Questioning The Architecture Of The “Obamacare” Websites

The Affordable Care Act health care exchange websites continue to be plagued with problems, beyond the first-day “glitches.”  The Obama Administration says it’s due to heavy traffic.  Now Reuters has published an interesting article suggesting an alternative explanation.

Reuters interviewed IT experts who question the very architecture of the federal health care exchange website.  They believe that the website simply requires computers to load too much software and information, overwhelming the system.  One expert found that clicking “‘apply’ on HealthCare.gov causes 92 separate files, plug-ins and other mammoth swarms of data to stream between the user’s computer and the servers powering the government website,” including 56 JavaScript files and plug-ins that allow data to be uploaded.

As one expert explained it, the massive volume of data moving between computers and servers resembles a computer hacker attack on a website — except this attack is self-inflicted, as part of the website’s basic design.  If the experts are right, the website designers made a very fundamental, almost amateurish blunder.

The bottom line from these experts is that the solution is not simply adding more servers, but reconfiguring the system.  That possibility would involve more expense, and delay, and frustrations for people who are just trying to comply with their legal obligation to obtain insurance.

Learning From “Obamacare”

Some people are ardent proponents of the Patient Protection and Affordable Care Act — known to many as “Obamacare” — and others are equally ardent opponents.  People on both sides of the issue feel passionately about whether the concept and purpose of the statute is good or bad, and it’s hard for a moderate to find common ground.

I think there is one thing, however, that fair-minded people on both sides of the issue might grudgingly accept:  the implementation of the statute hasn’t gone as its advocates forecast.  There have been delays in promulgating regulations, and developing systems to audit and enforce the different provisions of the law.  There have been unexpected consequences, as employers have considered the economic impact of different potential approaches to compliance with the law — a process that has resulted, for example, in some employers deciding to focus more on part-time workers.  The allegiances of former supporters of the bill, such as labor unions, have in some cases shifted as regulations are promulgated and the potential impact of the statute has become clearer.

None of this is particularly surprising, but it does teach a valuable lesson.  The American economy is extraordinarily complex, and whenever Congress promises to take an action that “fixes” a problem, we should all show a healthy skepticism.  Health care is a significant and complicated part of the economy, but it’s not appreciably different than, say, the mortgage loan sector.  People are, perhaps, more aware of the issues with the Affordable Care Act because it has been the continuing subject of withering public attention and because, in certain respects, its implementation is having an impact on everyday Americans — but I think it’s quite plausible that the financial institutions regulation that Congress enacted recently, or for that matter the Patriot Act passed in the wake of 9/11, are having similar issues and producing similarly unanticipated effects.

This has nothing to do with the party affiliation of the sponsors of legislation, or even the competence of the administrators trying to draft appropriate regulations.  It’s just reality.  The American economy is intertwined and interdependent and interconnected that broad-based regulations are going to have a ripple effect that could go far beyond whatever the politicians promise.  All of us, Democrat and Republican, should remember that the next time Congress makes confident predictions about the effect of a significant statute.

Up To The Supremes

The U.S. Supreme Court has decided to accept one of the appeals addressing President Obama’s health care statute, and thereby has set the stage for one of the most anticipated legal rulings in years.

In its order accepting the case, the Supreme Court identified four issues for the parties to brief and set aside five-and-a-half hours for oral argument.  Five and a half hours!  It’s an extraordinary amount of time, but why not?  The issues presented are titanic and unprecedented and could have far-reaching consequences.  Can the federal government require everyone to buy insurance?  If not, should the entire statute fall?  Should the Supreme Court even decide those issues on their merits, or should it wait for the law to be fully implemented?

Many people will focus on the political impact of any Supreme Court ruling on the health care statute, but I think the legal issues are of the most interest.  In many ways, the statute tests the outer limits of Congress’ power under our Constitution — if in fact there are any limits left.  The Supreme Court may well decide that issue come June.

The “Health Care Reform” Law Hits The High Court

It is looking increasingly likely that Supreme Court will hear an appeal of the ever-controversial “health care reform” law, and soon.

Both sides to a lawsuit — the Department of Justice in favor of the law, and 26 states and the National Federation of Independent Businesses in opposition — have asked the Court to accept an appeal and decide whether the law should be upheld or struck down as unconstitutional.  The Supreme Court has the discretion to decline the appeal, but the fact that the appellate court declared the law unconstitutional, and the fact that both sides to the case are seeking review, should increase the chances the high court will hear the case.

Stripped of its partisan baggage, the appeal poses a fascinating legal issue:  how far does Congress’ power to regulate interstate commerce extend?  In prior cases, the Court has articulated an expansive view of that power.  However, opponents of the new law argue that this case is different because Congress — through the “individual mandate” provision that requires all citizens to buy health insurance — is for the first time assuming the power to compel unwilling citizens to engage in commerce.  Proponents of the law respond that, when it comes to health care, every living American is already affecting commerce, because those who don’t have insurance and then need health care are imposing economic burdens on the rest of us.  A Supreme Court decision on this issue would go a long way toward defining, once and for all, the full extent of Congress’ power to regulate the daily lives of Americans.

If the Supreme Court takes the appeal, it would be likely to rule in the summer of 2012 — just before a presidential election where the wisdom of the “health care reform” law is likely to be a very hot topic.  And the decision will come against the backdrop of a recent report that shows a sharp increase in health care costs, which undoubtedly will cause Republican candidates to blame the unpopular new law and redouble their attacks on it.

Who Is This Guy? (The Health Care Side)

The third part of the approach President Obama outlined in his fiscal policy speech on April 13 addressed health care costs.  He first contrasted his approach with his characterization of the Republican plan.  He said Republicans intended to reduce health care costs in the federal budget by “asking seniors and poor families” to pay the health care costs, whereas his approach would “lower[] the government’s health care bills by reducing the cost of health care itself.”

How to do so?  First, by reducing “wasteful subsidies and erroneous payments,” cutting “spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market,” and working with governors “to demand more efficiency and accountability from Medicaid.”  Next, the government will “change the way we pay for health care” with “new incentives for doctors and hospitals to prevent injuries and improve results.”  Finally, “we will slow the growth of Medicare costs by strengthening an independent commission of doctors, nurses, medical experts and consumers who will look at all the evidence and recommend the best ways to reduce unnecessary spending while protecting access to the services that seniors need.”  These initiatives, the President said, will save $500 billion over the next 12 years.  And if those savings don’t materialize, “then this approach will give the independent commission the authority to make additional savings by further improving Medicare.”

This part of the speech seems completely inconsistent with a prior part of the same speech.  The President earlier observed:  “So because all this spending is popular with both Republicans and Democrats alike, and because nobody wants to pay higher taxes, politicians are often eager to feed the impression that solving the problem is just a matter of eliminating waste and abuse.  You’ll hear that phrase a lot.  ‘We just need to eliminate waste and abuse.’  The implication is that tackling the deficit issue won’t require tough choices.”

The clear implication of that passage is that promising savings from eliminating “waste, fraud and abuse” is not a serious approach to solving budget problems.  Yet isn’t that all that the President’s health care approach does?  Look again at the President’s proposed approach, and you’ll see plans to eliminate “wasteful subsidies and erroneous payments” (end waste), to demand more “efficiency and accountability from Medicaid” (prevent fraud), and to “improve results” while “reducing unnecessary spending” (avoid abuse).  It’s as if the two parts of the speech were written by two different speechwriters — or as if President Obama thinks that, just because he is the one making the proposal, the tired “waste, fraud and abuse” mantra has actual validity this time.

So, again, I am left to wonder what this President actually believes.  Does he believe that a deficit reduction plan that focuses on eliminating purported “waste, fraud, and abuse” is really no plan at all?  Or, does he truly think there is $500 billion in waste, fraud and abuse to be wrung from our health care spending — and if that is the case, why has that waste, fraud, and abuse been allowed to continue unabated during the first two years of his Presidency?

While we are asking questions, another fair question is whether the President honestly thinks that there is any real value in blue-ribbon commissions, when the political landscape is littered with the reports of prior blue-ribbon commissions that have been happily ignored by those in power.  And if the President does think such commissions are a powerful answer to problems, why does he hold that belief when he has pretty much ignored the recommendations of the Bowles-Simpson budget commission that he himself appointed?

Who Is This Guy?  (The Defense Side)

Who Is This Guy?  (The Spending Side)

Government By Waiver

One of the more troubling aspects of the “health care reform” legislation enacted into law last year has been the ability of companies and unions to get waivers that relieve them from having to comply with certain aspects of the law.  The waivers relate to provisions of the law that prevent plans from using high deductibles or low annual limits to control benefits.  Unfortunately, many plans need such provisions to manage costs; without those provisions, employers and unions would need to jettison their plans as unaffordable.

The Department of Health and Human Services may waive those provisions for certain employer and union plans.  The HHS website explains that, to be eligible for a waiver, the plan must certify “that a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage” and must inform plan enrollees “that their plan does not meet the requirements of the Affordable Care Act.”  Whether to grant the requested waiver then seems to be entrusted to the discretion of the HHS and its Secretary, Kathleen Sebelius.  To date, 733 company and union plans, covering 2.1 million Americans, have received waivers.

This concept of “government by waiver” is troubling.  I’m skeptical of the claims of some conservatives, who believe that the waivers are being handed out as rewards for prior political support.  I do, however, question a process that allows unelected bureaucrats to grants waivers from a law that is supposed to apply to everyone.  The waiver process is symptomatic of the accumulation of power in the Department of Health and Human Services that seems to be the true hallmark of the “health care reform” legislation. If the law remains in force, Americans will need to get used to the idea that HHS will be making all kinds of decisions that have a direct impact on our health care.

In addition, what does it say about this hastily drafted, poorly considered law that more than 700 plans have certified that one of the law’s provisions will either vastly increase costs or cause coverage to be sharply curtailed?  Does anyone doubt that, if all American businesses had been aware of the possibility of obtaining waivers, that 700 number would have been multiplied by a significant factor?  It also is worth noting that the waivers aren’t limited to small, Mom and Pop plans.  To the contrary, some of the plans that have received waivers have hundreds of thousands of participants.  According to the HHS website, the plans that have received waivers include the United Federation of Teachers Welfare Fund (351,000 participants), CIGNA (265,000 participants), Aetna (209,000 participants), and BCS Insurance (115,000 participants).  Given these waivers, how can the proponents of the “health care reform” legislation continue to contend that the legislation will neither increase costs nor reduce coverage?  By granting the waivers, the bureaucrats at HHS are admitting that the exact opposite will occur if the law is enforced as written.

Making A Statement And Fulfilling A Promise

The House of Representatives, now under Republican control, has passed legislation to repeal the “health care reform” legislation passed by the last Congress.  Democrats in the Senate, who control that chamber, are saying that repeal legislation will never come to the floor for a vote — and, of course, President Obama would be expected to veto any repeal legislation that would happen to reach his desk.

So, was the House vote a waste of time?  I don’t think so.  By voting to repeal the “health care reform” legislation, the Republican majority was fulfilling a campaign promise.  We should applaud politicians who do so, not condemn them.  The general public would have a more favorable view of politicians generally if more politicians actually tried to keep their promises.  By acting so promptly, the Republicans are demonstrating that elections have consequences.  And, of course, you never know whether political pressure will build on the Senate to consider some form of repeal legislation.  If Democrats in the Senate consider the legislation to be such a great success, why should they duck a vote on its proposed repeal?

Now that the Republicans in the House have met one of their promises, they need to turn to working on the others.  If I had a vote, I would urge them to focus on deficit reduction and a careful analysis of potential federal spending cuts.