Out of the Shadows

America gets a three-month break. The Republicans caved – the government shutdown ended and we didn’t go into default. What we are left with is the Republican dual disagreement, on tactics and on the usefulness of experience – the dispute about how trying what failed again and again, just one more time, in the hope that it might finally work this time, or not. That’s tearing the party apart, if anyone cares. It’s a wholly internal dispute – Mitch McConnell, who cut the deal in the Senate, and John Boehner, who threw in the towel in the House and decided to allow a vote on the matter, for the good of the country, versus Ted Cruz and his Tea Party posse in both the Senate and the House, who oppose any compromise on anything, because they know they’re right, even if no one else thinks so. But nothing changed. Obamacare wasn’t defunded. It wasn’t touched, really. The simple continuing resolution to fund the government for the next three months, at current levels, was passed, reopening the government after sixteen days of shutdown, but that could have been passed three weeks ago. The debt-limit was also suspended, rather than raised, as if that distinction really matters. This allows us to pay our bills, avoiding economic chaos and the collapse of the world’s financial systems, but without any laws being repealed or anything else the Republicans had said they wanted. The whole thing was pointless. Threatening pain and chaos, hurting as many Americans as you possibly can to get what you could not get through elections or legislation or in the courts, was a stunningly bad idea.

Everyone knows the whole thing was stupid, even forty-seven percent of Republicans – so perhaps we can move on. The current continuing resolution, authorizing all government spending, such as it is, expires in the middle of January. Congress, which has now formed another special super-wonderful bipartisan House and Senate committee, will then come up with an actual budget, the first since 2009 – unlikely – or they’ll pass another three-month continuing resolution – more likely. Life will go on. Ted Cruz says that he’ll somehow get all the Republicans to unite behind him this next time and shut down the government again, and this time it will work – Obama will be forced to dismantle the Affordable Care Act, all of it. Mitch McConnell says that will never happen, there will not be another shutdown, and anyone who follows any of this sees that most Republicans find Ted Cruz a preposterous bore – but the whole thing is a bore.

The Republicans need to settle their internal civil war. They can report back to us when then do. There’s no reason for the rest of us to follow their internal agonies. We can wait, and the only useful suggestion in all this came from David Gamage and David Louk – pass a new law, that if no one can agree on spending options and priorities, much less a real budget, then by law, the current authorized spending stays in place, as is, until they do. We’d just go on, indefinitely, so there would be no more crises like this.

Gamage and Louk also admit no such law would ever be considered. Politicians would lose their leverage to change what they couldn’t otherwise change, or to resist that, and although Gamage and Louk don’t mention it, politicians would also lose their opportunity to be self-righteous and smug on cable news shows. How could they feed their egos? They’d just be people who couldn’t get anything done, while the world goes on quite well without them. They couldn’t stand that.

As for the debt limit, the current authorization to sell a few more Treasury Bonds when there’s not enough cash on hand to pay the bills due on a given day – an accounts payable problem – expires in early February. That’ll be the next chance to force Obama to give it all up on the Affordable Care Act – but no one seems to want to toy with defaulting on our sovereign debt any longer. The costs are too high, as in the collapse of the worldwide economy, and Matthew Yglesias has already covered how the debt limit came into being and how dumb it is – “every country other than Denmark manages to get by without any sort of statutory debt ceiling” and so on. Robert Schlesinger, among many others, makes the same argument – Congress telling the president he cannot pay the bills now due for what specifically what they told him to spend is basically dishonest, if not stupid. There are simple are ways around it – like the Gephardt Rule from the Carter years, in place until Newt Gingrich stopped such nonsense when the Republicans retook Congress in the mid-nineties. That rule was simple – all authorized spending automatically authorized the means to pay for such spending. Gingrich didn’t like that. He wanted another weapon, and he got one – but getting rid of the debt ceiling, and thus embarrassing our Danish friends, leaving them all alone out there looking stupid, is an argument for February. We’re okay for now.

The odd thing was that this was all about Obamacare, which is actually in some trouble. The implementation isn’t going well, so the Republican strategy of shutting things down, crippling the economy, and then threatening economic collapse when the one safe place where the world parks its cash wouldn’t be safe at all anymore, was both incredibly nasty and tactically wrongheaded. They could have said, with some justification, that Obamacare is just not working very well, which might mean that it won’t work at all. Their argument, that the Affordable Care Act must be stopped before it turns America into a nation where the Takers get everything because the Makers are being forced to give it to them, implicitly assumes that the damned thing will work all too well, ruining everything that is good and right in American. The more powerful argument would be to point to the quite shaky rollout and suggest that this proves that the whole idea was crappy – this is the proof. They could have left the Affordable Care Act speak for itself. They’d have saved us a whole lot of trouble.

That’s not what happened. The crappy rollout of Obamacare was overshadowed by the seventeen-day government shutdown and all the talk of default, as were the amazing diplomatic breakthroughs with Iran on their nuclear weapons and Syria actually helping the UN folks secure and remove those chemical weapons. The sanctimonious self-pity and the angry shouting, and the waving of Confederate flags and tea bags, and the sincerity of the deeply-held beliefs of various odd people, dominated the news cycles, day after day. Obamacare itself remained in the shadows. The administration lucked out, or the Republicans blew it, big time.

That’s over now. Obamacare is out of the shadows, and the administration is scrambling, as Politico notes here:

The Obama administration Sunday said it’s called on “the best and brightest” tech experts from both government and the private sector to help fix the troubled website at the root of the Obamacare enrollment problems.

The unusual Sunday 600-word blog post from HHS was the first update in more than a week on the many failings of an expensive website that HHS itself described as “frustrating for many Americans.” But it didn’t specify who the administration had called in, or when the American people would see clear-cut results on Healthcare.gov.

“We’re kind of thinking of it as a tech ‘surge,’” an HHS official told POLITICO.

Yes, much of this is technical, so put on your geek-hat:

The Health and Human Services statement didn’t explain everything that’s wrong, or give technical details about the repairs underway. It outlined some steps being taken to fix the site, including updates with “new code that includes bug fixes.” The department also says it’s installing monitors to catch parts of the website that are proving the most troublesome for consumers. And it also said it had seen some improvements in wait times and consumer access to the website, the online portal to health insurance exchanges or marketplaces the federal government is running in 36 states.

The administration said one essential component – the federal data hub – is working as hoped. That hub is crucial. It links federal agencies to determine an applicant’s eligibility for Obamacare coverage and subsidies. States running their own exchanges have to be able to draw on that data as well, and some of them have been doing so successfully.

Actually the state exchanges have been doing quite well, particularly out here in California, but this is a Democratic state, where we set up our own. Those thirty-six states where this is not working are Republican states, where those folks refused to set up anything – let the feds do that if they want something as stupid as providing the working poor the opportunity to purchase low-cost subsidized health insurance from private for-profit third party underwriters.

That wasn’t exactly sabotage. That was letting the feds blow it all on their own, which was pretty clever. Much of this is the feds trying to do too much in too many places, all at once.

Who needs a government shutdown? This works better, and if enough folks can’t sign up fast enough the risk pool will be too small and the whole thing will collapse. The state Republicans are far smarter than the Republicans in Washington, and they have Obama on the run:

President Barack Obama will “directly address the technical problems with HealthCare.gov” and announce steps he’s ordered to address them at a Monday event, a White House official said Sunday. He also plans to underscore the benefits his health law will provide Americans, and will be joined at the Rose Garden event by people whom the White House described as already benefiting from the law, or helping with the outreach for people to understand and sign up for the new health coverage options.

In a separate statement Sunday evening, HHS announced some modifications to the home page to allow consumers to get more information up front without having to wrestle with the rest of the balky site. That includes both information about health plans, subsidies and costs, as well as a directions for signing up by phone, on paper, or with in person assistance.

Nothing is in the shadows any longer:

House Republicans are opening hearings into the rough Obamacare rollout later this week. Some Republicans have called on HHS Secretary Kathleen Sebelius to resign or be fired.

Sen. John McCain on CNN Sunday said the whole Obamacare rollout has been “a fiasco.”

“Send Air Force One out to Silicon Valley, load it up with some smart people, bring them back to Washington, and fix this problem. It’s ridiculous. And everybody knows that,” he said on CNN’s State of the Union.

That’s cleverly put, but the problems are real:

HealthCare.gov has received more than 19 million unique visits since the Oct. 1 launch, according to the updated numbers released Sunday. As of Saturday, about 476,000 applications have been filed in state-run and federal-run health insurance exchanges – but that’s just applications, not actually getting covered. About half of those applications came from the 36 states where the feds are running the exchanges.

Those numbers, however, don’t indicate how many people have successfully completed enrollment. The administration won’t release those numbers until next month – and it’s likely to be much smaller than the numbers of who have started the application process.

That gives the New York Times’ young conservative columnist, Ross Douthat, a chance to pounce, and he does:

This fiasco has always been a possibility, for reasons inherent in the architecture of the law. When The New Republic’s Jonathan Cohn, the most rigorous defender of the entire reform project, wrote up his “five Obamacare anxieties” in May, the first one was structural: The system’s sustainability depends on getting enough healthy people to sign up, he pointed out, and if they don’t then insurers “will have to raise everyone’s premiums,” which “could create what actuaries call a ‘death spiral’: Rising premiums prompt people to drop out, causing premiums to increase even more.”

Cohn thought such a death spiral was unlikely, and frankly so did I. Between the stick of the mandate, the carrot of subsidies and the planned PR blitz, it seemed as if enough Americans would sign up to at least postpone the cost problem and get the system off the ground.

But it seemed that way because it was hard to imagine the Obama White House botching the design and execution of its national health care exchange. Building Web sites, mastering the Internet – this is what Team Obama does!

Except this time Team Obama didn’t. Like the Bush administration in Iraq, the White House seems to have invaded the health insurance marketplace with woefully inadequate post-invasion planning, and let the occupation turn into a disaster of hack work and incompetence. Right now, the problems with the exchange Web site appear to be systemic – a mess on the front end, where people are supposed to shop for plans, and also a thicket at the back end, where insurers are supposed to process applications.

Douthat grants that all this can presumably be fixed, but the risk to Obamacare is high:

If the fix-it effort moves too slowly, it’s possible to envision a worst-case scenario unfolding. If the Web site doesn’t work soon, even liberals concede that the mandate would have to be delayed, because you can’t very well fine people for failing to buy a product they can’t access. And that combination – a hard-to-navigate online portal and no penalty for staying uninsured – could effectively discourage all but the most desperate customers from shopping, which in turn would create an unsustainably expensive insurance pool, driving prices up and driving people away, and potentially wrecking the entire individual insurance market in short order.

If this happens, there will be a lot of schadenfreude on the right at the spectacle of technocratic failure.

Yeah, they might grin sardonically, but Douthat also has a warning for them:

While conservatives think the Obamacare exchanges are overregulated and over-subsidized, they are actually closer to the right-of-center vision for health care reform than the Obamacare Medicaid expansion, which is happening no matter what transpires with Healthcare.gov. So if the exchanges fail and the Medicaid expansion takes effect (and, inevitably, becomes difficult to roll back), we’ll be left with an individual market that’s completely dysfunctional and a more socialized system over all.

In that scenario, the Democratic Party would probably end up pushing, not for the pipe dream of true single payer, but for a further bottom-up/top-down socialization, in which Medicare is offered to 55- to 65-year-olds and Medicaid is eventually expanded even more.

If this fails, then single-payer or Medicare-for-all becomes the only reasonable alternative:

The task for serious conservative reformers – already not the most politically effective bunch – might actually become harder, because they would have to explain how their plan to build an effective, exchange-based marketplace differed from the Obama White House’s exchange fiasco.

So while Republican politicians may be salivating over a potential Obamacare crisis, the conservative policy thinkers I know are not. They’re hoping, as I’m hoping, that this isn’t as bad as it looks. The chance to say “I told you so” is always nice, but not if the price is a potentially irrecoverable disaster.

Heck, maybe these federal insurance exchanges were actually designed to fail, or bring on single-payer or Medicare-for-all within a year or less. It was a clever Obama plot! If you’re conspiracy-minded, that might be how you’d read the Douthat column, as some have, but the very conservative Rick Moran just doesn’t see it:

The problem with the “set up to fail” conspiracy theory – aside from the fact that dozens of HealthCare.gov website contractors, HHS employees, and White House officials would all have to be involved and presumably sworn to silence – is the same one that Republicans had in trying to defund the law: it’s impossible to get through Congress. No Republican is going to vote for a single-payer system, nor would they support, as Douthat suggests, an expansion of Medicare. Obama and the Democrats are stuck with what they have and if it proves to be impossible to implement, it is extremely unlikely that Republicans will support further top-down, pseudo-socialist measures to fix it.

This is why it would behoove the GOP to have, at the ready, a concrete, modest proposal to introduce in both Houses after the president delays the individual mandate: a repeal of certain sections of Obamacare in order to substitute far more realistic and workable, market-based solutions to the health insurance problem.

You got a better idea? It’s time to reveal it, right now. Unfortunately it’s been many years now. They don’t have a better idea. They never had one. They don’t like the idea of the wrong sort of people having the opportunity to buy health insurance. That’s it. It’s a cultural thing. Moran expects too much, and Paul Krugman has suggested one might review Eric Stern’s lengthy exposé of Fox News’ Obamacare scare stories:

Sure enough, the businessman who claimed that Obamacare was driving up his costs, forcing him to lay off workers, only has four employees – meaning that Obamacare has no effect whatsoever on his business. The two families complaining about soaring premiums haven’t actually checked out what’s on offer, and Stern estimates that they would in fact see major savings.

You have to wonder about the mindset of people who go on national TV to complain about how they’re suffering from a program based on nothing but what they think they heard somewhere. You might also wonder about what kind of alleged news show features such people without any check on their bona fides. But then again, consider the network.

Systems problems can be fixed. Fox News cannot be fixed, and Max Ehrenfreund at the Washington Monthly sums up the underlying problem here:

We hesitate to take actions that would disrupt the existing state of affairs, and so we design elaborate solutions to achieve our goals without violating anyone’s established privileges. Obamacare is a perfect example: if we hadn’t been so concerned about protecting hospitals and insurers, we might have found our way to a simpler system with a better chance of success.

He sees a different problem here:

It’s far too early to give up on the exchanges, but if they do fail, it seems most likely that they will fail because of their conservatism – because Congress and the president weren’t willing to go far enough in 2010 in expanding the government presence in the healthcare system.

Those of us who have designed complex systems and gone on to manage teams of really bright and highly motivated teams of systems analysts and programmers designing such systems – yes, hospital and healthcare management systems too – know exactly what Ehrenfreund is getting at. Gathering system requirements takes forever, because everyone wants everything and there are too many parts, and one set of requirements will contradict another, over and over, and the requirements will change and change again, as end-users realize what they wanted isn’t exactly what they wanted, or maybe it was – they’ll get back to you. Then you show them the initial prototype and they hate it, and once everything finally gets wedged into the first working version, it runs slow as molasses and keeps crashing. That always happens, and these state insurance exchanges, unified in purpose and accessing a common hub, but customized for each state, with specific providers with distinct insurance rates, in tiers, for each state, are far more complex than any Washington politician could ever even image.

That’s what happened here. The Obama administration apparently hoped these state insurance exchanges would be fairly simple. Those who hate Obamacare are now telling everyone this should have been fairly simple, and the Obama folks blew it. Neither side has the slightest idea what it’s talking about. Simple is better, but life isn’t simple. Ehrenfreund imagines a simple thing – a national single-payer system, some sort of Medicare-for-all thing. That’d be cool. What imaginary Congress is ever going to go for that?

There’s only one good thing about all this. The real issue is out of the shadows, and we can ignore the internal Republican civil war for now, until they try to punish us all again.

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About Alan

The editor is a former systems manager for a large California-based HMO, and a former senior systems manager for Northrop, Hughes-Raytheon, Computer Sciences Corporation, Perot Systems and other such organizations. One position was managing the financial and payroll systems for a large hospital chain. And somewhere in there was a two-year stint in Canada running the systems shop at a General Motors locomotive factory - in London, Ontario. That explains Canadian matters scattered through these pages. Otherwise, think large-scale HR, payroll, financial and manufacturing systems. A résumé is available if you wish. The editor has a graduate degree in Eighteenth-Century British Literature from Duke University where he was a National Woodrow Wilson Fellow, and taught English and music in upstate New York in the seventies, and then in the early eighties moved to California and left teaching. The editor currently resides in Hollywood California, a block north of the Sunset Strip.
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One Response to Out of the Shadows

  1. Rick says:

    “Ted Cruz says that he’ll somehow get all the Republicans to unite behind him this next time and shut down the government again, and this time it will work – Obama will be forced to dismantle the Affordable Care Act, all of it.”

    Cruz may or may not be able to get Republican support to shut down the government again, but only over something small, not over Obamacare or anything else like it. That is, if he isn’t isolated and completely ignored, which I would think was much more likely.

    I think the fact that Cruz graduated from both Princeton and Harvard Law, and with honors, calls into question those institutions, given the fact that he doesn’t (or maybe just pretends not to) understand that insisting on adding his demand to destroy Obamacare as a condition to fund the government is a sure-fire way of closing down the government, which he claims he had no intention of doing.

    Douthat talks about the concept of exchanges being crucial to the alternatives the conservatives are offering to Obamacare, but I have to admit I’ve not heard this before.

    Maybe I’m just being cynical, but I think the main conservative “reform” plan seems to be “no reform”. Other than offering a few sops to make it look like they care — such as requiring insurance companies to cover preexisting conditions and keeping kids on their parents plans until 26 (and it’s hard to see how they’d do this without the government passing laws that regulate insurance companies, or without everybody in the plans, which would require an individual “mandate”, neither of which Obamacare critics like about Obamacare), the conservatives and Republicans have been spending little actual time championing any “plan” of their own — which, it seems to me, is because they really don’t want one anyway.

    I could be wrong, but I myself suspect that one reason the Obamacare roll-out has been so klutzy is that the company that won the bid was probably among the low bidders, rather than among the “best-and-the-brightest” of software engineers. I also heard it suggested on NPR, by a guest who is familiar with government bidding, that the winners are often not as good at writing code as they are at writing proposals.

    In any event, I still tend to think this is all overblown — that given some time (after all, people have until March to get signed up), this will all work out.

    And when it comes to making sure the young and the restless sign up, Congress might just end up increasing the fines to make them more comparable to premiums — that is, making the sticks look a bit more like carrots.

    Rick

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