November 02, 2013

Night of the (Obamacare) Demons

To be clear at the outset, I strongly support the objectives of the Affordable Care Act (ACA - "Obamacare") especially in terms of the goals of stopping long-standing insurance company practices of refusing to insure persons who weren't completely healthy -- and dropping them as soon as they became ill.

The lack of any kind of universal health care coverage here in the USA not only makes us essentially unique among developed countries, but a laughingstock of the planet. If you're rolling in dough, the US may have the claimed "best health care system in the world" -- but only by leaving vast numbers of persons behind and runaway costs that keep the lucky practitioners of the medical-industrial complex happily shopping at the local equivalents of Rodeo Drive in Beverly Hills.

Drug costs here are often obscenely more expensive than in the rest of the world, to a degree that seems no less than criminal. Lack of routine health care means that people don't get help until they're so sick they are often beyond help, and hospitals rake it in at emergency rooms and stick every taxpayer with the cost of uncovered persons who couldn't pull a wad of Franklins out of their pockets while being wheeled in.

The US health care and medical insurance system has become a bloated, middleman-laden nightmare.

The right way to fix this, of course, would have been with a single-payer system of some sort, as used in most of the world. Not perfect by any means, but the results speak for themselves when you see how far down the ladder the US is in terms of most health care outcomes compared with other countries (we pretty much rate as a third-world nation in key respects in this context).

But single-payer would likely cut out the insurance companies, who have paid their politicos the big bucks for many decades to make sure they remained entrenched. And naturally, single-payer would also trigger calls of SOCIALISM -- you know, like, uh, Medicare.

So we find ourselves now in the cusp of ACA -- a plan that seems to have been designed to encompass both lofty goals and the most abysmal details and implementations pretty much imaginable.

There are so many reasons for this mess, and so many people to blame, that I won't even try to get deep into this aspect.

But we know that the GOP and their masters in the "We gotta stop that uppity black Kenya guy claiming to be president" Tea Party Confederacy ("duh South will rise agin'!") did everything they could to stop, repeal, damage, thwart, and otherwise spit on ACA and all the people it could have helped. GOP governors made sure they waited until the last minute to officially proclaim that they were going to screw their own states' citizens by dumping them onto the federal insurance exchange, while related rules and regulation kept morphing and piling up until the last minute, making implementation a continuously moving target.

To be sure, we can't blame the GOP and their monstrous allies for the entire situation. Democrats -- as usual -- didn't have the backbone to push for the changes really needed -- like single payer. And their pockets have also been lined with insurance company moolah pretty much forever as well.

Federal procurement policies, seemingly written in such a way as to make the probability of any large information technology project failing horribly as lofty as possible, have done it yet again this time as well, making the federal ACA site a predictable disaster from the word go -- in terms of design, load, performance, security, and ... well, you know the drill. I've been working with IT one way or another my entire adult life. I've never seen such a godawful mess before. And I've seen some pretty impressive messes.

But even many related non-governmental sites are currently hosed. You can't get into the websites of many major insurance carriers today -- they're so badly designed and overloaded, often saturated with elementary coding and interface errors. Redirects lead nowhere. Single pages try to serve three megabytes of text, grinding browsers into the dust. It goes on and on.

And since I'm concentrating on mostly technical issues here -- which in theory can and will be fixed eventually -- I will but mention in passing the utterly confusing and panic-inducing framework of policy and fee changes associated with ACA, enough to make many individual insurance buyers who don't get insurance from employers more likely to have a stroke on the spot than anything else.

Ironically, it is possible that if all this were working right, the actual benefits of standard plans and premium subsidies would put many people in a better position than they were pre-ACA, no doubt about it. But the reality for now is that the entire system is largely in extreme disarray, and even after the reported nearly half a billion lines of code are working more or less properly, some people are still going to be royally burned by the insurance companies who managed to keep themselves firmly in the catbird seat under the new regime.

Some of the best technical minds on Earth have now converged to try get the federal ACA website working by the end of this month -- they'll likely succeed in some significant measures at least.

But the sense of utter and total confusion among persons most affected by these changes is palpable, and when you combine this with the currently mandated penalty regimes for not having insurance and all the other complicating factors, the possibility of a technical and policy implosion of a magnitude never before seen in US government history seems very real.

And here's the worst part. There's really comparatively little that can be done right now to avoid potential disaster that isn't already being done. The die is cast. Supercilious "eat the poor" monsters like Ted Cruz have performed with their usual hideousness in furtherance of their hopes that all we "little people" go splat against the wall at lightspeed.

Yet hope springs eternal, even in the face of these kinds of obstacles and odds. The websites will be fixed eventually -- to some level of practical usability anyway -- and continuing pressures may force delays and changes in a variety of associated rules and regulations.

And one thing -- a very positive aspect at that -- is utterly clear amid this Kafkaesque landscape.

There is no going back to where we were. The days of insurance companies dropping the sick and only being willing insure the healthy are gone in this country forever.

There is thankfully no return possible to that particular inner circle of hell, and even if the best we can do in the short term with ACA is push out a few notches to less punishing circles we'll still have the last laugh against the evil players who wish to drag us back into that pit.

Who knows? In the long run, we may even escape insurance hell entirely, and prove that our legislators care as much about the people of the USA as they do global geopolitics and caviar.

But don't hold your breath.


Posted by Lauren at November 2, 2013 02:05 PM | Permalink
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