The Three Burials of Obamacare
By ROSS DOUTHAT
THE first time Obamacare seemed finished, doomed, doornail-dead, the voters of Massachusetts played the would-be executioner. In January 2010, they sent a pickup-driving Republican to the Senate to fill Ted Kennedy’s seat, apparently depriving the health care bill of its crucial 60th vote and sending Democrats scrambling for a Plan B.
Except that Plan B turned out to be Plan A, thanks to the maneuverings of Harry Reid and Nancy Pelosi and the surprising stiffness of Democratic spines — and a bill that seemed undone by voter backlash went staggering across the legislative finish line instead.
The second time Obamacare seemed headed for an early grave, it was the conservative justices on the Supreme Court who were was going to see it off, by following through on their oral-argument inclinations and finding the individual mandate unconstitutional.
Except that Chief Justice John Roberts Jr. took the more politically cautious route instead — declining to overturn the mandate even though that’s where his analysis seemed to point, and finding a legal via media that kept the health care law limping toward implementation.
Now we’ve reached Obamacare’s third near-death experience, and if the law actually goes down this time there will be a lot of fingerprints on the murder weapon: Kathleen Sebelius and her hapless crew of Internet engineers; the voters infuriated at being thrown from their existing coverage into the not-really-working exchanges; panicking Congressional Democrats and gleeful Congressional Republicans; the media, long favorably disposed to the project but now scenting second-term blood; and of course the president himself, whose “noble lie” that everyone could keep their coverage has made the backlash that much worse.
But the deeper force at work, the reason that these near-death experiences keep happening, isn’t a website or a broken presidential promise. It’s a problem inherent to contemporary liberalism, which is that liberals’ proudest achievement, the modern welfare state, tends to resist, corrupt and baffle their efforts at comprehensive reform.
This was the message of Jonathan Rauch’s book “Government’s End,” which was first published in the Clinton era, and which I’ve recommended before as essential to understanding liberalism’s struggles in the Obama years. Because our government spends and regulates so much, Rauch argued, because its influence sprawls into so many walks of life, because so many clients and beneficiaries and interest groups depend on its programs and policies, the policy status quo is far harder to dislodge today than it was during the Progressive Era or the New Deal or the Great Society.
This status quo bias is structural rather than ideological; it frustrates limited-government conservatives as well as liberal technocrats. But the frustration has been much more acute and ironic for Democrats, who find themselves handcuffed by the very achievements they aspire to emulate, and attacked by the beneficiaries of yesterday’s liberal programs when they attempt to propose programs for tomorrow.
Despite the title, I'm including the following article because it represents an interesting and out-of-the-box perspective on the problems the ACA is experiencing.
-SPC
ObamaCare Clusterfuck: The ObamaCare Rollout, Organizational Dysfunction, and Public Relations in the Administration
Submitted by lambert on Mon, 11/11/2013 - 10:21pm
Tags:
ObamaCare [1]
[This combines the data from two earlier posts with some new interpretations. Basically, I'm not satisfied with a Big Lie interpretation for how the administration acts, and I'm seeking something more flexible and nuanced, and more susceptible to generalization across administrations. Basically, you can skip the aggregation of all the lies, and then start. Originally posted at NC [3]. --lambert]
Administration officials and defenders often claim that demand and volume overloaded the Federal exchange when it was rolled out. This claim is, in fact, not true, and I'd like to see what that lie tells us about organizational behavior inside the administration, and how it will react to future ObamaCare problems -- which will be numerous.
First, some examples of the false claim, both from the administration and its defenders:
Barack Obama [4] (U.S. President) 2013-10-01: [W]e found out that there have been times this morning where the site has been running more slowly than it normally will [1]. The reason is because more than one million people visited healthcare.gov before 7:00 in the morning. And we're going to be speeding things up in the next few hours[2] to handle all this demand that exceeds anything that we had expected."
Joan McCarter [5], Senior Political Writer for Daily Kos, 2013-10-01 [3]. "The glitches that the administration warned would be inevitable, that Republicans have been pre-gloating about for weeks so far, all come down to the primary glitch of our broken health care system: overwhelming pent-up demand for affordable health insurance, available to everyone."
healthcare.gov error message [6] (the Federal Exchange), 2013-10-02: ""We have a lot of visitors on our site right now and we're working to make your experience here better. Thanks for your patience!"
Paul Krugman [7], Op-Ed writer and blogger, the New York Times, 2013-10-3: "[T]he glitches of October won’t matter in the long run ... [a]ppear, for the most part, to be the result of the sheer volume of traffic, which has been much heavier than expected."
"Senior Administration Official" [8], 2013-10-04: "The amount of demand is really driving the issues. But we’re adding capacity every hour."
Todd Park [9] (U.S. Chief Technology Officer) 2013-10-05: "These bugs were functions of volume. Take away the volume and it works.''
Kathleen Sebelius [10] (U.S. Secretary of Health and Human Services), 2013-10-17 "[Sebelius] said that some of the website’s glitches wouldn’t have been identified'unless millions of people flooded the marketplace.' The system had been pressure-tested at five times the highest volume that the Medicare.gov website had ever seen, she added.[4]
Nancy Pelosi [11] (Minority Leader of the U.S. House of Representatives), 2013-10-20: "They were overwhelmed to begin with. There is much that needs to be done to correct the situation, but 19 million people, 19 million people, unique visits. .... [A]ny system that deals with that many millions of people frequently does have a glitch."[5]
How do we know these statements are not true? Two reasons:
http://www.correntewire.com/obamacare_clusterfuck_the_obamacare_rollout_organizational_dysfunction_and_public_relations_in_the
WASHINGTON — He's vented, attacked, apologized and adjusted. Now, President Obama has one move left in his attempt to salvage the rollout of his healthcare law: hope the website works soon.
The White House, knowing a functional website is needed to calm its panicky allies, has now entered the wait-and-see period of its triage after the turmoil that has followed the Oct. 1 rollout. With the latest fix to the law unveiled, a bruising House vote behind them and experts working feverishly on the broken website, administration officials believe they may have weathered the worst.
Although Obama's standing in polls and support within his party have dropped sharply, much like the downward trajectory of George W. Bush's second term, White House officials believe he can still recover.
That optimistic assessment depends almost entirely on the administration's ability to reboot healthcare.gov, the once-hyped online insurance marketplace now undergoing extensive repair. At stake are the future of the president's signature domestic achievement, his political standing and reelection prospects for vulnerable Democrats in Congress.
If the administration meets its goal of a mostly glitch-free site by the end of November, the last two months may be remembered as just another near-death experience for a healthcare overhaul that has had many. Even though many insurance executives and congressional Democrats are angry at Obama for his handling of the healthcare law, both groups have strong incentives to help the Affordable Care Act succeed.
But if the White House fails, the recent setbacks could become the beginning of years of trouble for Democrats in office, as well as those seeking to get there, officials concede.
Administration officials privately acknowledge that no argument defending Obamacare will connect with Americans until they begin to see the effects of the law at work. No work-around or temporary fix will reach enough people to build a critical mass of support. The website has to function, admit edgy aides who sometimes spit the word "website" with the contempt familiar to anyone who has ever called a tech help desk.
Obama revealed his own frustrations Thursday, saying at a White House news conference that he has an obligation to show Americans that the law has made health insurance more affordable and accessible — "if we can just get the darn website working and smooth this thing out."
Officials said Friday they were making progress on the site's many glitches and bugs. It now takes less than one second, on average, to load a page, down from eight seconds in the weeks after the launch, said Jeffrey Zients, a former top administration official who was brought back to oversee the repairs. The site can "comfortably" handle 20,000 to 25,000 consumers at the same time and more capacity is being added, he said.
Still, problems persist in the system that sends consumer information to insurers, and as experts have ticked off 200 software problems, more continue to pop up. Zients said the officials expect to make the Nov. 30 goal, but added: "Not all consumers going on the website will have a seamless experience."
http://www.latimes.com/nation/la-na-obama-obamacare-20131116,0,6823932,print.story
Administration officials and defenders often claim that demand and volume overloaded the Federal exchange when it was rolled out. This claim is, in fact, not true, and I'd like to see what that lie tells us about organizational behavior inside the administration, and how it will react to future ObamaCare problems -- which will be numerous.
First, some examples of the false claim, both from the administration and its defenders:
Barack Obama [4] (U.S. President) 2013-10-01: [W]e found out that there have been times this morning where the site has been running more slowly than it normally will [1]. The reason is because more than one million people visited healthcare.gov before 7:00 in the morning. And we're going to be speeding things up in the next few hours[2] to handle all this demand that exceeds anything that we had expected."
Joan McCarter [5], Senior Political Writer for Daily Kos, 2013-10-01 [3]. "The glitches that the administration warned would be inevitable, that Republicans have been pre-gloating about for weeks so far, all come down to the primary glitch of our broken health care system: overwhelming pent-up demand for affordable health insurance, available to everyone."
healthcare.gov error message [6] (the Federal Exchange), 2013-10-02: ""We have a lot of visitors on our site right now and we're working to make your experience here better. Thanks for your patience!"
Paul Krugman [7], Op-Ed writer and blogger, the New York Times, 2013-10-3: "[T]he glitches of October won’t matter in the long run ... [a]ppear, for the most part, to be the result of the sheer volume of traffic, which has been much heavier than expected."
"Senior Administration Official" [8], 2013-10-04: "The amount of demand is really driving the issues. But we’re adding capacity every hour."
Todd Park [9] (U.S. Chief Technology Officer) 2013-10-05: "These bugs were functions of volume. Take away the volume and it works.''
Kathleen Sebelius [10] (U.S. Secretary of Health and Human Services), 2013-10-17 "[Sebelius] said that some of the website’s glitches wouldn’t have been identified'unless millions of people flooded the marketplace.' The system had been pressure-tested at five times the highest volume that the Medicare.gov website had ever seen, she added.[4]
Nancy Pelosi [11] (Minority Leader of the U.S. House of Representatives), 2013-10-20: "They were overwhelmed to begin with. There is much that needs to be done to correct the situation, but 19 million people, 19 million people, unique visits. .... [A]ny system that deals with that many millions of people frequently does have a glitch."[5]
How do we know these statements are not true? Two reasons:
http://www.correntewire.com/obamacare_clusterfuck_the_obamacare_rollout_organizational_dysfunction_and_public_relations_in_the
In Fracas on Health Coverage, Some Democrats Feel Exposed
By JONATHAN WEISMAN
CONCORD, N.H. — The awards ceremony on Friday evening for New Hampshire’s police forces was full of pomp (a bagpipe band in full Scottish regalia), circumstance (tales of heroism and tragedy told to standing ovations), officers in dress uniforms and a show of support from the state’s full congressional delegation.
But almost as soon as all the awards had been given and the photos taken, New Hampshire’s four members of Congress, three of them Democrats, were set upon by local reporters with one simmering question: What are you going to do about the faltering Affordable Care Act?
Representative Ann McLane Kuster, the state’s freshman Democrat, displayed her own exasperation over the failed rollout. “Patience is a virtue, and Americans have it in short supply,” she said. “Frankly we are not well served by the politics of all this.”
For Democrats across the country, the reversal of political fortunes over the past month has been head-spinning. In mid-October, as Republicans were contending with voter fury over a 16-day government shutdown, Democrats had the momentum. In polls, a growing number of voters said they wanted the party to control Congress after next year’s election. Emboldened, a wave of strong recruits entered House contests. Democrats’ control of the Senate seemed secure. Money was flowing.
Then the problems with the Internet-based health exchanges came into focus, followed by millions of letters from insurance companies canceling individual policies that did not meet the health law’s minimum coverage requirements. Republicans found their voice. Democrats lost theirs. The polling gap closed, and Republican wallets opened. The National Republican Senatorial Committee raised $3.8 million in October, its best monthly showing of the year.
Representative Greg Walden of Oregon, chairman of the National Republican Congressional Committee, called it “a Category 5 political hurricane.”
New Hampshire may be ground zero in the political war over the Affordable Care Act, a state where the three Democratic members of the congressional delegation are under serious threat because of the fumbled rollout of the health care law. Suddenly they must balance their loyalty to the White House with the needs of an angry constituency that has had to absorb some of the worst problems with the new law.
The problems are many. The Tea Party-fueled legislature passed a law prohibiting the governor from setting up a state health insurance exchange, so the state must rely on the faulty federal government website, HealthCare.gov. So far, only 269 people have signed up for a plan that way, a total dwarfed by the number of residents whose policies have been canceled.
Ryan Williams, a Republican consultant from New Hampshire, noted that this year, 281 residents were issued permits to hunt moose. “You’ve got a better chance of winning the moose lottery than getting health care coverage through Barack Obama’s broken website,” he said.
What is worse, the federally run exchange for the state has attracted only one insurance provider, Anthem Blue Cross and Blue Shield, which touched off a furor when it excluded 10 of the state’s 26 hospitals from the health plans it offers through the exchange. Residents in the north of New Hampshire may have to drive an hour to find a hospital or doctor in their network. The Democratic governor, Maggie Hassan, is locked in a fight with the Republican-controlled Senate over how or whether to expand Medicaid as part of the health law.
White House optimistic Obama will bounce back from healthcare glitches
Despite President Obama's sharp drop in the polls, staffers believe a fix to the failed online insurance marketplace will bring healing.
By Kathleen Hennessey and Christi Parsons
5:50 PM PST, November 16, 2013
| advertisement |
WASHINGTON — He's vented, attacked, apologized and adjusted. Now, President Obama has one move left in his attempt to salvage the rollout of his healthcare law: hope the website works soon.
The White House, knowing a functional website is needed to calm its panicky allies, has now entered the wait-and-see period of its triage after the turmoil that has followed the Oct. 1 rollout. With the latest fix to the law unveiled, a bruising House vote behind them and experts working feverishly on the broken website, administration officials believe they may have weathered the worst.
Although Obama's standing in polls and support within his party have dropped sharply, much like the downward trajectory of George W. Bush's second term, White House officials believe he can still recover.
That optimistic assessment depends almost entirely on the administration's ability to reboot healthcare.gov, the once-hyped online insurance marketplace now undergoing extensive repair. At stake are the future of the president's signature domestic achievement, his political standing and reelection prospects for vulnerable Democrats in Congress.
If the administration meets its goal of a mostly glitch-free site by the end of November, the last two months may be remembered as just another near-death experience for a healthcare overhaul that has had many. Even though many insurance executives and congressional Democrats are angry at Obama for his handling of the healthcare law, both groups have strong incentives to help the Affordable Care Act succeed.
But if the White House fails, the recent setbacks could become the beginning of years of trouble for Democrats in office, as well as those seeking to get there, officials concede.
Administration officials privately acknowledge that no argument defending Obamacare will connect with Americans until they begin to see the effects of the law at work. No work-around or temporary fix will reach enough people to build a critical mass of support. The website has to function, admit edgy aides who sometimes spit the word "website" with the contempt familiar to anyone who has ever called a tech help desk.
Obama revealed his own frustrations Thursday, saying at a White House news conference that he has an obligation to show Americans that the law has made health insurance more affordable and accessible — "if we can just get the darn website working and smooth this thing out."
Officials said Friday they were making progress on the site's many glitches and bugs. It now takes less than one second, on average, to load a page, down from eight seconds in the weeks after the launch, said Jeffrey Zients, a former top administration official who was brought back to oversee the repairs. The site can "comfortably" handle 20,000 to 25,000 consumers at the same time and more capacity is being added, he said.
Still, problems persist in the system that sends consumer information to insurers, and as experts have ticked off 200 software problems, more continue to pop up. Zients said the officials expect to make the Nov. 30 goal, but added: "Not all consumers going on the website will have a seamless experience."
http://www.latimes.com/nation/la-na-obama-obamacare-20131116,0,6823932,print.story
Expanding Medicare to all can solve health care disaster
By Caroline Poplin, M.D.
Newsday, Nov. 14, 2013
Newsday, Nov. 14, 2013
Republicans can hardly believe their good luck.
The Obama administration has once again snatched defeat from the jaws of victory. After successfully holding off Republican efforts to destroy Obamacare by shutting down the government and threatening default, the administration badly bungled the rollout of the crown jewel of health reform: the insurance exchanges. (No surprise to those of us who wrestle with computers daily.) Somehow administration leaders also failed to anticipate the predictable response of insurance companies to a perfect opportunity to raise premiums wholesale, while blaming someone else.
Nevertheless, we need to keep in mind that even as they gleefully tear into the ACA, Republicans have not offered an alternative.
On reflection, however, this is no surprise. Republicans don't see a problem with health care in America. Insurers can sell what they chose to whom they chose; people can select policies they like and can afford, or save their money for other things.
This is how markets work. The only change Republicans would make is deregulation, so insurers and good prospects can find one another more easily across state lines.
As Ronald Reagan said: "Government is not the solution to the problem, government (in this case, the ACA) is the problem." For conservatives, health insurance and health care are ordinary commodities to be traded in the marketplace, just like automobile insurance and automobiles.
But health care is not just another item in the shopping cart. As the African-American spiritual observed, "If living were something that money could buy, the rich would live and the poor would die." And that is where we are in the 21st century. Health care is a matter of life and death. Our medicine is highly effective. Today, we can cure, or treat, diseases that were once fatal - heart attacks, many cancers, even HIV. That is, if you have the money. Today rich Americans live, on average, five years longer than poor citizens.
Nor is health insurance an ordinary insurance product.
A Doctor With a Cure: 'Medicare for All'
By John Nichols
The Nation, Nov. 11, 2013
The Nation, Nov. 11, 2013
Gene Farley and I shared a deep affection for Tommy Douglas, the Baptist preacher-turned-statesman who as the leader of Saskatchewan’s Cooperative Commonwealth Federation established the framework for what would become Canada’s single-payer national health care system.
Douglas, who is often recalled as “the Greatest Canadian,” had a congenial style that belied his determination to address social and economic injustices he knew to be immoral. “The inescapable fact,” he argued, “is that when we build a society based on greed, selfishness, and ruthless competition, the fruits we can expect to reap are economic insecurity at home and international discord abroad.”
Paraphrasing Tennyson, Douglas roused Canadians with a promise: “Courage, my friends; 'tis not too late to build a better world.” That line always came to mind when I was with Gene, who died Friday at 86.
Gene was an internationally renowned physician, an originator of family practice residency programs and innovative public-health initiatives who finished a distinguished academic career as chair of the Department of Family Medicine at the University of Wisconsin.
Yet, his great passion was as a “build a better world” campaigner. The man who proudly recalled joining the March on Washington for Jobs and Freedom in 1963 was still marching for those same causes in 2013.
With his beloved wife, Dr. Linda Farley, Gene devoted two decades of “retirement” to advancing a broad justice vision that — after Linda’s death in 2009 — could be seen in the remarkable ecological, agricultural and community-building work of the Linda & Gene Farley Center for Peace, Justice and Sustainability.
Because of their professional background, Gene and Linda focused particularly on advancing the cause of universal health care. With their longtime friend Dr. Quentin Young, they were early and enthusiastic leaders of the "Physicians for a National Health Program" movement, which for decades has encouraged US leaders to develop “an expanded and improved version of Medicare (to) cover every American for all necessary medical care.”
No comments:
Post a Comment