Health Care

Building the airplane during takeoff.

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Henry-Chao

UPDATE: The Wall Street Journal on how to fix the Obamacare crisis.

What can be done is Congress creating a new option in the form of a national health insurance charter under which insurers could design new low-cost policies free of mandated benefits imposed by ObamaCare and the 50 states that many of those losing their individual policies today surely would find attractive.

What’s the first thing the new nationally chartered insurers would do? Rush out cheap, high-deductible policies, allaying some of the resentment that the ObamaCare mandate provokes among the young, healthy and footloose affluent.

These folks could buy the minimalist coverage that (for various reasons) makes sense for them. They wouldn’t be forced to buy excessive coverage they don’t need to subsidize the old and sick.

Who knows ? Maybe Jenkins reads this blog. It’s so obvious that the solution should be apparent even to Democrats.

We are now learning that a large share of the Obamacare structure is still unbuilt. This is not the website but the guts of the system.

The revelation came out of questioning of Mr. Chao by Rep. Cory Gardner (R., Colo.). Gardner was trying to figure out how much of the IT infrastructure around the federal insurance exchange had been completed. “Well, how much do we have to build today, still? What do we need to build? 50 percent? 40 percent? 30 percent?” Chao replied, “I think it’s just an approximation—we’re probably sitting between 60 and 70 percent because we still have to build…”

Gardner replied, incredulously, “Wait, 60 or 70 percent that needs to be built, still?” Chao did not contradict Gardner, adding, “because we still have to build the payment systems to make payments to insurers in January.”

This is the guy who is the chief IT guy for CMS.

If the ability to pay the insurance companies is not yet written, how can anybody sign up ?

Gardner, a fourth time: “But the entire system is 60 to 70 percent away from being complete.” Chao: “There’s the back office systems, the accounting systems, the payment systems…they still need to be done.”

Gardner asked a fifth time: “Of those 60 to 70 percent of systems that are still being built, how are they going to be tested?”

The answer was the same way the rest was tested.

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Where do we go now ?

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I don’t want to wear out my welcome with posts but this is a topic that has interested me for many years. When I retired from practice, I spent a year at Dartmouth trying to learn how we can improve health care delivery and reduce cost without reducing quality.

The Obamacare web site now has lost its happy photo of the Obamacare girl. The fact that she is a non-citizen seems appropriate. The web site is supposed to be fixed by November 30. Will that happen ? Well, maybe not.

On Friday, the man tasked with the digital fixes said the site “remains a long way from where it needs to be” as more and more problems emerge.

“As we put new fixes in, volume is increasing, exposing new storage capacity and software application issues,” Jeff Zients told reporters on a conference call.

And at Tuesday’s White House Press Briefing, Press Secretary Jay Carney again said there was “more work to be done” on repairing HealthCare.gov.

Carney, along with Zients and other administration officials, have repeatedly said the November 30 deadline is to get the health care website working for a “vast majority” of Americans looking to enroll in the Obamacare exchanges.

So, what happens December 2, the Monday after the “glitches” are fixed ? First, they won’t be fixed. The contractor that designed the program, not just the web site, has a terrible record.

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It Doesn’t Matter

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I see today Diane Feinstein is ruffling her cankles and saying that she wants to force insurance companies to re-adopt programs that they were forced to cancel due to ZeroCare ™.

News flash Diane – IT’S TOO LATE.

Tens of thousands of small business owners like myself (and individuals and other entities) were forced to sign up to new coverage because of time constraints. Our (great) old policy was cancelled, our agents (and Blue Cross) couldn’t get to us with new policies in any sort of timely fashion because they couldn’t figure out what was legal, and what wasn’t. A few weeks ago we had a choice – sign for “this new policy” – with a dramatic price increase, or cut everyone loose to the exchanges (that don’t work) and provide them some sort of stipend.

We can’t just flip the switch back and forth. The real world doesn’t work this way. Ah, who am I kidding. They don’t exist in the real world.

Misunderstanding Self-Insurance

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Listening to Rush today. He is brilliant on politics but not as good on economics.

He was advocating self-insurance for small businesses and individuals, in response to the Obamacare fiasco. He mentioned as an example that he had decided to self-insure a building (I think his home near a Florida beach) in response to his property insurer’s insistence on an extremely high deductible. He also said that he self-insures for medical costs.

Two problems with his analysis. One, property insurance covers buildings and building contents, so liability is easily estimated and is capped at replacement cost. Unlike with medical care there is no possibility of very large, unplanned expenses. Two, Rush is personally wealthy and can afford to pay any medical expenses out of pocket. For these reasons his argument has limited applicability for most people, who buy health insurance precisely because they would be unable to pay an outlier medical bill without experiencing significant hardship. The same point applies to many small businesses as well. These groups thus need real insurance to cover outlier medical expenses. A self-insurance quick-fix would be inadequate.

Obamacare, WWII, and Why Effective Leaders Need Strong Subordinate Leaders

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Over at Sister Toldjah, Phineas cites an email which notes:

Putting things in perspective: March 21st 2010 to October 1 2013 is 3 years, 6 months, 10 days.  December 7, 1941 to May 8, 1945 is 3 years, 5 months, 1 day.  What this means is that in the time we were attacked at Pearl Harbor to the day Germany surrendered is not enough time for this progressive federal government to build a working webpage.  Mobilization of millions, building tens of thousands of tanks,  planes, jeeps, subs, cruisers, destroyers, torpedoes, millions upon millions of guns, bombs, ammo, etc. Turning the tide in North Africa,  Invading Italy, D-Day,  Battle of the Bulge, Race to Berlin all while we were also fighting the Japanese in the Pacific!!  And in that amount of time this administration can’t build a working webpage.

To be fair, the Obamacare support system is more than just a “webpage”…it also encompasses various back-end information-exchange systems. Still, it is a system that did not require the development of any truly new technologies or any conceptual breakthroughs in the use of existing technologies. Compared to any of a large number of WWII technology, manufacturing, and logistics efforts…proximity-fused ammunition, airborne radar, computer-based codebreaking, mass-production of airplanes and ships, the petroleum pipeline under the English Channel…the Obamacare support system is a very small thing indeed.

History and experience teach us that large, complex, time-critical programs only get done successfully when they are run by individuals who are tough-minded, possessed of practical wisdom, and willing to put their careers on the line to accomplish the goal…and when higher authority is willing to delegate sufficient scope and empowerment to such leaders. A couple of years ago, I wrote about one example of such a leader: General Bernard Schriever, who ran USAF ballistic missile programs.

In order to achieve his goal of delivering Atlas and other missile programs in the required time frames, General Schriever found it necessary to break a lot of china. For example, when  Secretary of the Air Force Harold Talbott, ordered him to relocate certain missile facilities from the west cost to the midwest (supposedly based on industrial dispersion for survivability, but actually probably driven by political factors) Schreiver flatly refused, citing his “prior and overriding orders” to get the program done in the shortest feasible time. By then a general, Schriever stuck by his position on this even when Talbott threatened him that “Before this meeting is over, General, there’s going to be one more colonel in the Air Force!”

I don’t think people with strength of character like that of Bernard Schriever do very well in the Obama administration or that they remain with it for very long. A man who can say, as Obama did, “I think that I’m a better speechwriter than my speechwriters. I know more about policies on any particular issue than my policy directors. And I’ll tell you right now that I’m gonna think I’m a better political director than my political director” is a very small man. Small men tend to hire and retain only other small men and women.

And small men and women don’t run large and complex projects effectively.