Tuesday, October 15, 2013

An Honest Assessment of Obamacare: Week Two

If House Republicans hadn't shutdown the government over a futile campaign to defund or delay the Affordable Care Act, today's headlines would be about the troubled launch of the government's enrollment web portal.  And the headlines would be ugly, very ugly, for the Obama administration.

Actually, they already are--it is just that the message has been overtaken by the government shutdown and debt ceiling debacle. Just take a look at what is being said about the Obamacare launch--by well-respected people who usually are supportive of the Obama administration and the ACA. The Washington Post's Ezra Klein calls it a "disaster" :

"So far, the Affordable Care Act's launch has been a failure. Not 'troubled.' Not 'glitchy.' A failure. But 'so far' only encompasses 14 days. The hard question is whether the launch will still be floundering on day 30, and on day 45." 

Former Obama press secretary Robert Gibbs called the launch "excruciatingly embarrassing" and suggested that someone should be fired:

“When they get it fixed, I hope they fire some people that were in charge of making sure that this thing was supposed to work,” said Gibbs. “We knew there were going to be glitches, right? But these were glitches that go, quite frankly, way beyond the pale of what should be expected.”

The Daily Show's Jon Stewart mocked the "team incompetent" responsible for the www.healthcare.gov website and grilled HHS Secretary Kathleen Sebelius on why the ACA's individual insurance requirement shouldn't she be delayed. 

Ouch, and this is from the administration's friends!

Mainstream press reports also have reported that the administration knew, or should have known, about the technology problems that have plagued the enrollment hub.  The New York Times reports that in March, 2013 "the chief digital architect for the Obama administration’s new online insurance marketplace, told industry executives that he was deeply worried about the Web site’s debut. “Let’s just make sure it’s not a third-world experience,” he told them.

So here it is, just the 15th day of the launch of an unprecedented national effort to expand health insurance coverage to tens of millions of uninsured persons and to protect the rest of us from being dropped from insurance coverage or from going bankrupt because we get sick, and some already are ready to declare the ACA's launch a failure?  Really?

To be clear, I share the frustration over the technology issues that are making it difficult, if not impossible, for people to sign up for coverage from the ACA's government portal.  I think the administration's unwillingness so far to be forthcoming in explaining why the problems occurred, and what they are doing to fix them, is inexcusable, because it adds to the perception that they have something to hide or even worse, have no idea or plan to make the web portal work as intended. And, as I blogged last week, the technology problems--if not fixed soon--will pose a much bigger threat to the ACA than conservative Republicans' ham-handed efforts to defund or delay it. 

So yes, it is concerning that the administration embarrassed itself by launching a not-ready-for-prime-time web portal.  And yes, they got some explainin' to do.  And yes, they need to have a clear and transparent plan, with clear deliverables, to fix it.  And yes, the people in charge should be held accountable. 

But let’s get real, the tech problems do NOT mean that the ACA is a failure.  Not after just two weeks and one day from the date that the marketplaces opened.  And not when there is almost six months left to go before the marketplace open enrollment period ends.  Not when the problem isn't with the ACA itself--the subsidies, the guaranteed essential benefits, the price competition it creates between competing health plans, the limits on annual and lifetime limits on coverage, the benefits for preventive care at no cost to the patient, all of these are good and necessary reforms.  Now we "just" need to get the technology fixed so the millions who will benefit from such reforms can avail themselves of them. 

Today's question: Do you think after only 15 days, it is time to declare the ACA a "failure" because of the tech problems with its enrollment site?


bruce said...
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bruce said...

I am a solo internist in practice for 22 years near Seattle. Our state exchange was unusable on Oct 1, but the next morning I completed the application process on my iPad mini in a local Starbuck's in about 45 minutes. The insurance is about the same cost as what I've been able to get in the individual market, but the deductible is lower, the out of pocket maximum is lower, and preventive care is covered up front. It is a PPO set up, like what I had before, from one of the state's premier companies.

I have longed for the day when our country could be said to have a national health plan, and the ACA will do for now. The Republicans would do well to reconsider their objections and work to improve the law, and thus claim some of the credit. Repentance is good for the soul.

ryanjo said...

I think that very few people people disagree with the concept of universal healthcare. The debate is over the process. Your last few columns are more evidence that the delivery on this noble concept will be seriously flawed and possibly fail completely because of political brinksmanship, poor planning and incompetent management -- distinguishing characteristics of our political system for some time now. Oh, not to forget blatant lies (the Administration continues to dismiss the signup process as "glitches", while knowledgeable insiders saw substantial problems much earlier.)

At what point will all the parties (doctors, insurers, healthcare companies) conclude that the present political solution to reform is a danger to itself and others, and take the car keys away? Is there enough foresight in the national leadership of non-government stakeholders to begin such discussions? I'd love to read a column with that topic, and skip the handwringing about how good Obamacare "could be".

Harrison said...

Maybe it is because I don't regularly read Drudge or watch O'Reilly or even read the Wall Street Journal but all I ever hear as criticisms of the administration in general and Obamacare in particular are hateful generalities.

Please be specific.
Please state what you feel is wrong and where you got the information.

Sean Hannity did a special on Fox where he asked 3 couples to discuss their problems with Obamacare. It was a special presentation. A produced and researched show.
Funny thing is that all three of the couples were wrong in their assumptions.
One ran a business with four people and explained how they could only hire part time employees.
The thing is though that business with 50 employees or less are exempt.
The couple seemed genuine. They just didn't have good information.
But the producer's of the Fox new show should have known better and should choose to not put misinformation on the air.
They did no such thing.
In fact they did it as a special presentation in primetime.

There was a picture that made the rounds in conservative media where the President has his feet up on the desk in the oval office.
This of course was considered an outrage.
But what doesn't go out to right wing media viewers is that there are pictures of almost every President with feet up on the desk in the oval office.
Including the Sainted President Reagan, may he rest in peace....

Fox news is now comparing the mishandling of the exchange debut with the mishandling of the aftermath of Hurricane Katrina.

I don't think that the computer glitches have killed anyone so far.

I don't think the right wing should pretend that they were all for this up until the computer glitches.
And I don't think that supporters of the law should get carried away with criticism about the roll out of the exchanges.

It needs to be fixed.
Of course.

Does anyone doubt that it will be fixed?


Clifford Dacso, MD said...

I am in the middle of a research project on breast cancer epidemiology. We need to make a Web based questionnaire. It is a bit complicated but we have a good team on the job...and we are six months behind. Amazon was not built in a day.

John said...

re: "First, President Obama’s repeated assertion, that if you like your plan, you can keep it, is misleading."

Misleading??? He lied time and time again.