22 thoughts on “ObamaCare’s Weakest Link”

  1. this whole mess started with Roosevelt’s wage controls during the war. But did they fix that?

    Path dependence is an unfortunate reality. Were it not for wage controls, we might not have the employer tax deduction for health insurance, and a health insurance system heavily slanted towards employer-provided coverage that leaves everyone not covered by an employer at risk. The current system is too entrenched to be remade from scratch, so we’re left with incremental steps like the exchanges.

    I’m hoping to buy coverage on the exchanges, so I’ll be checking on Tuesday to see how bad the IT situation is. They’re smart to open enrollment three months before coverage begins; most people will wait until December, after early adopters (like me) have exposed the most obvious bugs.

    1. Adding more government layers to a bureaucratic system is not an incremental step in the right direction.

      I could provide several incremental steps in the correct direction, but why? You won’t listen. Unfortunately, liberals dismiss conservative solutions. I think it is a form of elitism that turns off their ears when a conservative provides answers to this mess.

      1. Unfortunately, liberals dismiss conservative solutions.

        That’s a very strange comment in the context of Obamacare. The fundamentals of Obamacare — guaranteed issue, community rating, subsidies and the individual mandate — were first proposed by the Heritage Foundation, and championed by GOP conservatives. In this instance, at least, liberals haven’t dismissed conservative solutions, they’ve co-opted them.

        1. I see every republican voting against Obamacare as a sign that they were not included in the discussions. Can you point to a time when republicans were asked for their opinions?

          Your history is wrong as well. It is true that a couple of senators and the Heritage Foundation did propose a mandate over 25 years ago. However, the liberal desire for health care goes back to Bismarck. Please don’t imply in your argument that this is a conservative idea.

          Also, the Heritage Foundation wanted to mandate something small, such as catastrophic plans. These would have been individual plans, similar to car insurance. They would not be this overreaching behemoth called Obamacare.

          With regards to subsidies, if the democrats were honest, they could have simply given poor people vouchers and allowed them to choose the plan on their own. Instead, they were more interested in accumulating power, witness the violation of religious liberty the the Catholic church is now facing.

          1. Yes, unfortunately some people really believe that bravo sierra about this being a conservative idea. In Jim’s case, I think he’s just spouting it in the hope that people are clueless about the actual history.

          2. These would have been individual plans, similar to car insurance.

            The primary feature of Obamacare is individual private insurance plans, similar to car insurance. What do you think Obamacare is?

            With regards to subsidies, if the democrats were honest, they could have simply given poor people vouchers and allowed them to choose the plan on their own.

            That’s precisely how Obamacare works for people with incomes between 100% and 400% of the poverty line. You get a fixed subsidy, based on your income, and apply it towards the plan you choose. How do you think it works?

          3. in the hope that people are clueless about the actual history

            Here’s one article on the history by someone who was at Heritage when it proposed “A National Health System for America”.

            The individual mandate is a solution to the problem of health insurance adverse selection that was originally proposed by conservatives. You can check the “actual history”.

        2. guaranteed issue, community rating, subsidies and the individual mandate

          The individual mandate is not. Instead it was a subsidy incentive to encourage people to voluntarily join the system. One could opt out.

  2. Ah, so you think it’s more of a pyramid scheme where the early adopters will have the advantage, whereas I’m thinking it’s more like an organ donation scheme where the laggards get the good parts harvested from the bodies of the early adopters.

    1. Sorry that I wasn’t clear: I’m with you — I think the pioneers will get the arrows, but make things easier for the people who come later. I’ll go early because I work in IT, have a high tolerance for IT problems, and want to potentially be able to offer useful feedback to the poor IT people working to launch the system.

  3. Jim, you have more than once stated that “the bugs in ObamaCare” could be worked out only “John Boehner (and the couple dozen member of the TEA Party Caucus) are standing in the way.”

    As you are going to the Exchange to purchase your own health care plan, I wish you every success that you get something affordable that meets your needs with a minimum of glitches. And as someone whose father was dumped from retiree health care by a major U.S. auto manufacturer and went to the Medicare Advantage Exchange, I don’t wish IT problems on anyone, let alone for something as important for health care.

    But what are the Republicans in the House of Representatives obstructing right now? I don’t ask this question out of snark but out of innocence. Did they underfund HHS? If so, why haven’t I heard about it — from Mr. Obama’s Bully Pulpit?

    As to delaying the startup for one year to match the delay of the Employer Mandate, I cannot speak to your personal needs for Health Care, but many people I know currently purchase high-deductible Health Care plans and would continue to have that option until the Exchanges come into play, offering perhaps a lower out-of-pocket option, maybe in trade for a more restricted provider network, on account of the subsidies provided by the Health Care Act.

    Given that there is some evidence that the Exchanges are not ready for Prime Time (yes, yes, I know, this too may be Right Wing wishful thinking, but I sense this is a real possibility), are you saying that Congress would not agree to a delay as a way to cooperate with the Obamacare rollout and help it work? Do Secretary Sibelius and President Obama even need Congressional Action? Haven’t they acted “administratively” and claimed they don’t need Congressional approval for the mods they have in place, such as the Employer delay?

    1. Did they underfund HHS?

      Yes. HHS requested money for implementation, and the House said no. The difficulty of educating citizens about their options without that funding was the context for Max Baucus’s famous “train wreck” comment.

      If so, why haven’t I heard about it — from Mr. Obama’s Bully Pulpit?

      Obama talks about GOP obstruction, but rarely if ever goes into the specifics. If you want that sort of information I would recommend consulting other sources.

      are you saying that Congress would not agree to a delay as a way to cooperate with the Obamacare rollout and help it work?

      I’m sure the House would agree to a one year delay, but that Obama and most Dems wouldn’t. Such a delay would likely be fatal — no big system is ever 100% ready on launch day, and the reasons for delay now would still apply in a year. Plus we’d be in the middle of an election campaign, and there’d be calls to wait until the voters had spoken. A one year delay could become two, or more. One of the biggest challenges that HHS faces is that the people that the law is supposed to serve have little information or incorrect information about it. In one poll 40% thought that the law had been repealed, and delay at this point would probably drive that number up, making a successful launch even more difficult.

      But aside from all that, a delay of one year would (according to the CBO) deny 11 million people health insurance. Even if a delay would make the rollout somewhat smoother (and I don’t think it would, for the reasons given above), it wouldn’t be worth that loss of coverage.

  4. Obamacare’s weakest link is that 400-500 or so knuckleheads in D.C. operate under the extreme delusion that they and a phalanx of bureaucrats have the ability to manage such a huge, complex, system where the users get to use their imaginations to thwart it.

  5. “The difficulty of educating citizens about their options without that funding was the context for Max Baucus’s famous “train wreck” comment.

    I’m sure the House would agree to a one year delay, but that Obama and most Dems wouldn’t. Such a delay would likely be fatal — no big system is ever 100% ready on launch day, and the reasons for delay now would still apply in a year. ”

    You are speaking to the “difficulty of educating citizens about their options”, but the parent post and link were about an IT problem — getting “the computers” to “talk to each other” to talk across far-flung federal and other governmental agencies to calculate the subsidy.

    What is there for the Federal government to educate citizens about the exchanges? The news media, volunteer groups, the insurance companies and health care networks who seek to recruit customers and clients, would not these groups rise to the challenge? At least that is what is happening where I live — TV and print media are publicizing this and one major health care insurance provider is advertising their services as pathfinders through the exchanges. What these groups cannot do, however, is make the IT system healthy.

    I know that your argument is that Right Wing sources are not a reliable source of information that the IT part of the Exchanges is in trouble, but then you have suggested that a “bug free” rollout may not be in the cards either. The employer mandate has been delayed — what is wrong with delaying the individual mandate — by one year?

    Why would a one-year delay be fatal? We have been waiting (and the 11 million who would get insurance) since Harry Truman for such a thing, and we can’t spare one more year so as to not get a hurried rollout of a faulty super scale IT system? And it is the President and the Democrats who would not agree to the one year, when other parts of the implementation have been delayed, but you told me that the Republicans are obstructing this?

    So, the reason for the delay is that the IT system is in a shambles and that subsidies in a major new Federal entitlement are to be dispensed on the honor system, but one more year won’t change things? So are you saying that the IT system that is the centerpiece of Obamacare is undoable from a strong theoretical Computer Science perspective, kind of like Air Traffic Control Modernization and the original full-blown Reagan SDI?

    As to the politics, Health Care Reform was enacted, when, at the start of 2010, and this thing has been delayed until now along with the Employer Mandate (which is not unimportant because people are supposed to prove they have insurance, either through the employer or through the Exchange or through something). So the delays we had where Mr. Obama got reelected are OK, but another year of delay is going to allow the Republicans to “run the board” and get a veto-proof majority to get Mr. Cruz’s repeal in place? So you are saying that the President’s governing coalition is currently that unpopular that he is going to lose his signature and legacy legislative achievement in one off-year election?

    1. “Obama talks about GOP obstruction, but rarely if ever goes into the specifics. If you want that sort of information I would recommend consulting other sources.”

      So you are telling me that for the President’s communication skills, that he cannot admit to any problem with the Health Care Reform rollout, come up with a specific request to remedy the situation, and communicate this to the American People through the Presidential “Bully Pulpit”? That the IT problem is the result of a budgetary shortfall, and I don’t know about this through the major media outlets?

      I am not talking about the requested funds for “educating the public” that are controversial in our highly charged political environment as some regard them as the Federal government becoming a political advocate. I am speaking to the IT system and its rollout. And in this massive piece of legislation where it was known that the Federal Government would have to implement at least one exchange, that such a thing is not scalable, and that there wasn’t spending authority in the PPACA to do the IT?

      1. come up with a specific request to remedy the situation, and communicate this to the American People through the Presidential “Bully Pulpit”?

        What would be the point? The GOP has voted 40 times to repeal Obamacare (something Obama points out regularly), and is currently insisting that the government be shut down if isn’t defunded; the fact that they’ve also obstructed implementation in various ways is a minor detail. It’d be like complaining that the people trying to burn down your house are also parking on your lawn.

    2. this thing has been delayed until now

      No, 2014 is the start date in the law passed in 2010. No major part of the law has been delayed.

      So you are saying that the President’s governing coalition is currently that unpopular that he is going to lose his signature and legacy legislative achievement in one off-year election?

      I’m saying that it would be more easily lost after a 1 year delay than if it started in 2014 as originally planned.

      But what’s more important is that 10+ million people would go without coverage for another year, for no good reason.

  6. Maybe Mr. Rafael Eduardo Cruz, Son of the Dominion of Canada, knows something.

    He is perhaps the most hardcore TEA Partier in Congress right now, but he is a pretty smart and educated with some high power legal experience (Supreme Court clerking) guy. Sarah Palin, peace be upon her, is not in the same league, brain-power wise.

    Maybe this thing is all going to go smoothly and the concern-troll about faulty IT is just wing-nut wishful thinking. But maybe this thing will fail, and fail spectacularly. We don’t have evidence that the Team Obama are particularly good managers, except maybe their IT people on the political side with the reelection campaign. Maybe this isn’t a certainty, but maybe Mr. Cruz is betting his political career on this as he certainly has angered just about every other Republican on this.

    Suppose this thing goes Tango Uniform. Who was out in front, drawing attention to himself at the annoyance of every other Republican in public life, but who will proved to be a prophet?

    1. Cruz isn’t taking any great political risk. Obamacare will be unpopular with the GOP primary electorate for decades no matter how smoothly the implementation goes. Cruz’s personality ensures that he was never going to be the favorite of his Congressional colleagues, and annoying them in such a public way makes it easier for him to run against Washington in 2016.

  7. Jim,

    If Obamacare becomes affordable, practical and does not infringe in any way upon my freedoms as an American (and that includes no IRS harassment), and does not make me a sponge on the system, then I will consider it.

    However, I’ve already had my current plan cancelled, and the only insurance I can afford is 350 percent higher than what I paid in 2009. My catholic friends are getting their first amendment rights violated.

    What is so wonderful about any of this?

    1. the only insurance I can afford is 350 percent higher than what I paid in 2009

      Starting Tuesday (and until March 31) you can go to http://healthcare.gov to find out what you’d pay for a plan in your state in 2014.

      My catholic friends are getting their first amendment rights violated.

      How, exactly?

      And not leave a horrific debt to our children and grandchildren

      According to every CBO analysis Obamacare reduces the deficit.

      What is so wonderful about any of this?

      The primary wonderful thing is that 20-30 million people who would not otherwise have health insurance will have it.

      Here’s a good overview of the tradeoffs that Obamacare entails.

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