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.