For the past 5-6 years, I think we have been constantly living in a sense of disappointment. Perhaps the big financial crash scarred us and made us skeptical of everything around us even when things started to finally look up. The social media tools of quick feedback and need to comment on every issue you hear about often relied more on negativism. The tweets that bash people or make condescending puns tend to get retweeted more and hence subsequently get tweeted more. I’ve been guilty of this but over time, I realized the constant barrage of negativity around me. Part of the reason I stopped blogging as frequently was also because most of the posts we read during the heydays of blogging involved critical analysis, more often not constructive. So I decided to make a conscious effort of not doing that. The IIPM saga also hardened the cynic in me that nothing ever changes.
Among all the things we are constantly disappointed with, I think Obama’s presidency has to rank right at the top. More often than not, the right’s implication that he was considered a messiah by the left rings true. Things he never said or promised are often attributed to him e.g. ending all wars and waging none. What is easily forgotten that he in fact supported right until he got elected, the “good” war in Afghanistan. The drone warfare as illegitimate as it sounds is done with the complicity of the Pakistani and Yemeni governments (hence you don’t see drone strikes in Germany or India) and often result in a far fewer accidental civilian deaths. This is in no way a defense of the drone strikes. It should be subject to Congressional oversight and all legalities of conducting such strikes should be tested by the federal if not the Supreme Court; checks-n-balances and all that jazz.
However, this post tries to focus on the latest disappointment in the Obama presidency. I may often come across as an Obama apologist but this charge often comes from people who are more than willing to overlook the consequences of having the other side in charge  The rollout for Obamacare hasn’t been exactly smooth and the primary website where people can enroll has suffered from numerous technical glitches. If you use the relative scale, ten years ago, we couldn’t find WMDs that we were told existed before we invaded a Middle East country that cost thousands of American lives and countless civilian lives. Today, we have a slow website that can and is being fixed.
Obama clearly erred when he promised that no one would lose their existing insurance plans although such plans clearly are not up to the mark. He should’ve apologized and he did . It’s like letting people drive around in cars without seat belts and unusually low emissions standards. The insurance companies have been conning people into a sense of complacency by offering junk plans and denying people benefits when it came time to pay for healthcare. How bad are these plans? Here’s one example:
Under her current junk plan, she would probably receive no more than a few hundred dollars of benefits for doctor visits and drugs. It wouldn’t cover her surgery, her chemotherapy, her many expensive medications, or the repeated diagnostic tests she’d likely require. She would end up with probably $119,000 of unpaid medical bills. With the Humana plan [from Healthcare.gov), those bills top out at $6,300 a year, no matter what.
The law addresses such plans but yup, Obama should’ve qualified his statements which I admit don’t make for good soundbites in a fast-paced media world of today. I’m no health policy wonk but the least the White House can do right now, is to let those people keep their plans (grandfathered-in) for the next three years but prevent insurance companies from offering them to new customers. The Landrieu Bill in the Senate, I believe fixes this while requiring insurance companies to also offer the higher priced alternatives and showing the additional benefits offered under them. But then, in my opinion, this would be the wrong policy choice. The overall negative impact is far worse than having to eat crow and admit you misspoke or lied earlier. But then again, there’s the reality to consider:
The other issue is that of the slow and sometimes non-responsive website. I believe that it won’t be fixed in time before the end of this month and while that is unacceptable, penalties if you don’t get insurance don’t kick in until March 31, 2014. Latest numbers suggested that nearly 500,000 have at least filled out an application but have not bought a plan. I guess they are waiting until they have to since coverage will not begin until Jan 1, 2014 anyway. But it’s a far cry from the single digit enrollments that media reported happened on the first day.
On the other side, I can totally relate with the problems experienced in launching a website that will contain information from multiple sources and be useful to all. Because I’ve been doing exactly that for the past few months. However, my task was a millionth times as small as the Healthcare.gov website but it gave me an in-depth understanding of how state procurement even for technical services worked and I suppose the federal one is even more convoluted. The state agency originally tasked with contracting out the development was restricted in the choice of vendors it could seek out. It could, by law, only select from the vendors in its database and the program manager had nothing to go by in the list apart from names of the vendors and she had to pick ten at random without even knowing if they were capable of developing what we wanted. Clearly this was a sub-optimal solution so the process of contracting a vendor fell to our office and we could reach out to many more people, lay out specific requirements, and eventually select a private development company after an exhaustive search that included an on-site demonstration.
In our example, we had to design the system such that it could accept data from four different data systems from our sites and yet be flexible enough to handle additional fields that we could factor in for research. People often told us one thing about their systems and the data they had and it turned out to be completely different when they eventually delivered the data. Luckily we could go back and redesign the interface to handle such inconsistencies. From what I understand, the Healthcare.gov directly connects to 50 state exchanges that have been developed independent of each other and may be subject to different requirements. To top it, it contained health data so was subject to HIPAA regulations that made it doubly complicated. Further, this development and testing was happening just as the other party was willing to shut down the government in order to defund the law that administered this venture. It would have been a massive surprise if everything worked perfectly from the start.
So as much as disappointed we want to be in our state of affairs, it’s always useful to place things in context and view it relatively. Of course, we should complain but to argue that we would be better off than what we are doing right now just makes me dismiss you entirely. Changes to the status quo may hamper one party’s political future but to use that to convince the otherwise-sensible among us that we are doomed is downright evil. And it’s sad that people are willing to outrightly dismiss the efforts rather than rolling up their sleeves and saying, ok lets fix this thing and get it going.