Thursday, October 17, 2013

Mismanaged Care

While we're enjoying our brief intermission between acts of Fake Fiscal Crisis Theater, we can finally give some belated attention to that other sideshow called The Obamacare Rollout.  It would be a comedy of errors if not for the fact that so many people's lives are literally on the line for their inability to even get online to sign up.

And now that the Republicans and Democrats have agreed to reinstate that "minor tweak" of enhanced income verification to the digital hot mess, look for even more roiling in the roll-out. There was a reason the Obama administration initially decided to delay income verification, and it wasn't to allow hordes of fraudsters to sign up for junk health insurance on the public dime. It's because income verification is, by its very nature, fraught.

When so many low-wage or unemployed people have no way to show their assets because they lack bank accounts and jobs and tax returns, it seems cruelly designed to shut even more people out of health care. The most vulnerable people will be asked to prove a negative. The most vulnerable people will be victimized all over again. Ten million American households are now deprived of the basic economic right of a bank account. I'm willing to wager that most of these households also lack basic medical insurance.

Then again, maybe I'm worrying about nothing. According to the deal signed last night, HHS will not have to report to Congress on the "effectiveness" of income verification requirements until next July. It's really quite cynically meaningless and Orwellian -- the truth of verification is pending verification of the truth.

But still, is it just me, or does being forced to show how much money you have or don't have before getting health care smack of discrimination? Isn't this "meaningless" requirement every bit as draconian as being forced to provide a photo ID in order to vote? Maybe I'm just not sufficiently attuned to the symphony of the free market, and the exceptionalism of the United States being the only advanced country in the world without universal health care. Maybe I'm not sufficiently suspicious of my fellow human beings.

And maybe it's even more of a moot point, given that so few people have actually been able to sign up for insurance on the federal exchange in the first place, even without having to prove their income. Out of an estimated 50 million uninsured Americans, only 20 to 40 new applications on the federal site a day are being reported by the insurance industry. One health care policy wonk calls the Affordable Care sign-up process "like an astronaut on the tip of a rocket." Ouch. This brings up visions of oxygen deprivation, and Ground Control desperately trying to raise a comatose Major Tom floating somewhere in space. (You actually get a clue about their desperation when the first thing you see upon visiting the Enroll America gateway site for purchasing insurance is a request for donations to help facilitators sign more people up. They have neither competence nor shame.)

 Robert Lasziewski of Health Policy and Strategy Associates tells the Washington Post that the HealthCare.Gov site is so messed up that "what I’m worried about is that when people go to their doctor in January they may walk in, and the doctor and hospital won’t find them in the insurer’s computer system or their bank account won’t be appropriately debited or they’ll be signed up for the wrong plan. I’m worried about all these things. Now, we have a few weeks to get this straightened out. But only a few weeks."

He said one insurance company got a message enrolling and dis-enrolling the same person over ten times in a row. Multiply that one little glitch a hundred thousand-fold and it becomes uncontrollable. Affordable Care morphs quickly into Unmanaged Care. A real Tragedy of Errors:
This project is one of the single biggest IT projects in American history. When Amazon.com and Facebook started they came up as a small company and came up slowly. This had to become prime time on day one. And this business about building it for 50,000 people? You have 50 million people uninsured and 19 million in the individual market and a few hundred million who aren’t eligible for Obamacare but have been hearing about it for years! Did they not think a few of those would go take a look? I think it gets back to oversight. It was a lack of oversight on the part of the Obama administration. They needed to bring in the same kind of heavyweights in IT that the Obama administration brought in to sell this from the campaign.
Laszieweski recommends that people just refrain from signing up on the federal exchanges for the time being. That's how messed up it is. The problem with the Obamacare website, he says, is that it was designed as a public relations gimmick rather than a functional enrollment vehicle.

For even wonkier and headache-inducing ways that the ACA is a fraud wrapped in obfuscation surrounded by free market profiteering, read this run-down by economist Paul Craig Roberts. In order to understand what securing health care in the Age of Obama is all about, you really do have to be a certified public accountant or a tax lawyer.

The Affordable Care Act is 2,000 pages long for a reason. The Canadian law that enacted single payer health care, on the other hand, comprises a mere 13 concise pages. In humane societies, people are patients. In inhumane societies, people are "consumers."

The Republicans shut down the government for no good reason. They wanted to destroy Obamacare by defunding it. They needn't have worried. Obamacare is well on the way to destroying itself without their help. It's being debunked, in real time.

An upstate New York physician named Dr. Andrew D. Coates succinctly notes that the current D vs. R. debate over health care in Washington is actually a debate between the D One-Percenters and the R One-Percenters. Regular people are simply not part of the equation:
Because the debate in Washington is among, on the one side, a right wing that believes there should be no government intervention in health care whatsoever. This side believes that some individuals deserve to be sick, even deserve to die – that they deserve to go without health care because of the choices they may have made in their lives.
Meanwhile, on the other side – among the “left” of the 1 percent – there’s an idea that any government intervention could be a good thing, even if it’s government intervention to manipulate a profit-driven health insurance marketplace in a way that recruits more customers for private health insurance companies.
(snip)
Underneath it all, health care is becoming an industry. It’s becoming a business. And there are myriad new forces within the system, each trying to extract their tiny profit, and this drives all of us crazy. But it also drives prices and costs ever upward.
It doesn’t have to be this way, and everybody knows that. So when the discussion takes place in Washington, the disconnect kicks in. The 99 percent of us continue to have those undignified experiences. The consequences, of course, are grave in the short run. But in the long run, I believe that we will together build the kind of health system worthy of us as a people.
Enroll America? More like Get Rolled, America.

How about we start our own exchange, and call it Get Roiled, Citizens! Because the lives you save may be your own. And your lives are worth it. 

8 comments:

Pearl said...

Karen: Your column today about the problems with Obamacare or the ACA don't cover all the glitches to come. The costs of implementing this system, once they supposedly get their computer paperwork in order, involves the amount of funds necessary to cover more people since basic costs depend on using
for profit insurance groups as well as purchases for expensive equipment,
higher salaries for doctors, especially specialists as compared to the Canadian model where doctor's salaries as well as all kinds of medical purchases and medications are controlled by the government.
The current U.S. tax set up will not be able to cover the enormous medical
costs in sight until and when a fair progressive tax structure is in place
(when pigs fly). A proper universal health care structure cannot sustain
itself and allow the private market profits for health care to continue.
We must have a Congress in place to begin with where such changes will be
supported and implemented (when Hell freezes over on that one).

All the more reason to continue fighting and as Karen says, to fight fire with fire.

The health care debacle is a giant red flag for all the other financial
shenanigans going on and when the cans are too heavy to continue kicking them down the road and the younger generations begin facing the facts of life, maybe, just maybe something will begin to percolate. Even though it will be a long time coming if it does, we shouldn't let that discourage us from continuing our rantings and ravings. I am using the example of the U.S. chaos to gently mention what works and what doesn't to my university bound
granddaughters two of whom will be able to vote in the 2015 Canadian
election. We, and more and more others, are the guideposts now, so don't lose heart or energy. Karen hasn't.

My brother in the U.S. whom I have had differences with about the Obama
administration, told me that he finally wrote a strong letter of criticism to his President because he couldn't remain silent anymore. He was involved in a Walk for Cancer and was overwhelmed by the enthusiasm and energy and cooperation of people and wants to see that transferred to the political sphere. He pledges to continue fighting for change and feels very good about that and I told him I was proud of him. So maybe pigs can fly after
all !

Zee said...

ObummerCare sticker-shock from a leftish blog:

http://www.dailykos.com/story/2013/09/30/1242660/-Obamacare-will-double-my-monthly-premium#comments

"My wife and I just got our updates from Kaiser telling us what our 2014 rates will be. Her monthly has been $168 this year, mine $150. We have a high deductible. We are generally healthy people who don't go to the doctor often. I barely ever go. The insurance is in case of a major catastrophe.

Well, now, because of Obamacare, my wife's rate is gong to $302 per month and mine is jumping to $284.

I am canceling insurance for us and I am not pasying any fucking penalty. What the hell kind of reform is this?

Oh, ok, if we qualify, we can get some government assistance. Great. So now I have to jump through another hoop to just chisel some of this off. And we don't qualify, anyway, so what's the point?"

stev-oe said...

Face it, Amerika is Clusterfuck Nation. It is screaming this everyday. Clusterfuck Nation, Clusterfuck Nation. We think we are exceptional, but. C.N. Move to Vermont and help us succeed.

biggshoson said...

Not sure you know this, but it is perfectly doable to "sign up" over the phone. I'm sure people want to look at the charts and all, but the phone people I have talked with are very knowledgeable and very helpful. I waited less than a minute to talk to a human being.

Obamacare is helping people I love right now and will do even more by Jan 1, so you will get no grousing from me about the software glitches. They WILL sort it out.

Zee said...

@Pearl--

Once enough dim-bulbed Americans realize that they will be paying more for healthcare insurance than they did previously--like my pal on the DailyKos--and are getting less actual health CARE for that money than they did before, the rebellion against ObummerCare might begin in earnest.

I'm afraid your brother can write all the scathing letters he cares to to the Prez, but will receive nothing in reply. What does he care? He's already the lamest of lame ducks.

Your brother would be better served to call his Congressional Representative--if (s)he's a Democrat--and SCREAM into the 'phone that he's FINALLY seen ObummerCare for the disaster that it is, and that unless that representative starts working to roll back the ACA and work for single-payer, he'll be voting third-party in 2014.

Those should be followed up by e-mails, more 'phone calls, maybe a fax or two.

If his Senator is a Democrat up for election in 2014, he should do the same thing to her/him.

Enough pressure like that and maybe-- just maybe --Congress will start to listen.

Twice in recent years I have seen the American people get up on their hind legs and change what at first appeared to be the inevitable.

The first time was when, under Dubya and when the Republicans held both houses, they were all ready to pass so-called "immigration reform," which was essentially a total sellout to Big Business.

The people tied up the Congressional switchboard for days and weeks, and "immigration reform" ground to a screeching halt.

Second, was when SOPA and PIPA were stopped in their tracks thanks to enormous public outcry.

This kind of pressure CAN work, but it has to be HUGE AND SUSTAINED.

Forget demanding anything from Obummer. We're stuck with him.

Zee said...

@biggshoshon--

Certainly, some people will be helped--on the surface--but we're all still screwed to some extent.

The hidden "tax" in ObummerCare is that we all continue to needlessly pay private insurance companies to make their profit by withholding care from us in one way or another.

See also the link that I provided to the DailyKos article, above.

Jay - Ottawa said...

Yes they'll make it all right all right
They will they will
Gonna be all right you bet, you bet ‘cause
Jubilee’s a comin’ it’s a comin’ in the morning
So don’t you worry don’t worry
It’s a comin’ in the evening
And all through the night
What a happy happy time it’s gonna be
Oh yeah oh yeah
Everybody’s gonna be a shoutin’ and a singin’
Just close your eyes and put your finger on a plan
Just pick up the phone and tell ‘em what you want
‘Cause all God’s children gonna get covered
By the ACA at last it's here
uh-hun … uh-hun … uh-hun

Pearl said...

Zee: I admire your spirit and agree with you. My brother, who is no fool,
knew that the possibility of anyone at the White House reading his letter
was nil but this was his start to become active in his old age and learn to articulate his concerns. He is disgusted with the well off retirees in his area who complain and do nothing. I suggested he write out a letter of petition, have them sign it and send it to his representative and he said he will. I think I put a bit of a fire under him be telling him about my efforts.
This is how we get others to participate by being examples of how anything can be accomplished and I also point out to people how the huge negative response to Obama's plans to invade Syria without getting their boots wet stopped that bit of insanity.

If the plans for Obamacare will begin to show big cracks eventually, people
will become fighting angry. The increases you and your wife have for health coverage is nothing compared to figures I read from other sources as well as reports from readers to the NYTimes. Time will tell on this issue. More and more articles are coming out where the numbers are telling the story,will continue to do so and can no longer be ignored.