brainiac conspiracy

Light Blogging Day

Too busy haggling over health insurance with Covered California. I already sent them copies of my pay stubs for the year, and now they are telling me that those weren't sufficient documentation, and that I need to send a note from my employer verifying my wages. Naturally I'm trying to do this over the Interwebs, but I've spent the last 20 minutes staring at a pop-up window that tells me they're verifying my information. Why oh why does this have to be so goddamned difficult?

Annnnnd . . . just as I was typing this, the Covered CA server logged me out of the system, and I get to start all over again. Well played, Team Democrat, well played.

---Baron V

It's Easy to Fix a Website

But it's not so easy to fix a broken heath-care delivery system. By "broken", of course, I'm not referring to the people who profit from the system as it's currently constituted: Drug companies, HMOs, insurance companies, their executives and their largest institutional shareholders, etc. For them, our health-care system is the greatest! The rest of us, however, are still going to be paying too much money for too little care, even after Goldberg.gov is debugged and running flawlessly, because we still haven't addressed the fundamental reason why our health-care system is so damned expensive: The army of middlemen, insurance agents, underwriters, claims adjusters, administrators, sales reps and CEOs who siphon billions of dollars from the system each year in exchange of essentially nothing. Get ride of the middlemen, and we'll have more affordable heath care.

---Baron V

Still Not Getting It

Maybe the smartest guy in the room, like, isn't:

I continue to believe and [I'm] absolutely convinced that, at the end of the day, people are going to look back at the work we've done to make sure that in this country, you don't go bankrupt when you get sick, that families have that security. That is going be a legacy I am extraordinarily proud of.

You want to prevent medical bankruptcies, you prevent medical bankruptcies. The Goldberg Act doesn't really do much to address this; it only shifts the costs around. Yes, many Americans---maybe even a majority---will benefit eventually from its provisions. But many Americans will not, and will be required to pay more---sometimes, a lot more---simply to access a medical-industrial system that routinely gouges its patients, and which pads its payrolls with thousands of unproductive middlemen. There has always been a smarter, less wasteful option!

---Baron V

Thin Gruel

Wish I could be this optimistic:

[O]ne response I've heard on this front goes something like this: Sure, most of the uninsured will get covered and people with preexisting [conditions] will be protected and you won't be able to be dropped if you get sick but it's just going to be an endless PR nightmare and the Dems will be paying for it in 2014 and 2016 and maybe 2018 and it may 'work' but never be popular.

This doesn't strike me as probable or logical. Over time, if the key market failures in the health care system are removed, I think most people will decide it was a good idea.

But this is a major stumbling block because many of the "market failures" in our health care system---the army of middlemen, brokers, sales reps, administrators and insurance adjusters who siphon billions of dollars out of the system in return for nothing that affects positive health outcomes---are enshrined in the new law. You want to cut health-care costs, you cut health-care costs. The Goldberg Act, by and large, doesn't do that. It forces everyone to patronize a parasitic industry that we really don't need, and transfers billions of taxpayer dollars to that same industry to provide coverage for the working poor. Even if all the cost-sharing mechanisms work, and health-care costs flat-line under the new law---which is a pretty rosy scenario---we're still paying far more for the same (or worse) care than people in any other developed nation. I mean, it's not even close.

There is, of course, a much fairer and simpler alternative that will provide more affordable health care to everyone. It may not be politically feasible now, but it was four years, and it probably will be again one day, and that's what liberals need to be lobbying aggressively for, not resigning ourselves to the idea that the Goldberg Act is the best of all possible worlds, because it isn't. You want to make health care more affordable, get rid of the middlemen and rent-seekers.

---Baron V

Winners and Losers

Why must there always be (sigh) . . . ?

During a meeting last week, officials at Covered California, the state’s much-touted health insurance marketplace, made a pretty stark admission: Half of the approximately 1 million consumers whose health plans are being canceled will pay more under the Affordable Care Act.

They may be a small percentage of the total insurance pool, but next November they will all remember the lovely holiday parting gift that Team Democrat gave to them! It should also be noted that our "successful" Covered California is not exactly a fast-moving train; I set up an account there and applied for enrollment 10 days ago, and up to now, have heard nothing back. Then again, that could be because they are still waiting to hear back from the Social Security Administration, the Internal Revenue Service, the Homeland Security department, the Bureau of Indian Affairs and Experian. I suppose this was all to be expected because, as a rule, Rube Goldberg devices take ten times longer to perform a simple task than, say, actually performing the simple task.

---Baron V

Killing off Liberalism

In the larger scheme of things, the latest Goldberg Act delay probably won't change things much since most small businesses purchase their health-care plans from private brokerages, so the government exchanges probably won't affect them. But the fact that they've had nearly four years to get this right and they still can't get it right suggests that maybe, just maybe, that all of these clumsy snafus are emblematic of a piece of legislation that is, well, a clumsy snafu. Not for everyone, of course---some people will benefit greatly if they can ever get enrolled. Big picture, though, whether it's deserved or not, the Goldberg Act will be associated forever with Team Democrat in particular and activist liberal government in general. If it fails, it will be seen as a failure of liberalism, and that's something that the administration really needed to have thought through when they were planning the rollout.

Then again, maybe they've always wanted to kill off liberalism from the get-go, in which case they're doing a heckuva job, and your humble blogger has been playing for the wrong team.

---Baron V

Taking Credit For . . . ?

Yes, the escalating cost of health care has slowed dramatically over the last five years. So has consumer spending on everything else---because we still have a long-term unemployment crisis.

When people don't have money, they can't afford health care. Make it free at the point of delivery, and people will get the health care they need. Because if you don't, they won't.

---Baron V

Easy to Overstate The Problem

Yes, for tens of millions of people in this country, the Goldberg Act will prove to be be beneficial. But many of these people---the "winners" in this game---don't know they're winners because they haven't been able to enroll in the exchanges yet, or because the law's supporters have done such a terrible job explaining it to the winners. Ahhh, but the "losers"---you know, the ones who got sent cancellation letters, and who are now facing higher premiums---they all know who they are, and that's one reason why it's been so easy to portray the law as an abject failure up to now. First impressions count for something, after all, and since shopping for health insurance is only slightly more pleasant than shopping for a funeral plan, they had to make sure that the online enrollment process was as easy and hassle-free as possible. They didn't do that, so sorry, but failure.

---Baron V

Beside The Point

Of course the insurance companies---or at least, some insurance companies---are going to willfully mislead customers about the Goldberg Act. That's how they make their money---by getting you to believe that they cover certain medical treatments/procedures, then inventing lots of clever ways to not cover them. That's an integral part of their business model, so the administration is kind-of wasting their time---and ours---by trying to persuade bad-faith negotiating partners to behave themselves.

Of course, this is yet another symptom of the Goldberg Act's cardinal weakness: Relying on the people who have created our broken, wasteful and inefficient health-care delivery system---and who have extracted immense profits from it---to solve the very same problems they created. Why should they? What exactly is their punishment if they don't?

---Baron V

Good Analysis

This:

The underpinnings of Obamacare could crumble in a number of ways: if young people fail to sign up for insurance in the droves needed to make the numbers work (and, given the meager penalty for failing to do so, that remains a definite possibility); or if the so-called Cadillac tax on high-dollar health plans scheduled for 2018 never happens (labor unions, among other interests, hate it); or if Congress, at the behest of the industry, follows through on its threat to eliminate the tax on medical devices; or if the long-promised savings in Medicare fail to come to fruition; or if, down the road, a cash-strapped federal government abandons its Medicaid commitments to states.

While describing Obamacare as a house of cards falls squarely within the lexicon of conservative hyperbole, the simple truth is that the Affordable Care Act is, from a certain point of view, either a finely tuned machine whose parts have to work in an almost orchestral fashion for it to produce the wellspring of results that have been promised, or an infernal, jury-rigged contraption that could collapse from the smallest series of stresses.

That's the problem with Rube Goldberg devices: if any single component doesn't work, the entire machine fails. There is an easier, less complicated, and less costly alternative, though!

---Baron V

They've head Nearly Four Years to Get it Right, And The Fact That They Haven't Should Tell Us Something

One of the reasons why Goldberg.gov has been so difficult to access is because so many people have tried to create individual accounts there. Which kinda flies in the face of administration claims that the individual health-insurance market is only a "tiny fraction" of the total marketplace. That might have been true once, but given how many people are unemployed or underemployed and working part-time with no benefits, it's not true anymore. And even if we are "only" five to six percent of the market, in a nation of 300 million that works out to 15 to 20 million people. Worse yet for the administration, many of those people vote, and every time they try to set up an account and get logged off, they're being given another reason to vote for the other guys. That's unfortunate for the Republic since the other guys are, for the most part, insane---but then again, the Goldberg Act was the other guys' health-care policy all along. Perhaps next time we'd consider a liberal alternative?

---Baron V

Perception = Reality

It shouldn't have to be that way, but that's just human nature, so while the tech wizards behind Goldberg.gov will eventually fix the site, the P.R. damage to the health-care law has already been done. Not to mention the actual damage that is still being done by inflicting frustration and aggravation upon people---including some of the Act's many supporters---who've been trying for weeks to enroll and who have been unsuccessful. Not to say, "I told you so," but I think anyone who took a dispassionate look at the way the law was hammered out at the time could have predicted a mess of a rollout because it is a mess of legislation. There are, of course, many good things in it, but also a lot of terrible things, and most of all, no meaningful cost controls on a system that's already bankrupting the Republic and which we are all now forced to patronize. Sure, I'm getting a pretty good deal on my insurance next year, but that's only because I didn't make a lot of money this year. I'm grateful for the help, of course, but poor people shouldn't be the only Americans to get access to genuinely affordable health care.

There is, and always has been, a simple proven alternative, but as with other systemic crises that afflict us, the people who would govern us have refused to even consider it. So, I'm guessing "failure."

---Baron V

Hard to Know How to Interpret This

But if it really is true that the President was deliberately kept in the dark over how his signature legislative achievement was being implemented, you would think some firings would be in order. He's probably stuck with Sebelius because it would next-to-impossible for him to get a replacement confirmed, though I suppose he could get creative and nominate a Republican for the job, and dare the Senate to filibuster him. I don't realistically expect him to do that, but given the policy stakes here, you'd think a few senior-level heads would have rolled by now.

---Baron V

Normally We Wouldn't Care What They Think

But since Team Democrat decided to throw in its lot with private health-insurance companies, it probably bears mentioning that letting us keep our inferior health-care plans for another year---assuming the insurers decide to go along---is probably going to make premiums more expensive for all the healthy uninsured people who are trying to buy policies over the exchanges. It's not the worst that could happen, but it basically ensures that our wasteful, inefficient, too-expensive health-care system stays wasteful, inefficient and too expensive for yet another year.

---Baron V

What Does it Mean Then

Does it means that the cancellation letter I got last week is now un-cancelled? It's complicated!

I still think this highlights---yet again---just how crappy and ill-conceived this health-care law really was. I mean, they've had nearly four years to prepare for the rollout, and they clearly weren't ready, and they're not going to be ready anytime in the foreseeable future. Politically, I guess it's the smart thing to do, but for those of us who are among the cancelled, are we, like, still cancelled? Such needless confusion when a simpler alternative has always been available to us.

---Baron V

Goldberg Agonistes

It's long been a liberal shibboleth that government is capable of undertaking some and big and ambitious projects that are beyond the reach of the private sector. You know, like Medicare and the TVA and the Interstate highway system! The latter-day addendum to this, however, has been that government can do these big ambitious things most effectively if we place our trust in technocrats who are interested only in maximizing efficiencies and who have no ideological axes to grind. Problems arise, obviously, when it becomes apparent that the technocrats don't know what the hell they are doing because it undercuts the argument for liberal governance when what really needs to happen is for liberals to ditch the technocrats. Maybe one of these years, we'll wise up!

---Baron V

Don't Worry. We Got This

It's a great attitude for campaigning, but it's a lousy way to govern:

Insurance industry representatives spoke frequently with administration officials and relayed their concerns with the website, particularly about the transmission of enrollment data to insurers.

“They were told, ‘It’s not a big deal, they’re fixing it,’” one industry source said.

This was the same response health policy experts would receive when they raised any number of issues with administration officials, sources said.

“There was such an environment of don’t do anything that can get bad press,” the insurance industry source said. “That is why nothing was being shared out of CMS. We would share stuff with them. The general viewpoint was---don’t do anything to get any bad press whatsoever. They didn’t create an environment where that would be OK.”

So naturally, they got lots of bad press, and they're still getting it now. Too bad, since the failure of this program to deliver affordable health care---or any health care at all---will be framed in the media as a failure of liberalism and not as a failure of the serious persons who swore up and down that we couldn't possibly have single payer because, well, because. Good luck with those midterms!

---Baron V

Roll of the Dice

One of the biggest frustrations I have with the Goldberg Act is how much of it, in a way, is built on a foundation of sand. What I mean is, the cost-saving mechanisms only function properly if lots of young and healthy people enroll along with all the olds and sicks. If they don't, the model collapses and health-insurance premiums skyrocket for everyone a year from now. So how's it going?

Getting ‘young invincibles,’ as insurers sometimes call them, to sign up for insurance is an uphill climb. Even with the public campaigns, only about one in four 19- to 29-year-olds is even aware of the exchanges where they might buy affordable insurance, and the ignorance is especially acute among the uninsured, according to a survey this year by the Commonwealth Fund, a nonprofit research group.

Sure, there's still time to correct this, and young/healthy people who are very poor may be able to take advantage of the Medicaid expansion (at least in the states where it's expanding). But considering that a 20-something young person making $20K per year only has to pay a $200 penalty instead of $450 a year for insurance (California estimate; other states will likely be more), it's easy to see that a lot of them might choose to opt out of coverage, or at least until the penalties exceed their insurance expenses. Sure, $40 a month for a bronze-level plan is a pretty good deal, but if you have to choose between food and medical care, as many low-wage earners unfortunately do, you can see where this could end up. That's what I mean about the house built on sand---the authors of the Goldberg Act gave themselves (and, by extension, us) little margin for error, and if their estimates of the number of young and healthy enrolling is wildly inaccurate, those of us olds and sicks who are enrolled are going to get regally hosed. Given how good their judgment has been up to now, it's not unreasonable to expect the worst.

---Baron V

It's Easy to Exaggerate

About the Goldberg Act's many flaws---and naturally, there are plenty of bullshit stories attendant to it. And to be sure, if you earn, say, $30 grand a year or less---and that's a lot of people in this country---and you've had trouble obtaining/affording health insurance, the Act is going to be a big help for you. But if you don't qualify for the subsidies and (like me) you're in the individual market, you're probably going to end up paying more---in some cases, a lot more. In my case, its another $1,200 a year on top of the $4,500 I already pay, and while I'll get more comprehensive (silver) coverage, unless my health takes a drastic turn for the worse next year, the added benefits will likely not outweigh the added financial strain. That's because we're all paying too much for health care in America as things stand now because of the layers of middlemen, brokers, sales reps, etc.---not to mention the CEOs who must get their bonuses and the shareholders who have their dividends---who skim billions out of the system in exchange for nothing that enables more positive heath outcomes. And sadly for us, the Goldberg Act doesn't do much to change that equation. It simply shifts the costs around. Get rid of the middlemen and the rent-seekers, and we can lower everybody's health-care bill.

(Via.)

---Baron V

Today's Worst Person

Barack Obama:

Anthem Blue Cross tricked tens of thousands of Calfornia policyholders into giving up health insurance plans from which they could not be dropped and pushing them into policies that Anthem knew would be cancelled, according to two lawsuits filed in Los Angeles [...]

Since March 23, 2010, "Blue Cross successfully enticed tens of thousands of its individual policyholders to switch out of their grandfathered health plans and forever lose their protected grandfathered status," the lawsuits state. "Blue Cross concealed information about the consequences of switching plans and intentionally misled its policyholders to encourage the replacement of grandfathered policies."

Well, I certainly wasn't told anything about compliance and noncompliance when I purchased my individual plan in the summer of 2011. I assumed---naively, obviously----that health insurance was health insurance! And I didn't even purchase the cheapest available Anthem plan because I wanted extra coverage. So now, I either pay more money each month starting in January, or pay the same amount of money for a shittier plan and lose my physician. And we all know who invited all the "stakeholders" to the bargaining table when the Goldberg Act was being debated, so, worst person.

---Baron V