Health Care

Another Phony Obamacare Victim Story

NBC News' Obamacare victim, who it turns out is not actually a victim.
In the last couple of decades, a particular technique of news-story construction has become so common that I'm sure you barely notice it as something distinctive. It's the use of a device sometimes referred to as the "exemplar," in which a policy issue is explained through the profile of one individual, whose tale usually begins and ends the story. It's ubiquitous on television news, but print reporters do it all the time as well. As the Affordable Care Act approaches full implementation, we're seeing a lot of exemplar stories, and I've been noticing one particular type: the story of the person who seems to be getting screwed. If it were true that most Americans were indeed being made worse off by the law, that would be a good thing; we'd learn their stories and get a sense of the human cost of the law. The trouble is that in the real world, there are many more people being helped by the law than hurt by it, and even those who claim to be hurt by it aren't being hurt at all. To see...

The Biggest Design Flaw in Healthcare.gov

The pathway to disaster.
In my column today , I argue that the Healthcare.gov disaster has its roots in the government-contracting system, where big projects that go past deadline and over budget is standard operating procedure. There is one particular design flaw, however, that I didn't get a chance to discuss there but is worth noting. My guess is that it wasn't given all that much thought, or at the very least, somebody had what sounded like a good reason at the time to do it the way they did. But the result was that the administration needlessly multiplied the headaches it would have with the rollout and made everyone's experience significantly worse, and it didn't have to be that way. Before I tell you what it is (the suspense is killing you, I know), let's stipulate that Healthcare.gov did indeed present an extremely complex challenge, much more so than just creating an ordinary website. That's because it isn't a closed loop, but rather needs to communicate in real time with a bunch of outside systems,...

Healthcare.gov 2: The Contractors' Search for More Money

AP Photo/John Amis, File
AP Photo/HHS E veryone agrees that the rollout of Healthcare.gov has been something between a fiasco and a disaster. One of the mysteries is how a famously tech-savvy administration, headed by a president whose campaigns broke new ground in using digital technology to accomplish their goals, could have presided over this kind of screw-up. The answer is nearly as complicated as the website itself, but as the administration has said, the problems are not insurmountable and the site will be fixed (hopefully sooner rather than later). The next important question is what we can learn from this episode. There are vital lessons to be absorbed about how our government functions—not the Obama administration in particular per se. Instead, we got a good peek at what happens when private companies adept at squeezing billions from the taxpayers are hired to build something big. There's plenty of blame to spread around, from the White House to the Department of Health and Human Services to the...

Mission Affordabled: Why Obama’s Website Problems Aren’t “His Iraq”

AP Photo/J. Scott Applewhite
AP Photo/Jacquelyn Martin, File Y es, the Affordable Care Act website rollout has been a fiasco. And, as always happens when political catastrophe strikes, the wave of bad analogies has rushed in its wake. One in particular is gaining ground: Healthcare.gov is for Barack Obama’s presidency what the invasion of Iraq was to George W. Bush’s administration, complete with outraged liberal reactions to it . Here’s the funny thing: it’s a bad analogy, which could turn out to be accurate … but probably won’t. To start with, the fact that people died in Iraq, as opposed to the inconvenience involved in a malfunctioning website, doesn’t make it a bad analogy. The analogy has to do with presidential decisions; it’s about process, not outcomes, and there’s nothing at all wrong with that. No, what makes it a bad analogy is that Iraq War was misconceived from the start, and the actual events of the war, to a large extent, made obvious what some saw from the beginning. With the exchanges, on the...

Terrible Republican Idea Exposed as Even More Terrible

Flickr/adwriter
Yesterday, the Congressional Budget Office came out with a report assessing the budgetary impact of something many conservatives have supported, raising the Medicare eligibility age from 65 to 67. What they found was that the change would save far less money than had previously been assumed: only $19 billion over the next decade. The main reason is that many of the people no longer eligible for Medicare would be eligible for either Medicaid or insurance subsidies through the health exchanges, so the net effect on the federal budget would be small. But more important than that, this is an opportunity to remind ourselves that when government is doing something worthwhile, doing less of it isn't a good idea even if it saved a lot of money. And if cutting back only saves a modest amount of money, it's a really bad idea. You know what else would save a lot of money? Eliminating the United States Navy. But I'm guessing that most conservatives think having a navy is a good thing. Medicare is...

Kasich Goes Rogue on Medicaid

AP Images/Tony Dejak
AP Images/Tony Dejak W hen news broke Monday that Ohio would be the 25 th state to expand Medicaid, there were plenty of cheers on the left. After months of negotiations with lawmakers that repeatedly broke down, Republican Governor John Kasich, who has made the expansion a centerpiece of his agenda, decided to take a new tack. With the legislature out of session, Kasich, through his Medicaid director, requested a waiver from the federal government to expand the existing Medicaid program without the assembly’s approval. It was an unusual move. He got permission to spend the money from a small body, called the Controlling Board, composed of three lawmakers from the House and Senate, respectively, as well as a governor appointee. The board normally moves money between programs to adjust for shifts in spending throughout the year. This time, it approved $2.5 billion in federal funds to open up health care for nearly 300,000 Ohioans. Kasich has been one of the leading Republican voices...

No, Healthcare.gov's Problems Will Not Offer the GOP Political Deliverance

Some of the healthcare.gov contractors testifying today.
Today marks the beginning of what will surely be a series of hearings in Congress at which members will fulminate and shake their fists at various people who had responsibility for creating Healthcare.gov. It's quite something to see some congressman who's still struggling to figure out how to work the Blackberry his staff gave him asking questions about beta testing and error logs and a bunch of other stuff he doesn't begin to understand. But maybe the weirdest thing is the feeling one gets from the GOP over the last few days, which can be summarized as, "We got 'em now!" They seem to believe that the website problems are going to provide the deliverance they've been waiting for after the political disaster of the government shutdown. Here's a little prediction: Feigned Republican outrage over the ACA web site is going to be just as effective in reversing the GOP's current fortunes as feigned Republican outrage over Benghazi was in undoing Barack Obama's re-election bid. Nevertheless...

The Key to the Broffordable Care Act's Success

Flickr/CNDOZ
W hen Barack Obama made the decision to design a universal health care program based on the private insurance market, he faced one key problem. If you require insurance companies to accept anyone regardless of pre-existing conditions—as everyone wanted—you face the threat of "adverse selection," in which only those who are sick (and therefore expensive) get insurance. Just as the system of car insurance needs those who go long periods without having an accident to pay premiums so there's enough money to fix the cars of those who do have accidents, the health-insurance system needs the currently healthy to keep paying to support the currently sick. The answer was the individual mandate, which pulls people into the system and expands the risk pool. And especially critical to expanding that risk pool is getting as many young, healthy people as possible to get insured. So it may have been inevitable that young people would become targets for both the law's advocates and its opponents. A...

Popping the Pill's Bubble

AP Images/THE JONES INSTITUTE
A s the Affordable Care Act creaks into gear—and the Obama administration sends its armies of tech elves into the back end of the Healthcare.gov website to deal with the glitches—newly insured women can, for the first time, begin to start thinking about what kind of birth control they want , rather than what they can afford. Under Obamacare, all forms of female contraception will be offered without a co-pay to insured women as part of a larger package of preventive-care services. The logic behind the “contraception mandate” is so simple it’s hard to believe insurers didn’t come up with it themselves. If women can choose a form of birth control that works for them, without worrying about the cost, they’ll be less likely to get pregnant, saving insurance companies thousands of dollars in sonograms and prenatal vitamins. Obamacare has the potential to end the birth control pill’s dominance over the contraceptive market. More than 8 in 10 women will use a contraceptive pill at least once...

Before Long, We'll Forget about the Problems with Healthcare.gov

I'll confess that I was pretty surprised about the difficulties Healthcare.gov has been having. After all, despite all the complexities of creating this system, it wasn't exactly hard to foresee that the workability of the exchange website would be a very big deal. So you'd think that once a day or so for the last six months, the President would be calling the Secretary of Health and Human Services and saying, "This is going to go smooth as silk, right? Don't let me down, Kathleen." And she'd light a fire under everybody reporting to her to make damn well sure it did, so they wouldn't have to scramble like mad to fix a hundred problems once it had already launched. While the different things the site has to do certainly present technical challenges, they're hardly insurmountable. Now, you might just put it down to the fact that the whole thing was outsourced to private corporations, and we all know you can't trust the private sector to do anything without screwing it up (ha!). But...

Blurred Lines at the Border

AP Images/Matt Rourke
AP Images/Matt Rourke L ast year, during the height of the “religious freedom” fracas over the Affordable Care Act’s (ACA) contraception-coverage requirement, three Catholic laywomen made the church’s case to an audience at the Catholic Information Center (CIC) in downtown Washington, D.C. Housed in an unassuming bookstore on K Street and operated by the controversial Opus Dei order , the CIC claims to cater to the spiritual needs of Washington’s political elites with daily mass as well as lectures and panels featuring prominent conservative pundits and activists. The “Women for Freedom” panel aimed to teach lay Catholics to “convince rather than antagonize” the public about the church’s stances on divisive issues, and, in the words of one panelist, “share and show love.” “Our goal,” said Kim Daniels, then the head of the organization Catholic Voices and now the spokesperson for the president of the United States Conference of Catholic Bishops (USCCB), “is to make the church’s case in...

In Praise of Designer Babies

One day, I will rule this measly planet. (Flickr/paparutzi)
Imagine you knew that you carried a gene for a debilitating illness. But doctors could go into your egg (or your spouse's) and remove that gene, enabling you to have a baby who, whatever other problems they might encounter through their lifetime, wouldn't have to worry about the illness. Would you let them? Most people would say probably yes, provided they were sure the technique was safe and wouldn't produce some kind of two-headed mutant centaur baby. That, after all, is what people were worried about when the first baby conceived via in-vitro fertilization was born in 1978—although in that case, they were worried about cyclops babies ( seriously ). It turned out in the end that IVF is perfectly safe, and now it's a common procedure, the ethics of which is questioned only by radical anti-choice extremists. Well we may be approaching the time when doctors can fix certain kinds of inherited diseases before an egg is even fertilized. And naturally, people are worried about "designer...

No, Really, Blame John Roberts on Medicaid

The Prospect 's Paul Waldman has a terrific piece noting the terrible effects of states refusing the Medicaid expansion contained in the Affordable Care Act. Slate 's Matt Yglesias notes who should get the blame for this: John Roberts and the other conservative Republican justices who—in an unprecedented decision—ruled that making existing Medicaid money from the federal government contingent on accepting the expansion was unconstitutional. Kevin Drum of Mother Jones , however, argues that we shouldn't blame John Roberts because he was right : I think this is unfair. In fact, there were only two justices who upheld the Medicaid expansion (Ginsburg and Sotomayor). All the rest, including the liberals Breyer and Kagan, struck it down. So it wasn't even a close call. The vote against the Medicaid provision was 7-2. And as much as I dislike the result, I can't find a lot of fault with this. The basic holding was simple: given our federalist structure, states can't be forced to help fund...

The Big Donors Behind the Shutdown

The big donors behind the crisis in Washington are finally being called out by the mainstream media. Yesterday, the New York Times had a major investigative piece about how the Koch brothers and other major conservative donors pushed the Republican Party toward its current extreme strategy of trying to stop Obamacare. I have been saying the same thing for some time, citing the key role played by the Club for Growth in threatening House Republicans with electoral retaliation at primary time if they don't go all out on Obamacare. But the Times story breaks new ground by spelling out exactly how deep pocketed donors are using their clout with Republicans in Congress. These donors have made defunding Obamacare a litmus test and have directed intense fire, in the form of TV and Internet ads against Republicans seen as not falling in line behind this push. This stands in contrast to the usual narrative about the government shutdown, along with debt ceiling brinksmanship—which is that it's...

The Myth of Obamacare's Bad Sales Job

Flickr/Brent Moore
When they went forward with their plan to shut down the government in order to undo, defund, or otherwise undermine the Affordable Care Act (ACA), conservatives convinced themselves that their plan was going to work because Americans hate Obamacare. If you look at it in an extremely narrow, context-free way, that's sort of true. If you just ask people whether they approve of the ACA, you get between 35 percent and 45 percent approval. But the closer you look, the more complicated it gets. Some people disapprove of it because they feel it didn't go far enough; add them with those who say they approve, and you'll get a majority. Furthermore, and most critical for what I'd like to discuss, the actual components of the law, like giving people subsidies to buy insurance, outlawing denials for pre-existing conditions, and so on, are extremely popular (the one exception is the individual mandate). One thing's for sure, though: You can't say that the ACA as an abstract entity is...

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