Tuesday, October 22, 2013

HEALTHCARE.GOV: MIXED FEELINGS ABOUT THE BOTCH

I'm of two minds about the failures of Healthcare.gov. On the one hand, the rollout is obviously a botch, and that's a threat to the reputation of anyone who believes that government can do good things for people -- a notion that's been challenged so relentlessly over the past few decades that it has to be strenuously rebutted at every possible opportunity. On the other hand, there's this:


The technology of a customer-service interface is difficult to navigate? You think this is unheard of? Try getting through a telecom's phone tree if you have a service problem. Try disputing a claim rejection with a private health insurer right now.

Right-wingers have made Obama and Obamacare seem so evil and menacing and totalitarian -- death panels and all that -- that technological incompetence might actually be defusing the fear. See? We're not all being shipped off to extermination camps. We're just getting 404 errors for hours. Bumbling has to seem less scary than the Big Brother tactics Republicans prepared us to expect.

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That said, this from Ezra Klein (via Andrew Sullivan) is a problem if it's true:
The problem here isn't just technological. It's managerial. The White House's senior staff -- up to and including the president -- was blindsided. Staffers deep in the process knew that HealthCare.gov wasn't ready for primetime. But those frustrations were hidden from top-level managers. Somewhere along the chain the information was spun, softened, or just plain buried.

The result was that the White House didn't know the truth about its own top initiative -- and so they were unprepared for the disastrous launch. They didn't even know they needed to be lowering expectations. In any normal corporation, heads would roll over a managerial failure of such magnitude and consequence.
Any top government official who's liberal or even semi-liberal, and who has or shares the responsibility for rolling out a new government program, needs to be deeply, deeply invested in getting it done right. The right attacks government at every opportunity, and the mainstream press absolutely loves stories about government waste and inefficiency and incompetence. Heartlanders are bombarded with this narrative; they're inclined to believe that government is no damn good at anything, even though there are a lot of services they want from government. Officeholders and aides in Democratic administrations don't put enough emphasis on proving the naysayers wrong by getting programs to work right. That needs to change.

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Sullivan goes on to quote W. James Antle III of The American Conservative, who worries about precisely the outcome I'd prefer:
Nothing would better vindicate [conservatives'] case against Obamacare than the "death spiral" that would follow young people fleeing exchanges that are being flooded with the old and sick.

Yet if Obamacare undermines the entire individual health insurance market, it will make it even more difficult -- and perhaps impossible -- to ever implement any free-market health care reforms. In fact, single payer may loom ever larger as the only viable remaining option to an employer-based system that both conservatives and liberals would like to substantially remodel.
Sully adds:
[Republicans] will continue a policy of sabotage -- and the possibility that we could all end up in single-payer as a result is not the kind of empirical thing they can compute.
Hey, I'd be delighted if the end result of all this were single-payer. But anyone who thinks that an irreversible Obamacare failure would lead to single-payer is smoking crack.

First of all, right-wingers will never acknowledge the failures of the marketplace, including the marketplace that would be left after an Obamacare failure. More important, right-wingers don't give a goddamn whether anyone except the 1% has heath insurance, as long as the uninsured don't take it out on them at the polls, and as long as corporations are fat and happy. Right-wingers would be perfectly happy to replace Obamacare with whatever washes up in its aftermath, if voters put up with that. Alternately, they would be happy to create a system in which insurance sales across state lines put all health insurance in one state with incredibly pro-business laws, the way so many credit cards originate in South Dakota, where the sky's the limit on interest rates charged. They would be happy to put such great restraints on malpractice suits that the deserving just gave up on seeking redress. They would be happy to watch the numbers of the insured steadily climb. They would, in short, be perfectly happy to turn America into one big Texas as far as health insurance goes.

All they'd need to do is persuade the voters that it's their fault if they're insured, or it's the fault of the poor sucking up all the Medicaid, or, well, it's because Obamacare screwed everything up permanently. Alas, I think voters , who've been abused by the economic and politic and health-care systems for years, would just sigh and go along with that.

So I suppose that's one good reason for the administration to get this right -- not because the alternative will be socialized medicine, but because it will probably be PerryCare.

11 comments:

peabody nobis said...

I'm generally not one to see black helicopters, but what if some of the contractors for the website were paid by Conservative groups to sabotage the website design? I know it may sound crazy, but I don't put it past those people. They'll do anything to win.

The New York Crank said...

Funny, the same thought about sabotage occurred to me. Remember the hoo-ha about Diebold voting machines a few years back?

Very crankily yours,
The New York Crank

Victor said...

"But anyone who thinks that an irreversible Obamacare failure would lead to single-payer is smoking crack..."

And drinking tequila, eating pot brownies, and swallowing Oxycontin and peyote.

And yeah, to echo the sabotage comments above - I'd believe it. In a heartbeat!

It wouldn't take much to make Reich-Wing rubes like Dennis go to websites, and tie them up with utter BS, in an attempt to discredit what someone who's NOT part of their tribe is trying to accomplish.

If you can't created sh*t, ruin the sh*t other people create.

What's more Conservative than that?


Danp said...

Maybe the Conservatives took over the Maddowblog site as well. I'm not buying it. More likely they hired a bunch of people from Microsoft.

Examinator said...


It's a matter of limited supply of experienced people in health insurance "management" service I mean cutomer, Cutsomer ....well you know what I mean.... This means that they are:
- Already employed with the existing insurance robber barons...I mean insurance corps.
- defectors to the "dark side" are confused about the meaning of THAT "C" word
- Inexperienced
- screw ups
Or Sh#t happens.
Like axiom goes to err is human but to REALLY screw up you need a really BIG computer.

Continuum said...

I worked in systems development for over 20 years. I have never, ever seen any kind of new implementation work correctly upon installation. Even the best model office testing, and beta testing will never identify the problems which will bite you in the rear. So, from my perspective, the fact that there are problems with a system set to serve 30 or so million people is not surprising.

As for lower managers faking progress to middle managers, who in turn mislead upper management . . .well that's par for the course.

Also, as I understand it, the ACA website was developed by an independent computer software firm out of Canada. The failure, if it is really a failure, rests with the free market independent business, and not with government programmers.

Ten Bears said...

It's not like the O had the opportunity to beta the rollout. Nor like any "customer reponse" (like, your current insurance company) site has ever had a glitch.

Don't know if anyone has noticed, it is afterall only all over the place, but Oregon's rollout has been a huge success. What you might have expected to see had The Retards not shoved their heads so far up their collective asses they couldn't see past the pasty white skin of a half black man. I'm certainly happy with it: premiums down to about a third, actual doctor visits, blood tests... all those little things related to staying healthy rather than treating sick. Doctor tells me I'm good for another fifty-eight, so I expect I'll outlive the ignorant squaws. Poetic Justice, that.

No fear.

Luigi said...

This doesn't matter to the public. They want to check it out and see if Obamacare is better than what they have. As they hear and see news stories about progressive states (like California, New York, and Kentucky)holding down prices and extending and expanding coverage, there will be hell to pay. And that hell will be directed at the Republican governors (that includes you, John Kasich!)who withheld private exchanges from the citizenry they pledged to protect.

Examinator said...

Continuum,

Exactly!

Philo Vaihinger said...

The problem here isn't just technological.

It's managerial.

The White House's senior staff -- up to and including the president -- was blindsided.

Staffers deep in the process knew that HealthCare.gov wasn't ready for primetime.

But those frustrations were hidden from top-level managers.

Somewhere along the chain the information was spun, softened, or just plain buried.


Balls.

When big decision makers don't want to hear warnings of disaster they just don't hear them, and they radiate down the chain a message that demands people shut up and get with the program, stop being negative, blah blah blah.

In short, the problem is not that people lied to their bosses.

It's that bosses don't want to hear the truth, a whole lot of the time.

Because, hey, when disaster strikes it will absolutely NEVER be the fault of the guys at the top who made the bad call and then wouldn't listen to warnings.

As now, say.

Theophylact said...

Yeah, but the telcos and the health insurance companies want to make fixing your problem as difficult and unpleasant as possible.