Assessing the Exchanges

National Review ^ | Yuval Levin

[Raebie]

Over the last few days, I have spoken in some detail about the state of the federal Obamacare exchanges with several officials of the Center for Medicare and Medicaid Services (the HHS agency that is running the exchanges), and with a number of reasonably well placed insurance company officials in Washington. The picture they paint of how the rollout of the exchanges has gone is similar in its broad strokes to what has emerged in other reports in recent days, so I don’t think I’ll be breaking much news here, though some of the details have (I think) not been reported. For what it’s worth, I offer below the basics of what they had to say and some reflections on its implications. This is a long post, with apologies, but I thought some of the particulars would be of interest.

[Raebie]

"One key worry is based on the fact that what they’re facing is not a situation where it is impossible to buy coverage but one where it is possible but very difficult to buy coverage. That’s much worse from their point of view, because it means that only highly motivated consumers are getting coverage. People who are highly motivated to get coverage in a community-rated insurance system are very likely to be in bad health. The healthy young man who sees an ad for his state exchange during a baseball game and loads up the site to get coverage—the dream consumer so essential to the design of the exchange system—will not keep trying 25 times over a week if the site is not working. The person with high health costs and no insurance will. The exchange system is designed to enable that sick person to get coverage, of course, but it can only do that if the healthy person does too. The insurers don’t yet have a clear overall sense of the risk profile of the people who are signing up, but the circumstantial evidence they have is very distressing to them."

[Gaffer]

My overarching question about all this agonizingly fruitless analysis of a system that cannot even begin to barely function at any level beyond ‘the few’, is why does the media, academia, health profession, concerned citizens, et al feel it necessary to analyze something that is no more advanced than the pretty pictures my 4 year old grand daughter gives me?

[repentant_pundit]

Within the next 3 months, the 0baMao regime will blame the insurance companies for this train wreck.

And without Congressional approval, the regime will unplug the exchanges and impose a new tax (on all of us who pay taxes) for a new Universal Single-Payer coverage.

Maybe they’ll call it SiPa-Care. It will operate like Medicare, and will increase the national debt in similar fashion.

When SiPa-Care creates a rationing mess, how will they blame the GOP for that?

[cableguymn]

When SiPa-Care creates a rationing mess, how will they blame the GOP for that?

---

did the GOP give them everything they wanted? every dollar they asked for?

No?

There is your blame.

Plus the GOP runs around with a “blame me” sign on their back and they absolutely suck at deflecting blame. So bad that I think they want to be blamed.

[Thommas]

..how will they blame the GOP for that?

Seriously? The same way they have in the past..

The evil Republicans have bought and paid for the Health Insurance companies, ergo, they have conspired to sabotage the Savior's crowning achievement. It's all an insidious plot by Tea Party extremists, and it's Bush's fault.

The only way to thwart these rascally Republicans is to foist Single Payer Health Care on everyone. It's that simple.

[Thommas]

Your argument is better than mine. I envisioned Health Insurance companies still in the picture; they won’t be.

[upchuck]

From the article:

One key problem, which to date has been the most prominent in public, has to do with a late-in-the-game decision to require users to go through a complex account-creation process before even reaching any coverage options. Administration officials apparently went back and forth several times on this question, and the ultimate decision required the creation of a series of patches over an already developed site in a very short time.

For folks not familiar with web site design, consider this analogy:

You've had an architect design a one story house. The builder has built it per the specs. The house lacks only interior painting and floor coverings to be move-in ready.

You approach the architect and ask, "How much trouble would it be to add a second story?"

That is very similar to what happened with healthcare.gov.

[Raebie]

Exactly.

Except it’s my strong suspicion that the first floor needed a lot more than paint and floor coverings when the demand was made. I don’t think they even had all of the support beams up.

[blueunicorn6]

So, the people who have the most to benefit from this have been working hard to get it while the ones who are going to have to pay for it seem to be dragging their feet. Who’d a thunk it.