Should the health exchanges be shut down?

My sense is that the biggest reason Obamacare is now in trouble is because of the top-secret way in which the administration has handled the rollout. If they had developed the computer system in a transparent way, the marketplace would have told them long ago this would not work.

No one outside the inner circle at the Department of Health and Human Services has any idea what’s really going on behind the wizard’s curtain. Hasn’t for months. Doesn’t now.

So any technical advice any of us could give would be, to say the least, uninformed.

If I were on the inside, and it were up to me, the first thing I would do is bring in a group of heavyweight information technology experts to tell me just what was really going on. The administration cannot trust the people who have been working on this because they told them to launch this mess on October 1 and almost three weeks in there has been no improvement on the website or in the backroom — they no longer have credibility.

I would ask those experts to very quickly answer three questions:

  1. Can this thing be fixed on the fly — as the administration appears to be trying to do?
  2. If it can’t be fixed on the fly — and three weeks into this that sure looks doubtful — then can it be taken down for one or two months with a high degree of confidence it can be brought back up in time to enroll people sooner rather than later?
  3. If the first two options are not possible, just how long will the computer system have to be shutdown before Obamacare can be launched in a way that there can be confidence it will work smoothly?

Then I would take their advice.

Right now the Obama administration appears to only be looking at this through a political lens: How do they minimize the political fallout?

There are two things wrong with that perspective.

First, the politics of this can’t get any worse. This is now a political joke. Republicans can make lots of snarky comments about Obamacare and they won’t be able to do more damage to Obamacare than the administration is doing to itself. Any Republican reaction to taking the system down won’t last more than a couple of news cycles. More, the president would never lose politically by making a decision about every American already knows he has to make.

Second, the Obama administration, by keeping this computer system up and so far not being able to fix it, is not only wasting people’s time they are on their way to destroying Obamacare.

As I have repeatedly said on this blog, the real longer-term threat Obamacare faces is that not nearly enough healthy people will sign-up for coverage in order for the program to be able to pay the medical costs for the sick people who enroll.

Left as is, I have to believe that the only people willing to put up with the repeated attempts and frustration with the Obamacare website and call centers are people so sick and in need of health insurance they have no alternative.

The greatest threat to Obamacare right now is a computer system the Obama administration continues to defend. And maybe their inability to understand how much damage they are themselves doing to the president’s signature domestic accomplishment.

When these computer problems are finally fixed, then we can move onto the main event: Can Obamacare work?

Robert Laszewski is president, Health Policy and Strategy Associates and blogs at Health Care Policy and Marketplace Review

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  • Thomas D Guastavino

    Maybe you can answer a question for me. The coverage itself notwithstanding, would the goals of the health care exchanges also have been achieved by simply eliminating the barriers that would have allowed health insurers to compete across state lines?

    • ninguem

      There are lots of things that COULD have been done. Lots of things that could have been done as demonstration projects. The Administration chose the system they did, for POLITICAL reasons.

      Then they turned around and exempted themselves, and their favored political constituencies, from the system they created.

      • EE Smith

        And they conveniently delayed the business mandate till 2015, to make sure their big donors wouldn’t feel any pain until after the 2014 elections.

        I wonder if they’re not now wishing that, instead of shutting down the government and calling the GOP terrorists and anarchists and raaaaacists, they had taken the Republicans up on their plea to delay the individual mandate for a year too.

  • Disqus_37216b4O

    My health insurance policy, that I LIKED, is cancelled as of 12/31/13. That means I have to have finalized the purchase of a NEW one, by 12/15/13, or else I’m going to find myself uninsured for the first time since I left home at age 18.

    Are more previously responsible INSURED people going to end up UNINSURED under Obamacare, than previously uninsured people end up with insurance for the first time?

  • Ron Smith

    The problem is all at the top. Obama rides a wave of high arrogance that defies description and will culminate in not only his face plant but the dismantling not just of our healthcare system, but of American life as we know it.

    This failure is unrecoverable.

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • azabigail

      So true. At this point Obama is letting his pride get in the way of doing what’s right for America and for the American people.

  • doc99

    How would anyone decide to set up a massive online business without involving Jeff Bezos?

    • Deceased MD

      LOL.brilliant.

  • glassa

    No, it cannot work. Not when people like my sister & step-brother are finding out that their premiums are going so high that they have to drop it. Don’t tell me about subsidies. That’s a total cop out. This is crushing the middle class.

  • ninguem

    Pardon me if I remain unimpressed by “heavyweight information technology experts”.

    The British just dumped their nationwide EHR that set them back £11-billion-pounds.

    http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-pulls-the-plug-on-its-11bn-it-system-2330906.html

    The Obama Administration set out to create a perpetual motion machine.

    When the perpetual motion machine fails to work, do you blame the engineers?

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    The computer system has bugs. Every computer system has bugs. Very few computer systems are going live for the first time, at such enormous scale and with so many lights shining on them, and that’s the only difference between this computer system and what Jeff Bezos or all the other wunder kinder are running.
    The computer system will be fixed. It may take a month or two, but it will be fixed, because that’s how computer systems work. Even after it’s fixed, there will still be bugs, but they will be smaller and less frequent.

    This has absolutely nothing to do with Obamacare, the law, which should be debated separately from a lousy piece of unremarkable software. It may have something to do with the “business” decisions driving the design of the software, such as turning off the ability to browse without first signing up (this has been turned on now), and most importantly, the inability to see and evaluate the provider network for each plan (there are hard to find lists on insurer websites, but I doubt people are checking those, so some rude awakenings will certainly be forthcoming).

    • ninguem

      The bugs were, of course, deliberate.

      There was absolutely no desire to let anyone have a look at what “obamacare” would offer until AFTER the 2012 election.

      If they had, likely we’d have a President Romney today.

    • EE Smith

      “such as turning off the ability to browse without first signing up (this has been turned on now)”

      They haven’t actually “turned on” that function, they’ve just put up a lame “guesstimator” which will give almost everyone a lowball figure, which will lead to extreme “sticker shock” when they see what they’re actually going to be forced to pay.

      “See Plans Now” on healthcare-dot-gov separates consumers into two groups, those under 49 years of age and those 50 and over. But the application bases all answers for the younger group on what a 27-year-old is likely to pay, while the older group is based on the average 50-year-old. And in both groups, actual insurance costs run significantly higher than the government’s estimate.

      So if you are 40 or 49 and look for an Obamacare estimate of what they’re going to charge you, they just give you the rate for a healthy 27-year old… and that’s NOT the rate you’re actually going to be paying. And of course, the “guesstimator” doesn’t tell people what their co-pays, deductibles and out-of-pockets are going to be. It’s really just about useless.

      • EE Smith

        And it’s not just the front-end of the program that’s not working. The data it’s been sending to insurance companies (from those very few people who’ve managed to get through) is apparently all but unusable, as well.

        This is not just normal “glitches”. There are severe structural problems with the whole thing.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          The bugs are big, but they are fixable. Backend EDI transactions are always a mess. If you submit claims to insurers electronically (in the US), then you know how easy it is to screw that up on a regular basis.

          As to the browsing, I agree. The details provided are not nearly enough to base a decision on. I didn’t actually try to make a purchase, so I wonder if at any point in the process, you get a clear description of the plan, what the costs are, what is covered and what the network is.
          If anybody signed up and got enrolled, chime in…

  • buzzkillerjsmith

    The rollout issue is important to Republican shills who want to hammer Obamacare. The rest of us see through the canard. Look at the big picture.

    R. L.’s post does have some merit, however. In particular, the comment about the possible death spiral due to young healthies refusing to sign up raises a non-BS issue. Time will tell how it works out.

    In addition, I will allow that if this indicates general incompetence on the part of the feds, which it might, that would be concerning.

    We docs have many problems with Obamacare which we have gone over at length at this blog. But the rollout is a teapot tempest in the long run.

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