Jonathan Chait has an interesting idea about Obamacare. It is also really dangerous. He suggests that if the websites for the healthcare exchanges are not working properly by December, the federal government should delay the individual mandate for the first year. His argument is that the government shouldn’t penalize people for not getting something that is very hard to get. Fair enough. But my problem with the whole law has always been that the government shouldn’t force people to go to the private health insurance market and pay excessive prices for it. (We pay about twice what people pay for insurance in other advanced economies.) The whole of Obamacare is crony capitalism of the most blatant kind. That too makes getting healthcare harder. But I have seen damned few of my fellow liberals calling for that.
But it is very likely that the administration will have to do exactly that if the websites don’t get fixed soon. The issue is not really the state websites. Covered California seems to be working fine. The problem is with the Republican controlled states where the federal government has to do all the work. So not getting these problems worked out is a major problem. It will only embolden the Republicans to continue their efforts to kill the program with a thousand cuts. What’s more, it will tell the state-level Republicans that they were right to deny federally paid-for healthcare for their current uninsured poor.
Chait’s idea gets even worse in that he isn’t calling for a complete delay in the individual mandate. He only wants to delay it in those states where there is a problem. Again: these are the states where Republican legislatures and governors have not set up exchanges simply out of spite. Chait is offering to give the worst behaved politicians in the country exactly what they want: a delay in the new healthcare law. So what extremist Republicans couldn’t accomplish on the federal level, Chait thinks it is fine to allow them to accomplish on the state level.
The situation is very bad. And the federal government has to fix the problem and fast. It reminds me very much of all the building projects in Iraq after the war. In this case, I really wonder about the contractors that the government hired. My friend Will and I do different kinds of projects: setting up network labs and that short of thing. But it is very easy for us to be passed over for a job because some slick company comes in that spends 90% of its money on marketing. I suspect that the same thing is going on with the Obamacare exchange websites. The truth is that if the government had its own office to do this kind of thing, they’d probably do a great job for far less money. But the trend for the last four decades has been to outsource and that’s a constant problem.
I don’t consider myself any kind of a technical genius, but I have a very clear picture of the technical challenges facing the people working on the system. And they really aren’t that great. Basically, it is just a highly distributed database application. The main problem is making all the different parts work together. It ain’t rocket science. Unfortunately, as I’ve noticed in high tech there is a real prejudice against older techs and against anyone with colorful backgrounds. I’ve had many experiences working in groups where well over half the people were worthless. I’m sure in the bloated consulting firms that the government loves to hire, this is exactly the kind of thing that is going on. But I’m also sure that there are some great people working on the problems.
I think it is way too soon to start talking about granting waivers. What we should be doing is focusing on solving the problem by any means necessary. I really can’t imagine the system being so screwed up that people can’t use it in December—and probably November. And if it does come down to granting waivers, giving them only to the states that have worked the hardest to kill Obamacare is not the way to go. The waivers should go to everyone. Most people without insurance really want to get it. They won’t be doing it to avoid a $95 penalty on 15 April 2015.
I’ve always thought that the ACA was going to be a huge turnoff for people signing up for the first time; whether because they were motivated by the tax penalty, getting to an age where they needed health insurance for their first kid, whatever.
I was at a "benefits seminar" my company mandated the other day, and information about how the ACA instigated tax penalties made the younger people furious. Especially once the details became clear on exactly what our employer-cofunded plan provided (not much) and how often people told stories of the insurer reneging on claims it promised to cover (a lot.)
The older people were generally slightly pleased with the ACA. It can’t make things worse, and allowing pre-existing conditions definitely makes things somewhat better.
Can anyone blame first-time enrollees for sitting back and thinking, "this is Obamacare? I HATE this!" No, one can’t. And that was a beef I had with the ACA all along. I know it’s a marginal improvement, and will help many people. It will turn many people off from government oversight, too. My opinion was that liberals should have held fast to demanding a public option, and if they lost, blame the ever-worsening state of our health insurance system on the politicians who barricaded against reform.
That would have been very harmful to people in the short run. Might it have been better in the long run? I don’t know. But I’ve already started to see what I feared from the ACA (people blaming government regulation for their shitty coverage, instead of realizing the problem isn’t enough regulation) start to come into play.
We’ll see what happens, and, as I always lament, we live in interesting times . . .