Monday, October 21, 2013

Health Care Is Hell

While we're waiting* for The Presider to give out bouquets to a few lucky duckies who've beaten the odds and already acquired their golden tickets to Obamacare Nirvana, let's take a gander at Health and Human Services' online apologia for its glitch-ridden rollout.

The first sign that these people are still not ready for primetime is their pledge to scour the earth to find "the best and the brightest" minds to fix the troubled HealthCare.Gov. site. The Best and the Brightest, as you may recall, is the title of a scathing book by David Halberstam about how a group of so-called White House intellectuals made a total botch of Vietnam. Think Team Obama is sending us a subliminal message?

The rest of their announcement is just simply Orwellian, if not weirdly jingoistic. Some snippets:
 Initially, we implemented a virtual “waiting room,” but many found this experience to be confusing.  We continued to add more capacity in order to meet demand and execute software fixes to address the sign up and log in issues, stabilizing those parts of the service and allowing us to remove the virtual “waiting room.” 
The earth-tone Naugahyde couches and ratty copies of People magazine have been removed in the interests of your mental clarity. Because we know that when you're feeling ill, you really need the fixes to be executed. So while you're waiting to see an actual health care provider in our maze of confusion, you may now proceed to shop around for your middleman in the thousand aisles in the virtual Walmart. And then on to the next phase of your medical shopping experience: The Tech Surge!!!!!
To ensure that we make swift progress, and that the consumer experience continues to improve, our team has called in additional help to solve some of the more complex technical issues we are encountering.
Our team is bringing in some of the best and brightest from both inside and outside government to scrub in with the team and help improve  We're also putting in place tools and processes to aggressively monitor and identify parts of where individuals are encountering errors or having difficulty using the site, so we can prioritize and fix them.  We are also defining new test processes to prevent new issues from cropping up as we improve the overall service and deploying fixes to the site during off-peak hours on a regular basis.
Oh jeeze. In America, you are not automatically entitled to medical care as your basic human right. You're a soldier on the virtual battlefield who has to spill blood for it, a consumer in the marketplace who forks out the cash to buy it, a team player who has to compete in the arena for the prize, a loyal citizen ready and willing to even jump off the operating table to help your own surgeons scrub up!  Just as the troops are forever deployed by the American hegemon, so too are the Obamacare fixes. And the monitoring, of course, will be aggressive.

For a country embroiled a forever War on Terrah, I guess the bellicose symbols are bound to extend to our grand public-private partial insurance program. In his column yesterday, Ross Douthat wrote:
Like the Bush administration in Iraq, the White House seems to have invaded the health insurance marketplace with woefully inadequate postinvasion planning, and let the occupation turn into a disaster of hack work and incompetence.......
Where, Ross moans, is there a tech-savvy David Petraeus to save us from the terror?

Just what we need. Another wanker with a surge to throw gasoline on the sectarian flames of a civil war that never really ended.

* Update: Obama now has spoken for the consumers and wounded civilian warriors of America. Some money quotes:
"And I think it's fair to say that nobody's more frustrated by that than I am. Precisely because the product is good, I want the cash registers to work, I want the checkout lines to be smooth, so I want people to be able to get this great product."
"They're reaching out. They're offering to send help. We've had some of the best IT talent in the entire country join the team. And we're well into a tech surge to fix the problem. And we are confident that we will get all the problems fixed."
"But I just want to remind everybody, we did not wage this long and contentious battle just around a website. That's not what this was about. (Cheers, applause.) We waged this battle to make sure that millions of Americans in the wealthiest nation on Earth finally have the same chance to get the same security of affordable quality health care as anybody else. That's what this is about." (Applause.)
Got that, virtual consuming citizen soldiers of America? Some of you, not all of you, will have the chance and the privilege of purchasing health care product under the aegis of a virtual three-tiered class system. So please do not confuse this equality of opportunity with fairness of outcome. Depending on where you live, your money will either be gladly accepted by the free market of the wealthiest enclave of wealth on earth -- or it won't. Because like all wars, Class War is Hell. (Applause.)

"A good plan violently executed now is better than a perfect plan executed at some indefinite time in the future.” --  Obama Administration Best and Brightest HHS IT Special Ops George S. Patton Jr.


Pearl said...

The maze of confused responses to Krugman's column about Obamacare included comparatively few comments about the need for Universal Health Care. I cannot comprehend how anyone can figure out the best way to get coverage under Obamacare without fear of going bankrupt, especially when the costs into the future are vague.
Unfortunately, until basic political changes occur, nothing of significance will happen.

My friend in Florida, with serious health problems is worried that when her supplemental coverage to Medicare runs out shortly, she may not be able to get decent care. Some responses about the wonders of Medicare and possible extension to everyone do not realize the increasing inadequacies since it deals with the private sectors in purchasing equipment and paying doctors whose incomes are not regulated. She broke down telling me of the extra payments she has to make even with Medicare and supplemental coverage on her meager social security income. They don't care about us, she said. I try to help her when I can which adds to her feelings of losing dignity and

Nothing infuriates me more than the way my birth country treats its less
prosperous citizens who work hard, live their lives decently and are caught in a destructive net.
Thank you once again Karen for your hard hitting column today. You should
have included it in Krugman's readers' column.

Karen Garcia said...


Maybe your friend would qualify under expanded Medicaid were not Florida among the states refusing to participate. Medicare only pays for 80% of costs, and most indigent seniors in nursing homes (and let's face it, most nursing home patients do end up indigent) have the slack taken up by Medicaid. Most Medicaid patients are elderly, not the mythical slackers and takers.

Too tired to contribute to Krugman last night. I would have added today's post to his column, except that their 1500 character allotment would never have allowed it. And I don't believe in appending endless additions to my own comments, as some of the board hogs do over there.

The Black Swan said...

I think this is a good time to once again talk about a Basic Income Guarantee. If we, the citizen/consumer are going to be required to pay for everything ourselves (health care, school, food, housing, transportation, electricity, water, waste disposal, communications, etc) and we the citizen/consumer are getting less and less in real wages, then we need to institute a Basic Income so that we can afford to be alive. While I would really like to discuss a post-capitalist world, it is better now to talk about how we can all survive in this world. But if basic survival is linked to having a job and earning a wage, and there are less and less jobs with lower and lower wages, then the only outcome is people dying. Needlessly.

The apparatus of our enslavement is the tool of our liberation.

May all beings be happy.

ps. I am writing an essay on this for my Eng 102 class. Karen, if you would like, I can submit a summary for your blog when I am done.

Karen Garcia said...

Black Swan,

Yes, please do send in your essay. Theer has not been enough coverage of living wage and guaranteed income policies. I believe they experimented with g.i. in a Canadian province (forget which one) with some success.

Noodge said...

This Republic had its beginning, and grew to its present strength, under the protection of certain inalienable political rights—among them the right of free speech, free press, free worship, trial by jury, freedom from unreasonable searches and seizures. They were our rights to life and liberty.

As our nation has grown in size and stature, however—as our industrial economy expanded—these political rights proved inadequate to assure us equality in the pursuit of happiness.

We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence. “Necessitous men are not free men.” People who are hungry and out of a job are the stuff of which dictatorships are made.

In our day these economic truths have become accepted as self-evident. We have accepted, so to speak, a second Bill of Rights under which a new basis of security and prosperity can be established for all—regardless of station, race, or creed.

Among these are:

The right to a useful and remunerative job ...
The right to earn enough to provide adequate food and clothing and recreation...
The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad...
The right of every family to a decent home...
The right to adequate medical care and the opportunity to achieve and enjoy good health...
The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment...
The right to a good education....

Franklin Roosevelt

Zee said...

@Black Swan--

I'll look forward to reading your essay; perhaps doing so will force me to give the topic the thought that I have been promising myself to give it.

Zee said...


I tend to agree in principle with the intent of Roosevelt's Second Bill of Rights, but I guess I bridle a bit at the notion that these are rights, rather than public goods that any advanced society should offer to all of its citizens.

Unlike the first Bill of Rights appended to the Constitution, the Second Bill of Rights imposes a positive obligation on someone else to provide the specified benefit to all individuals. Without that “someone else” who is willing and able to provide the right, where then exists the right?

The “rights” to “adequate health care” and “a good education” are cases in point. If, for some reason—impossible, I know, but just consider the thought experiment—suddenly, no one cared to be a physician or teacher, where then are those rights?

If no one cared to be a farmer or rancher anymore, what would “The right to earn enough to provide adequate food...” matter? One can earn all one wants, but in that situation there would be no food to buy.

So, if for some reason, suddenly no one cared to offer all the services required to fulfill the Second Bill of Rights, what then?

This is why I prefer to think of them as public goods, and not as absolute rights. Picky of me, perhaps, but to my mind, an important distinction.

The Black Swan said...

I always bristle at the idea that we all need a useful and remunerative job. Because no one really seems to have an idea of what a job is. And what if technological advances make it that we don't have enough useful jobs for everyone? I don't like the idea that a 'job' as defined by someone else should be the arbiter of living a happy and healthy life. Sitting around drinking tea and writing poetry should be considered as useful a job as being a doctor. And what use are many of the jobs in the FIRE sector?

Zee said...

@Black Swan--

It's not clear to me, either, that all of human existence should rely upon a requirement that we each perform “a useful and remunerative job.” This is why I am looking forward to reading your essay in these “digital pages,” and for an interesting discussion thereafter.

It is my firm belief that the whole point of human endeavor in pursuit of “technological advances” is to progressively free all human beings from (what is still) our hardscrabble existence, in order to do greater things.

Though I freely confess that I don't have imagination enough to know exactly what those “greater things” are, just at the moment. (Neither tea nor poetry have ever been of great interest to me, but I have a very “live-and-let-live” attitude toward human interests.)

Still, I think that you and I have, in the past, agreed that we need to initiate change starting from the world as it is. At the moment, it appears to me that the vast majority of us will have to work for a paycheck even as we try to effect dramatic—maybe even revolutionary—change.

Unless human civilization collapses abruptly and calamitously—as Chris Hedges seems to think/hope it will—this will be a gradual process, IMHO.