Medical Costs Bankrupt Patients; It's the Computer's Fault

nbauman writes "Don't get cancer until 2015. The Obama health reform is supposed to limit out-of-pocket costs to $12,700. But the Obama Administration has delayed its implementation until 2015. The insurance companies told them that their computers weren't able to add up all their customers' out-of-pocket costs to see whether they had reached the limit. For some common diseases, such as cancer or heart failure, treatment can cost over $100,000, and patients will be responsible for the balance. Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs? 'A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: "We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs. They asked for more time to comply."'"

Comments

A cynic's view

[mariox19]

The rollout is being delayed until after the 2014 congressional elections. The problem is political, not technical.

Re:A cynic's view

[Anonymous Coward]

A cynic would also know that billing system software is some of the most byzantine crapware on the face of the planet. It's hacking on this kind of software--plus payroll, HR, accounting, etc--that sustains both Oracle and IBM, plus thousands of smaller consulting firms.

So, the administration's excuse is both plausible and fortuitous. In other words, I doubt the insurance companies had to twist the administration's arm to postpone the mandate and cap.

Re:A cynic's view

[gander666]

This.

The mess is deep and wide, and likely still has some duct tape applied to cover up the Y2K transition. Many/most of these systems are ancient, and creaking under their own mass.

Re:A cynic's view

[cusco]

The last time I had to deal with the insurance programs they were nothing more than a web GUI hiding a dumb terminal interface. Most are still on mainframes.

Re:A cynic's view

[meglon]

Don't believe every little talking point you hear..

http://www.leadertelegram.com/blogs/tom_giffey/article_c9f1fa54-d041-11e1-9d01-0019bb2963f4.html

I was curious to know how the length of the Affordable Care Act compared with other major pieces of legislation. Take, for example, the Wisconsin state budget (officially known as Act 32) signed into law last July by Gov. Scott Walker. The PDF of the budget, as approved, is 532 pages long. I cut and pasted the text into my word processor, and learned the budget ran to 409,629 words (give or take -- the figure includes some page headers and other extraneous verbiage). How long is the Affordable Care Act? By my count, it’s 418,779 words (again, that’s approximate).

In other words (pardon the pun), a law refashioning one of the major sectors of the U.S. economy is only slightly longer than a law setting the two-year budget for one of the 50 states.

http://www.fourmilab.ch/uscode/26usc/

The complete Internal Revenue Code is more than 24 megabytes in length, and contains more than 3.4 million words; printed 60 lines to the page, it would fill more than 7500 letter-size pages.

Part of The Big Lie strategy is repeating a lie over and over again till it's common enough people start to believe it. Don't fall for that type of dishonest stupidity.

Re:A cynic's view

[meglon]

http://www.factcheck.org/2013/05/congress-and-an-exemption-from-obamacare/

Ezra Klein of the Washington Post says THIS:

There’s a Politico story making the rounds that says that members of Congress are engaged in secret, sensitive negotiations to exempt themselves and their staffs from Obamacare.

Well, they were secret, anyway.

The story has blown up on Twitter. “Unbelievable,” tweetsTPM’s Brian Beutler. “Flat out incredible,” says Politico’s Ben White. “Obamacare for thee, but not for me,” snarks Ben Domenech. “Two thumbs way, way down,” says Richard Roeper. (Okay, I made the last one up).

If this sounds unbelievable, it’s because it is. There’s no effort to “exempt” Congress from Obamacare. No matter how this shakes out, Congress will have to follow the law, just like everyone else does.

Based on conversations I’ve had with a number of the staffs involved in these talks, the actual issue here is far less interesting, and far less explosive, than an exemption. Rather, a Republican amendment meant to embarrass Democrats and a too-clever-by-half Democratic response has possibly created a problem in which the federal government can’t make its normal contribution to the insurance premiums of congressional staffers.

Maybe.

See? This is getting boring already.

Here’s how it happened: Back during the Affordable Care Act negotiations, Sen. Chuck Grassley (R-Iowa) proposed an amendment forcing all members of Congress and all of their staffs to enter the exchanges. The purpose of the amendment was to embarrass the Democrats. But in a bit of jujitsu of which they were inordinately proud, Democrats instead embraced the amendment and added it to the law. Here’s the relevant text:

The only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are — (I) created under this Act (or an amendment made by this Act); or (II) offered through an Exchange established under this Act (or an amendment made by this Act).

(Snip)

But no one is discussing “exempting” congressional staffers from Obamacare. They’re discussing creating some method through which the federal government can keep making its current contribution to the health insurance of congressional staffers.

“Even if OPM rules against us,” one staffer said, “it’s inaccurate to imply that any talks are aimed at exempting federal employees from routine mandates of ACA since any talks are about resolving the unique bind that the Grassley amendment puts federal employees in.”

This isn’t, in other words, an effort to flee Obamacare. It’s an effort to fix a drafting error that prevents the federal government from paying into insurance exchanges on behalf of congressional staffers who got caught up in a political controversy.

All you really need to know about Obamacare is: republicans lie, republicans lie, republicans lie.

Re:A cynic's view

[profplump]

You'd be amazed how difficult it actually is to track accumulated values (like out-of-pocket payments) in most insurance software. It's not just "SELECT SUM(claims.oop) WHERE claims.member = X" -- it should be, but it's not. And the process in place is so fragile that any change at all might well break the whole thing.

There's also the problem of the system not being able to accommodate things like a legislative limit that's different from the contract limit, or a contract that changes after initial implementation -- if you don't assign a new group number to the members you can't apply new limits to them. And you can't assign a new group number without a new contract entry. And there is no new contract because the change was legislative not contractual. And you can't just update the old policy entry because it would apply retroactively to all old claims.

It's all stuff that any one with 2 credits in database administration could fix in like 4 minutes, but it's all baked in to 40 years of COBOL, intermixed with business logic, writing fixed-width data to ASCII "tables", and no one is willing to risk changing anything unless God and his wife both sign off on it.

Re:A cynic's view

[AK Marc]

Sadly, the reason we can't comprehend the problem is that nobody will make intelligent decisions. With "only" 300,000,000 records, and probably not more than 100 q/s (which should be restricted to UID, as privacy is important), the thing could run on any of a number of cheap and ubiquitous databases. Use off-the-shelf querying programs for reporting. Standards-based interfaces, and require other systems connect in standards-based ways. Instead, we have ancient systems built in the '70s and such on unusual languages with proprietary interfaces, and everything new needs to connect back with the old interface. When 30% of your systems are big-endian and 30% little endian, and 30% some bastardized undocumented middle endian (just making up a worst case, hopefully it's wrong), integration costs are large.

Burning the place to the ground and starting over would be cheaper. The problem is they never figure that out until after the first hundred billion dollars are spent. And the bigger problem is when they do burn it all down and start over, the never remember to lock the politicians in first.

Re:A cynic's view

[i.r.id10t]

Which is funny, because my health policy company (whatever BCBS in Florida is called this month - FloridaBlue I think?) sends me a statement every month of what was charged, what was paid, what I paid. And at the end of the year they send a nice summary for tax filing purposes. Heck, hte pharmacy the family uses - Publix - has a "year to date" on each receipt we get for prescriptions.... so, it obviously isn't impossible, or even too hard....

Re:A cynic's view

[jamstar7]

Problem is, insurance companies as well as financial institutions HATE to spend money unless it's on executive perks. If it ain't broke yet, it don't need replaced. No matter how obsolete or kludged it is, if it still works, it'll be kept around. That's why the Y2K 'bug' had them so freaked out, they were using old COBOL software from the Stone Age that kept working, and they didn't want to spend money to upgrade.

Re:A cynic's view

[Martin Blank]

A board that reviews health care expenses and recommends cuts in specific areas isn't new with or unique to Obamacare. Every insurance company has one, and they feed off of an existing, independent board that recommends prices for the entire medical industry (and which is sometimes wildly off the mark in terms of current costs).

Unlike Obamacare, every insurance company also has employees (doctors, yes, but not the ones treating the patient) who can decide that a given treatment isn't worth the cost associated with it and deny its coverage, thereby in some cases sentencing the patient to death. That nearly happened to my then-86-year-old grandfather who was denied coverage for a triple bypass because he was already beyond his life expectancy. It wasn't until it was pointed out--twice--to the insurance company that he was still working 40 hours per week that the surgery was approved, by which time he was in the ICU on oxygen. It was his employer-provided insurance that tried to nix the surgery. This was about 2005. He lived another five years or so after the surgery.

I'm not entirely certain how the insurance-company doctors making such decisions will fare under Obamacare, but I expect that they'll still be around.

Re:A cynic's view

[dkleinsc]

In most polls on the subject, including some internal studies by the Republican Party, younger voters don't exactly like the Democrats, but think the more prominent Republicans are so insanely dangerous that they won't even consider them. I mean, running down the list of everyone who has made it onto the Republican presidential ticket in the last decade:

- George W Bush: Flat-out incompetent, with policies that: bankrupted the US treasury, gutted FEMA and then stood by while a major American city was destroyed, started 2 wars on false pretenses, willfully broke at least 5 of the 10 amendments in the Bill of Rights, ignored counterterrorism until it smacked him in the face with the biggest intelligence failure in US history, and caused the greatest economic mess since the Great Depression. The Republican Party has done its best to minimize his influence on the current campaigns.
- Dick Cheney: Admitted war criminal, and the architect of many of the bad policies of George W Bush.

- John McCain: In his first key decision as a would-be president, chose Sarah Palin. If he'd wanted a woman, he could have gotten someone at least competent like Christine Todd Whitman.
- Sarah Palin: She was stumped by the question "What magazines and newspapers do you read?" Enough said.

- Mitt Romney: Didn't know where Iran is, which I would think is kinda important if you're president. Announced that he didn't care about the fate of half of the citizens of the country.
- Paul Ryan: Produced budget after budget where the numbers, based on ludicrous assumptions (like 20% economic growth), fail to add up. And that's his area of expertise.

As for the last round of Republican primary candidates:
- Rick Perry and Newt Gingrich: Both at least appear to be racists, whether intentionally or not. That's a big deal to the growing percentage of young people who aren't white, and also to the significant percentage of white young people who oppose racism.
- Rick Santorum and Michelle Bachmann: Both have made it quite clear that their religious beliefs will trump scientific or statistical or factual evidence where the two conflict.
- Herman Cain: Had no actual factual understanding of any of the issues, as anyone who listened to an extended interview figured out pretty quickly.
- Ron Paul: Insightful about some stuff, also nuts about some other stuff. By all appearances, he believes the US government should not be in the business of issuing money.

So who is this Republican that is not going to be seen as incompetent, corrupt, or crazy?

Re:A cynic's view

[Anonymous Coward]

Just so you know, every time you write a check in the united states, the format that it needs to get converted into follows the x937 spec. Each record is in ebcidic but requires a big-endian record header except for the records with image data in them, where the image data is required to be little-endian. The medical systems running our nations hospitals make banking look sane.

There's your 10 minutes of terror for the day.

Re:A cynic's view

[MoneyT]

Part of the reason for the resistance is lost institutional knowledge. These are old systems, probably poorly commented and poorly documented. They've been modified and patched a thousand times over to handle corner cases, odd hardware based bugs, new interfaces, new regulations and new laws, as well as mashing with new insurance companies, new plans, old plans, outdated data and new data and 50 states worth of independent regulations. How much money and how much time do you suppose it would take to rewrite that entire 30 year history, including refactoring all of the data such that is accessible back to the beginning, in a modern language, with modern technologies and can guarantee that it is 99.99% exactly the same functionality for all possible input combinations?

For reference, the state of North Carolina recently overhauled their Medicaid billing system. They are months and billions of dollars behind in payments from this change over, and the project was already over due and over budget.

What a sick system

[Anonymous Coward]

It's just another example of bought and paid for politicians sucking the dick of corporations. The famous words "of the people, by the people, for the people" are such a sick joke if you look at the USA government. Coming from a country that covers 100% of such common procedures, I just can't imagine how people can live like that. And Americans still think they have the most superior country in the world. America! Fuck Yeah! Please stop spreading your ideas of freedom to the world and try spreading those ideas at home instead.

Re:That's funny

[Sarten-X]

Having worked firsthand in the medical data field, I'm actually more inclined to believe them. It's pretty easy for a billing system to say "You haven't met your deductible" or "You've paid about enough"... but as I understand it, the legislation requires that each patientis cost be tracked on a per-patient basis - not per-policy or even per-insurer. That means the records have to be combined from every participating hospital, correlated with information from every other insurance provider, and deduplicated accurately, before they can be added.

There are many people with multiple health insurance policies, who go to several healthcare systems, or have incorrect identification data in their records. What's being asked is not simply adding a few numbers in a bill, but rather merging trillions of records with few errors, across hundreds of formats from thousands of providers.

I wish them luck, and I'm glad I'm not in that field any more.

Just curious

[Trailer Trash]

By what legal authority did Obama delay this implementation?

Re:Just curious

[laird]

Wrong on so many counts.

The executive branch has the authority (granted by Congress) of delaying implementation of laws if there are implementation issues that require a delay to work out. It happens fairly often, though usually without the whining that's accompanying this instance. Which is odd, because it was Republicans asking for the delays, and causing the problems that lead to the delays, so it's nonsensical for them to complain about having been given the delay they asked for.

The waivers are a part of the ACA, to give states flexibility in how they implement healthcare reform, as long as they meet or exceed the targets for cost and coverage. And since Republicans were asking for the waivers via the mechanism defined in the ACA, I'm not sure how they'd justify complaining that they were given the waivers that they asked for. Or that it's somehow an exception to the ACA.

And the price support that Congressional staff is receiving for healthcare bought through the exchange is exactly the same as the price support that they are receiving for their current healthcare. Surely you're not arguing that people should lose their existing healthcare benefits from their employer.

So all of your examples of illegal acts are legal.

Care to try again? Perhaps after some more research...

Re:Paver Stones on the Road to Single-Payer

[Gavrielkay]

5) This is an improvement over the decisions about life or death being about share prices and executive bonuses. I don't want it to even remotely cross the mind of anyone with a say in my health care that they might possibly make more money if they leave me sick.

6) Having someone in the family get a very nasty, expensive disease no longer ends in bankruptcy. Which means the rest of us continue to pay for it, but the afflicted family isn't ruined. As we live longer and eat more crap, this begins to affect almost everyone.

7) We quit talking about health care as though it should be less important than police or roads or a standing army - things we already care enough about to devote tax dollars to.

Oooo, ooo. Pick me teacher. I can solve this one

[rsilvergun]

just do away with insurance companies and switch to single payer. We all need health care to live and stuff. What we don't need is a middle man that adds no value between us and our doctors.

Face it, health 'insurance' made since when the only thing a doctor could do was a) amputate and b) give out aspirin. It didn't matter that they only did a few big things that were mostly comfort before you died. Now we want to _use_ insurance. Insurance can't be profitable if we're all going to use it. The entire _point_ of insurance is that most of us aren't going to use it.

It's like hurricane insurance in Florida. Good luck buying it.

Re:Paver Stones on the Road to Single-Payer

[achbed]

It's not such a great idea to remove personal accountability.

You get cancer, it's your responsibility. Can't pay the bills? Then don't get cancer.

You get crippled by a drunk driver who speeds off and is never caught? It's your responsibility. Can't pay the bills? Then don't get hit by a drunk driver.

Leg blown off in a terrorist attack? It's your responsibility. Can't pay the bills? Then don't go to spots that terrorists want to blow up.

Oh, that happened to you? So sorry, here's a bailout because you had personal accountability. Enjoy your long life!

I love the "personal accountability" line. It's simply a nice way of saying "not my problem - fuck you".

That's the beuaty of it

[rsilvergun]

they don't get to decide. Doctors do. It's single PAYER, not single INSURER. It doesn't work the way you're thinking in Europe, Canada, Germany or any of the other single payer systems where people are entitled (whoops used a bad word) to health care. The only purpose of the gov't is to pay doctors. And they can be well paid and still provide great service.

But far be it from me to let a little thing like facts and the failures of the US healthcare system get in thy way of irrational fear mongering perpetuated by a multi-billion dollar insurance industry. Viva la death panels (well, the private ones anyway) :).

Re:That's the beuaty of it

[Anonymous Coward]

Tell me more about how great this works and procedures aren't rationed or wait listed.

It's worked well for me in Australia so far.

Last time I needed it, I went to the hospital (severe abdominal pains), they admitted me immediately. Within 20 minutes I was in a bed and being checked over. Within half an hour, I was on pain relief and monitoring. Overnight, I had a diagnosis and initial treatment so I could leave the hospital. The following week I was given a schedule for follow-up surgery, which I duly attended and which solved the problem.

The sole bureaucratic action I had to make was to present my Medicare card when I first attended the hospital, and even that was optional, if I didn't have it with me. I paid nothing, was treated promptly and got well.

How about you tell me what you think is wrong with it?

Re:That's the beuaty of it

[Hatta]

And my appendices were taken out within 3 hours of diagnosis.

How many did you have?

No so much

[rsilvergun]

Obamacare is really an attempt to create the sort of socialism that Americans can stomach. I got a good buddy with some serious health problems who relies on gov't health care (got several actually, because if you have a health problem it isn't long until you die or need help from the gov't unless you're an Heir/heiress).

Anyway, I started asking him what he was gonna do. How would he use private insurance. Wouldn't they insurer just keep raising his rates. He said that would be wrong, and so somebody should do something 'bout that. I asked who, and how and he said there should be a law that the insurance companies could only charge so much.

Basically he, like most Americans, deep down want single payer health care. But we're been taught from cradle to grave that socialism is bad. We're indoctrinated. It's called cognitive dissonance. He knows he needs socialism to live. He knows he needs help, and he knows it's his right (as a human) to live. Not just to have some blind dumb chance at good luck, but to actually have a life. But he's been taught, over and over, lied to and lied to. So he breaks down.

Obama recognized that there's lots of people like that. So he's giving them what they need (socialized health care) but doing it in the only way he can. He's letting the devil have it's due, and he's going to give billions and billions to parasitic insurance companies who's only purpose is to make us feel better about getting something that's a basic human right.

Re:No so much

[Maxo-Texas]

I get your point if we were talking about a million dollars a year to keep them alive.

But in many cases it's as simple as getting a colonoscopy now if you have money vs in january if you don't (true story - and yes in america).

It may be as simple as $6000 worth of pills a year to stay alive and healthy.

In a country as wealthy as america is, you have to ask how we can let people die.

It's not about suckers- it's about if you are willing to chip in a couple grand a year to make sure everyone in the country does well vs letting 40% of the country die an average of five years sooner. It's really appalling.

I guess if it were 60%- we'd already have decent health care. But talk radio has done a lot of damage. I listened to a guy on the local conservative talk radio.

He was 59-- his unemployment was about to run out- he wouldn't be eligable for social security until he was 62. He was going to lose his house-- his wife was divorcing him.

He couldn't get a job. And being conservative- you know he tried. And he was railing against unemployment. Saying we shouldn't extend it to 99 weeks.

He was literally slitting his own throat- he was so brainwashed.

Re:No so much

[Man On Pink Corner]

BTW, what was this basic "human right" again? I can't seem to place it from what you're saying. You've just been yacking about "socialized health care".

Question: Do you believe that someone without insurance, or who otherwise has no ability to pay, who is suffering from an acute medical emergency, should be turned away from a hospital emergency room and left to die on the sidewalk?

If the answer is "Yes," then you're some kind of barbarian, and we're done here.

If the answer is "No," then I've got some even worse news for you: we already have "socialized medicine." The patient will, in fact, be treated, and you and I will, in fact, pick up the tab. It just costs us several times more than it would in any other civilized nation on Earth, because unlike those nations, we insist on kidding ourselves.