for the snark towards all the people complaining are two-fold: 1. I have a pre-existing condition that allowed insurance companies to previously discriminate against me; 2. Due to so many un-insured people using the ER as their primary care centers (which, by the way, charges double the rate of a normal primary care office visit) and then not paying for it, the rest of us wound up picking up the tab in both higher medical costs and higher insurance premiums. So, if about nine million people are forced to pay a little extra, which they will get reimbursed for on their tax returns, you’re going to have to give me better reasons than what I’m reading on the internet. If people are seeing their private policy premiums getting jacked up significantly, why not go and get a new policy in the ACA marketplace? We do it for so many other things: cell phone plans, car insurance, home insurance, grocery shopping, etc.

    According to Jonathan Gruber, the MIT professor who oversaw the Massachusetts Health Reform back in the ’90s, he told the New Yorker that “it’s only a small percentage (3 percent, to be precise) of Americans who you can really argue might at least potentially get screwed.”

    He further broke down the “winners” and “losers” thusly:

    The 80% will be more or less left alone by the health-care act—largely people who have health insurance through their employers. (The Kaiser Family Foundation puts it at 79%.)

    The 14% that are currently uninsured and will have access to an affordable insurance policy under the A.C.A. (Kaiser puts this group at 16%).

    The three percent who will receive a cancellation letter and can enroll in a new plan that is very similar to the one they had before.

    The three percent who will have to buy significantly different plans, many of whom will have to pay more for them. However, that’s before the law’s tax credits and other financial assistance kick in. The primary reason that plans are being canceled is that they don’t comply with the ACA’s requirement of 10 categories of care (known as essential health benefits) be covered. Plus, 40% to 67% of these policies were purchased and in effect for one year or less. Meaning, a lot of turnover already existed before the ACA.

    The KFF doesn’t break out the last two groups, but says combined they only account for five percent. Now, what does the “loser” group get in return for their increased rates? We all know it’s going to be better coverage, but what exactly does that entail?

    Back in December 2011, the administration released a report that explained how well the individual insurance market covered those essential benefits. It found that the reasons these policies are being cancelled are due to one or more of the following:

    *62% didn’t cover maternity care
    *34% didn’t cover substance abuse services
    *18% didn’t cover mental health services
    *9% didn’t cover prescription drugs.

    Plus, there are also no annual caps and no lifetime limits under the ACA, which almost eliminates the risk of going bankrupt because of medical costs in a way that didn’t exist before the law. That’s why many experts have said that to try and compare pre-ACA policies with post-ACA policies is ludicrous because the post-ACA policies are much more robust. Furthermore, no one has done any analysis of what people who had their policies cancelled will be paying under the ACA because there’s no way it can be done with any modicum of accuracy.

    To close this out, again 97% of Americans are either left alone or are clear winners, while 3% are arguably losers. As Gruber said in the article, “We have to as a society be able to accept that. Don’t get me wrong, that’s a shame, but no law in the history of America makes everyone better off.”

  • DaGoat

    To close this out, again 97% of Americans are either left alone or are clear winners, while 3% are arguably losers.

    You can express this in different ways. You could say of the people affected by the ACA 15% are losers. Or you could speak in absolute numbers and say 9 million people are losers, which is more than the population of New Jersey.

    Obama was not straight with us making his claims. If he made a guarantee he can’t fulfill he should say so. Instead he tried to make it sound like all the policies cancelled would be garbage policies, something that isn’t true. He is basically doubling down on his previous erroneous statements.

    If people want to claim there have to be some losers in order for the ACA to work then that is an honest approach, something the Obama approach is not.

  • sheknows

    NO DG, that is simply not the case.
    It sounds as though you would rather NOT have ACA in our society and continue on just as we have been. It sounds like, you are in favor of keeping those ER’s jammed with insuranceless people, and making certain that people with pre-existing conditions will be kicked to the street…if poor, receiving no treatment, if wealthy, using up every last dime to stay alive.

    All of your arguments against ACA are , IMO, directed at Obama, and nit-pick every detail. But it is clear, you are one of those who wish we did not have ACA in this country, and will continue to fault find and complain until like Medicare, it becomes commonplace. Just my take on your attitude…but I could be wrong. I hope so.

  • DaGoat

    SK once again you want to focus on me instead of my post. If you disagree with what I posted please say why.

    I’d refer you #4 in the commenting rules above.

  • brcarthey

    Hi DG. I’m not sure where you’re getting the 15% figure. Could you help me out?

    I think the only sin embedded within the administration’s explanation of people affected and unaffected were that they failed to account for are those that would be dropped because their current policies did not meet the new guidelines. Now, one could argue that they had those policies because they wanted the bare minimum coverage, kinda like the driver who drives with little to no car insurance. But, when an accident happens the other person(s) is (are) left holding the bill, in both instances: medical and driver’s insurances. So. in that sense, I guess the President was at fault for not saying more clearly, “Hey, we won’t be able to stop insurance companies from dropping you or canceling your crappy policy if they don’t meet these new guidelines. However, that’s the only reason you will not be able to keep your current policy. Otherwise, if it’s a sound policy, you can keep it as long as you like.”

    Again, if three to six percent of the population is inconvenienced so that almost 20% of the rest of the population can be covered (many for the first time ever), oh well. To quote Spock, “The needs of the many outweigh the needs of the few.”

    Taking it further, conservatives (and previously liberals) in many cases seem to sacrifice any and all legislation unless it is 100% perfect, which is impossible when every representative and senator seems to have a different definition of perfection.

  • DaGoat

    Hi brcarthey,

    80% of people are not affected by the ACA at all. Of the remaining 20%, 15% of those will be affected negatively. Since the 80% aren’t affected at all, let’s take them out of the equation.

    On the plans that do not meet the new guidelines, some of them are “crappy” but others don’t meet the new guidelines because they fail to meet the new wellness guidelines or have higher deductibles than the ACA allows. Here is a link (to!) that details the wellness requirements:

    I currently have a high-deductible policy through BC/BS that does not meet the wellness guidelines. It is not a “crappy” plan, it is a sound policy and I am happy with it. I likely will lose it and be forced to buy a more expensive “better” plan. This is counter to Obama’s repeated comment “If you like your plan, you can keep it”. And frankly even if someone had a crappy plan they should be able to keep it if Obama was being honest.

    As I alluded to above your comment “the needs of the many outweigh the needs of the few” is an honest response and legitimate reasoning. It’s not what the Obama administration has said or is saying though.

  • DaGoat

    Here is an article by David Frum on his experiences getting his policy canceled:

    This is his conclusion: Self-employed professionals who earn too much to qualify for ACA subsidies will soon discover what I have discovered: They are paying more for a worse product.

  • sheknows

    Hi DG, Sorry I perceived what you said negatively. You seemed to exude more attitude than seemed necessary in explaining your position. 🙂

    As for David Frum, Really? Aside from the fact that he couldn’t be more right wing, his testimony about his insurance policy say several things. First, It says he had a really crummy policy if it was cancelled due to not meeting basic coverage needs. Then he claims he had to pay more. Well, yes, if you get a better policy with better benefits, it does cost more.
    He gives no information of either the policy he had and it’s details, or the policy he replaced it with and it’s details.
    IMO, it is just another Rep rant about the evils of ACA.

  • brcarthey

    Hey DG, now I understand what you meant by the 15%. 🙂 I agree that the statement was too broad based, but as you see now with how Republicans on the Hill are making so much hay out of these “three percenters” (15%), if Obama had ever tried to say any thing short of that blanket statement I doubt we would have gotten even this far in heath care reform, all because Republicans would be defending these 7.5-9 million people at the expense of the other 40+ million.

    I can understand your frustration with the possibility of having your policy cancelled because it does not meet the wellness guideline. So, even though on its face your policy does not fall into the “crappy” category I was alluding to yesterday, there are two things which may, in the long run benefit you besides having a wellness facet within your plan: no annual or lifetime caps should you get seriously ill and need long-term treatment; and they can’t drop you for any reason should you develop a serious illness. Furthermore, the ACA bans any plan that would require a person who gets sick to pay medical fees greater than six thousand dollars per year.

    Now, I don’t know if that’s going to all hold true once everything kicks in under the ACA. The problem is is that no one else does either. Yes, I realize some people say they are getting hit with higher premiums and deductibles right now, but that’s also because until 2014 insurance companies can get away with that as I read the law.

    I know I’m not going to change your mind about the evils of the ACA or that it can really benefit most of pus in the long run. However, I would hope that it could at least be mitigated that your present inconvenience could very well help so many millions of others in the near and long-term future.

  • DaGoat

    Brcarthey, your arguments make sense. What you are saying is that Obama couldn’t tell the truth otherwise the plan wouldn’t have gotten passed. My feeling is that if Obama couldn’t tell the truth about the plan, maybe the plan wasn’t worth passing. We should expect honesty whether the President has a D or a R after their name.

    I don’t think the ACA is “evil”. It was written with the best intentions but is heavily flawed. To repair those flaws it needs to be presented honestly, something you are doing a much better job of than our politicians.

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