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Jeffrey Zients Appointed To Fix Healthcare.gov
An anonymous reader writes with news that the Obama administration has appointed Jeffrey Zients to lead the effort to revamp Healthcare.gov after its trouble rollout earlier this month. Zients said, "By the end of November, healthcare.gov will work smoothly for the vast majority of users." Obama created a position for Zients within the government in 2009, when he was made the OMB's Chief Performance Officer. The purpose of his position was to analyze and streamline the government's budget concerns. "Healthcare.gov covers people in the 36 states that declined to run their own health-insurance exchanges. About 700,000 applications have been begun nationwide, and half of them have come in through the website. The White House aims to have 7M uninsured Americans covered by the scheme by the end of March." Zients's appointment came after a contentious House Committee hearing about the healthcare website, in which many were blamed and few took responsibility. The government also said that contractor Quality Software Services Inc., a subsidiary of UnitedHealth group, would "oversee the entire operation" of Healthcare.gov. QSSI has already done work on the website, building the pipeline that transfers data between the insurance exchanges and the federal agencies.
The thing you have to keep in mind about the US Health System is that it's a series of kludges. Active Federal employees on the civilian side use a version of the Dutch system. There's a bunch of Federally owned hospitals (aka: the British system) for military retirees. To insure retirees in the 60s we stole Canada's system, even keeping the name "Medicare," and simply added the words "over 65" to the bill. Which means we have three entire countries worth of health regulations simply for retirees and Federal employees. Most people are insured by their employers , which is a fourth country worth of regulations. Roughly 10% of the country buys on the individual market, which is regulated at the state-level by 50 different regulators, for a fifth country. Medicaid for the poor is a federal/state mixture, which makes it sixth. The uninsured pay their bills a variety of ways, from charity care to sticker price. So we don't really have a health system, we have seven health payment systems.
If we were Canada or the UK, and we didn't have significant Checks and Balances in the policy-making arms of the government, we could do what any smart engineer would do in this situation and start a massive project to replace these seven systems with one system. But we aren't that country. Every American is convinced that his health insurance is great, therefore he will simply not believe your new system will be better for him, therefore he will bitch at his Senator if you try to (for example) let poor people formerly on Medicaid visit his VA Hospital. And getting 51 Senators (or 50 and the VP), and 218 House members to agree to do anything like that has proven to be damn near impossible. You can get them to agree to pour money into one section of the system or another, but they don't change people's health care very often.
So what Obama did was take the least popular one of those systems (the uninsured), and send half of them to Medicaid and half to the Individual Market in a manner reminiscent of the Dutch. He changed the individual market so it is more affordable. In other words the Affordable Care Act had to have the same amount of regulations in it as the entirety of Dutch law relating to Dutch health insurance. Since it kept five of the other six system it also had to include a lot of language/code to insure compatibility with those systems. For example a student whose dad (with custody) is on Medicare, Step-mom is eligible for insurance through her job and the VA, and Mom-mom (no custody) has a policy on the Exchange. Is the kid eligible for the Exchange policy, the VA policy, or does stepmom have to switch over to her job's insurance?
It possible that in China the technocrats who run the Communist party could all have learned a proposal this complicated in a year or so's debate without majorly neglecting their other duties. But we aren't China. We aren't led by nameless suits whose entire role is to exude policy confidence. We are led by us. And it turns out we aren't smart enough to learn a half-dozen slightly different versions of the Dutch system in eight months. Frankly I don't blame us.
What we are smart enough to do is learn the outlines of the ideas, to a surprisingly high level of detail in many areas; and then muddle through the rest the best we can. This is what happens in a democracy with Checks and Balances, entrenched interests (ie: people calling their Congressman in panic when their insurance changes), and an independent legislature whenever anyone tries to fix any major problem.
There was ***NOTHING*** bipartisan about the Affordable Care Act. It was passed without a single Republican vote and lots of dirty parliamentary tricks.
The Democrats and the Obama administration own this.