The Deadline Arrives

It’s December 1.  Normally that wouldn’t mean much, except for a turn of the calendar page.  This year, however, it’s a bit different, because it’s been established as the date by which the healthcare.gov website is supposed to be operating at some reasonable level of functionality.

It’s not entirely clear what standard of performance will be the measuring stick; if you listen to different members of the Obama Administration, the goals seem to be a bit of a moving target.  But back when the healthcare.gov website was a crashing, frozen embarrassment, the Administration set November 30 as the deadline.  Now we can expect the website to be the most scrutinized, evaluated website in the history of computers.  There will be a huge spike in usage today, caused in large part by hordes of journalists and bloggers and curious folks who just want to see what the fuss is all about.  You have to wonder — how many of the people on the website are actually using it for its intended purpose of trying to shop for health insurance, rather than messing around trying to see what causes an error message?

We can expect lots of stories about the website over the next few days, from all points along the political spectrum.  Progressives will rave about how much the website has improved, and conservatives will focus on its remaining failures.  The website story will be treated like a horse race, with winners and losers.  In the meantime, average Americans everywhere should be asking how this happened, and why we are spending so much money to fix a website that clearly shouldn’t have been so poorly designed at the outset.  On that latter point, the New York Times has an interesting piece about how the failure happened and how the Obama Administration reacted.  It’s not an attractive story.

Thanksgiving Table Talk

President Obama’s website suggests that Americans talk about health insurance and the Affordable Care Act over their Thanksgiving meal. Some people object to this, arguing that the President is trying to hijack the holidays for political purposes.  I disagree.

In reality, the President is trying to perform an important public service.  Like everyone else who has moved from the kiddie table, he knows from painful experience that family discussions at the Thanksgiving table often can be difficult and filled with awkward pauses.  He just wants to be helpful by suggesting a new topic of conversation for families in which every Thanksgiving conversation sounds the same themes.

During the early ’70s, for example, every Thanksgiving meal at the Webner household included these conversational non-starters:

Grandma W. — The turkey is a bit dry.  Don’t you think the turkey is too dry?

Mom (trying to change the subject) — Would anyone like some jello salad?

Dad (to me and/or UJ) — When are you going to get a haircut?

Grandma N. — Cathy, your mother tells me you’ve been seeing a young man.

Uncle Tony — The football game is about to start.

Dad (to me and/or UJ) — When are you going to get a job?

Those meals cried out for presidential conversational guidance.  And by suggesting that people talk about the Affordable Care Act, the President is doing his best to help families find common ground this Thanksgiving — because just about everyone, young and old, from any point on the political spectrum, thinks the healthcare.gov rollout has been disastrously botched.  Raising that topic is bound to produce some jokes and apocryphal tales to keep the table talk going.

Thanks, Mr. President!

When Everyone And Everything Seems To Suck

These days America, collectively, is like Mikey in the old TV commercial for Life cereal.  We seem to hate everything — or, more precisely, everyone, or every party, that has anything to do with national politics.

NPR had an interesting story last night about the unusual poll results we are seeing.  President Obama’s general approval numbers not only are plummeting, but public perception of his personal qualities for honesty, trustworthiness, and awareness of the concerns of ordinary Americans also is falling like a brick tossed from the roof of a skyscraper.  And he’s not alone.  Approval ratings for Congress, and for congressional leaders, Democrats and Republicans alike, are incredibly low, and their negative ratings are spiking.

I think the mood of abject disgust that these polls reflect is real, and likely to be long-lasting.  The debacle with “Obamacare” and the healthcare.gov website, coming on the heels of the government shutdown, have contributed to that mood, but the sense of fear and loathing has been brewing for some time.

President Obama’s awkward comments about the “Obamacare” rollout, which suggest his seeming disengagement with nuts and bolts decisions and bad news,  his failure to truly monitor important activities, and his apparent discovery that everyday activities like buying insurance can be complicated, aptly capture our concerns about all politicians.  Forget about being competent; are they even paying attention?  Do they feel accountable for blunders that cost taxpayers billions to fix?  Are they so insulated by a phalanx of sycophants and enablers and excuse-makers that they really don’t live in the same world the rest of us occupy?

From time to time during my adult life, people have questioned whether a viable third party could emerge, but America’s two-party system is just too engrained.  These days, however, I wonder:  are the repeated failures we are seeing fraying the ties to political parties for everyone other than the true believers?  Might a significant chunk of Americans be willing to look in a new direction?

The Manhattan Project, The Apollo Space Program, and Healthcare.gov

Today the Obama Administration announced that 106,185 people have “selected” health insurance since the Affordable Care Act took effect on October 1, about 20 percent of the Administration’s stated goal for October.  The much-maligned Healthcare.gov website performed even worse than expected — fewer than 27,000 people used it to sign up for coverage.

In an odd way, the Affordable Care Act seems to be knocking down some of the political barriers between Americans.  Democrats and Republicans, liberals and conservatives, tea partiers and progressives alike are scratching their heads about where things went wrong.  I don’t diminish the technological challenges of developing a website for the Affordable Care Act — I couldn’t do it — but commercial entities manage to develop websites that are nimble, easy to use, and capable of handling far more volume than has been handled by Healthcare.gov.  Why couldn’t the government do so?

Some people are suggesting that maybe the Affordable Care Act is showing that government simply is not well suited to managing massive and sprawling projects.  That notion, I think, is completely belied by history.

During the 1940s, the United States somehow managed to successfully fight a two-front overseas war, raise and equip the largest army in the nation’s history, and turn a depressed economy into an awesome engine that produced staggering amounts of planes, tanks, jeeps, battleships, and other implements of war.  It topped off the World War II years by single-handedly, and in great secrecy, unlocking the destructive force of atomic power and figuring out how to use that power in weapons capable of leveling entire cities.

Two decades later, in response to a challenge from a new President, the United States built a space program from the ground up, conquered countless engineering problems involved in protecting humans unscathed from the unforgiving environment of space, and devised the rocket systems, docking systems, computers, space capsules, and space suits necessary to send men to the Moon, allow them to romp on the lunar surface, and return them safely to planet Earth.

The Manhattan Project and the Apollo space program were far more complicated and challenging than building a functioning website that would allow people to shop for health insurance coverage and sign up when they have found a plan they like.  Are people who wonder whether our government is capable of handling large-scale tasks really saying that intrinsic limitations in the capabilities of our government mean we couldn’t successfully complete the Manhattan Project or the Apollo program these days?

I just don’t buy it.  The history of America shows that government can perform admirably on big jobs, and I don’t think Americans or their capabilities have changed for the worse since the 1940s or the 1960s.  The problem isn’t the government or its structure, the problem is who was running the show and managing the effort.  Could the President’s falling approval ratings be a reflection of the fact that more and more people are coming to that conclusion?

To Each His Own Reality

This week there were gubernatorial elections in New Jersey and Virginia.  Voters went to the polls, cast their ballots, and there were winners and losers.  Right?

Not so fast!  Apparently the number of actual votes received by candidates don’t tell the real story — at least, according to the losing party.

In New Jersey, Republican Chris Christie won a crushing victory in a traditionally Democratic state.  Yes, but, the Democrats say, Christie is not a Tea Party Republican and the vote for him actually should be interpreted as a rebuke to Tea Party extremism.  In Virginia, Democrat Terry McAuliffe took back a governorship that had been in the hands of the GOP.  Yes, but, the Republicans say, his opponent turned an apparent landslide into a close contest in the weeks after the problems with the Affordable Care Act hit the news, and the vote really should be seen as a repudiation of “Obamacare.”  It’s silly, of course, to try to extrapolate the results of state elections, which often turn on state-specific scandals and superstorms, into some kind of national Rorschach test.  Clearly, though, nobody apparently accepts a loss as a loss anymore; every bad election result just provides a platform for spin, excuses, and sketchy rationalizations.

It’s one thing to take that approach with election results, but quite another to apply it to functioning government programs.  Republicans see the troubled Healthcare.gov website as yet another example of catastrophic governmental hubris and ineptitude, Democrats say Republicans should accept some of the blame because they have stoutly opposed the Affordable Care Act at every turn.  The parties have radically different views of the meaning of governmental debt, whether the economy is performing poorly or well, what constitutes poverty or need for governmental assistance, and countless other topics.

How are these people supposed to reach agreement on anything if they don’t seem to even occupy the same frame of reference?  To paraphrase a classic line originally directed at Cliff Clavin on Cheers:  “Republicans and Democrats, what color is the sky in your world?”

Sherrod’s Softball

Kathleen Sebelius, Secretary of the Department of Health and Human Services, was back on Capitol Hill today to testify about the Affordable Care Act and the troubled healthcare.gov website.  According to NBC News, was “grilled” by both Democrats and Republicans in the Senate Finance Committee.

Except, apparently, for Ohio Senator Sherrod Brown.  If the rest of the hearing was a grilling, Senator Brown must have been in charge of the backyard softball game.  NPR reports that Senator Brown asked Sebelius to talk about the law’s legacy:  “What are people going to say about the Affordable Care Act in five years and in 48 years?”

Huh?  The Secretary has presided over the most disastrous rollout of a federal program in living memory, the country is currently grappling with the fallout from that failure and other issues posed by the Act, and Senator Brown is channeling his inner Oprah and asking Secretary Sebelius to speculate about a legacy?

In fairness, these kinds of politicized questions aren’t unusual.  As the NPR story also reports, a Republican Senator used his entire allotment of time to make a critical speech, without asking Secretary Sebelius a single question.  What’s the point of having Cabinet officers testify if they aren’t asked questions?

These partisan antics are the kinds of things that drive me nuts about Congress.  There are dozens of entirely legitimate questions to ask Secretary Sebelius about how this landmark statute is working, why the website wasn’t better designed, and other topics of great interest to Americans who are trying to understand why the rollout of “Obamacare” could be so mishandled and what they must do to comply with a complicated statute.  Can’t members of Congress lay aside their party affiliations and their desires to make speeches, even once in a while, actually ask questions that should be answered, and get answers that will help them to decide how we can move forward?

The Network Issue

Another area in which the Affordable Care Act will have an impact on health care in America is beginning to get some attention.  It has to do with the “provider networks” — that is, the collection of doctors, hospitals, and other health care facilities and personnel being offered by some of the new insurance plans.

The Affordable Care Act posed some difficult challenges for insurers.  Under the statute, they were required to include a number of new, mandatory forms of coverage in their health care plans.  That requirement, obviously, limited the ability of insurers to control the costs of particular plans by tailoring the kinds of care covered by those plans.  But the insurers still need to figure out a way to control costs, because their plans need to be competitively priced.

There aren’t a lot of remaining cost-control options. One is to tinker with things like co-payments and deductibles and increase the non-premium payments that the insureds must make when they use health care.  Another is to limit the networks to particular health care providers who, due to location or contractual agreement or some other consideration, are offering health care at lower prices than their competitors.

That’s the gist of an article in the Wall Street Journal by a cancer patient whose existing policy has been canceled and who can’t find a substitute policy that includes all of the providers that have given her the unique combination of care that has allowed her to beat the odds and survive.  It’s an indication of the kind of long-term effects that will play out over time, as the Affordable Care Act reshapes the health care market.  In the individual market, at least, Americans who are used to going to whichever doctor and hospital they choose may need to change their habits — and they probably won’t be very happy about it.

The Perils Of Overpromising

In a memorable episode of the classic TV sitcom 3rd Rock from the Sun, Sally the alien and Officer Don are discussing becoming intimate for the first time.  The straightforward Sally asks:  “Well, Don, are you ready to rock my world?’  And the nervous Officer Don gulps and responds:  “Well, perhaps jostle it a little bit.”

Officer Don clearly understood the perils of overpromising.  It’s a lesson that President Obama and his administration are learning the hard way these days.

Hundreds of thousands of Americans have been receiving cancellation notices from health insurers that are discontinuing existing coverage because it doesn’t satisfy all of the requirements of the Affordable Care Act, or “Obamacare.”   It’s not clear how many people ultimately will receive cancellation notices, but experts predict that a significant percentage of those who currently buy individual coverage — between 7 and 12 million people — will be affected.  Under the Act’s “individual mandate,” all of those people will need to find new insurance that complies with the requirements of the Act, either through the dysfunctional Healthcare.gov website or some other process.  News sites are filled with stories about people who have found that they will need to pay much more each month for coverage, often with higher deductibles.

These people are upset because they remember President Obama’s repeated promise that, under the Affordable Care Act, if you like your insurance, you can keep it.  But the statute and its regulations were written to prevent that pledge from being honored, by requiring that all insurance plans include certain forms of coverage, such as maternity care, mental health benefits, and prescription drug benefits, that were not offered by many stripped down, inexpensive plans.  The inevitable result was that those plans would end and the new options, all of which include the mandatory coverage, would be more expensive for many people.  Of course, when you hit people who are trying to live within their means with monthly insurance costs that are significantly higher than what they had budgeted, you’re bound to make those people angry and bitter.

It’s a predicament that the humble Officer Don would have avoided.  Of course, few politicians seem to truly appreciate the perils of overpromising.

Public Sector Vs. Private Sector

You’ve got a new product that you want to roll out to the American public.  It’s hugely important, and hugely controversial.

You’re trying to appeal to young people.  You want them to sign up for your product.  You know that their participation is crucial if you want your product to be a success.

You also know that most of the people in your target demographic are tech-savvy folks.  If they are going to sign up, they are going to do so through a website.  After all, it’s how they buy music, and concert tickets, and other things that they want.  If your new venture is going to be successful, it’s essential that you have a website that is user-friendly.

So, who do you select to manage and supervise your roll out and website development?  A computer geek who has developed successful, accessible websites for google, Amazon, and other lucrative internet businesses?  A tech wizard who is intimately familiar with cutting-edge technology and user interface concepts?

Or, the ex-governor of Kansas?

Toto, I don’t think we’re in Kansas anymore!

Consumer Reports Meets Healthcare.gov

When Kish and I need to buy a car, a major appliance, or some other significant product, we typically consult Consumer Reports.  There we find objective evaluations of our potential purchases by knowledgeable analysts, written in plain English accessible to the non-gearheads and non-techies among us.

So, I was interested when Consumer Reports tackled the process of trying to use Healthcare.gov, the federal government’s health exchange website.  It makes sense when you think about it.  One of the primary goals of the Affordable Care Act is to get uninsured consumers to buy insurance, so why not have one of the country’s preeminent consumer publications take a look at the process from the consumer’s standpoint?

Unfortunately, the Consumer Reports review of the Healthcare.gov process isn’t very encouraging.  It notes that of the nearly 9.5 million people who apparently tried to register on Healthcare.gov in the first week of its operation, only 271,000 — about 1 in 35 — were successful.  The article then provides tips about how to increase your chances of successfully navigating the website, offered by a software pro who has taken a careful look.  (You can find the software pro’s blog, which addresses some of the problems he has found with the website, here.)  Among other issues, he finds the instructions “garbled” and “needlessly complicated,” advises that you should simply ignore error messages that do not match reality, recommends that you immediately try a new user name, password, and security questions if “anything at all doesn’t go right,” and suggests that you check your e-mailbox frequently for a confirmatory e-mail, because Healthcare.gov will time you out if you don’t respond promptly.  The software guy also notes that many people are experiencing problems because of a crucial design error on the website:  it loads “cookies” and other code onto user computers during the registration process that prove to be too large for Healthcare.gov to accept back.

Consumer Reports also recommends that potential users “[s]tay away from Healthcare.gov for at least another month if you can,” because “[h]opefully that will be long enough for its software vendors to clean up the mess they’ve made.”  This advice is particularly interesting, because Consumer Reports also believes that the best source of information about healthcare options for consumers who are looking to buy health insurance themselves is through the health insurance marketplace in their state and Healthcare.gov — if it could only be made to work.

 

Some Explaining To Do

The House Energy and Commerce Committee has scheduled a hearing on Thursday on the federal government’s health exchange website.  They’ve asked Kathleen Sebelius, the Secretary of the Department of Health and Human Services, the agency that is principally responsible for the website, to testify.  Sebelius has declined, saying she is not available to testify.

It’s not clear to me why Sebelius has declined the request.  The CNN story linked above doesn’t say Sebelius has a conflict on her schedule.  Instead, the HHS spokesperson said:  “Given that the government was shut down until today, we were given a very short timeline to respond to this request.”  Does that mean that the Secretary of HHS needs more than a week to be prepared to answer questions about how the website is working?  If so, perhaps the problems with the website are even more extensive than has been reported.

I hope Sebelius’ response to the request doesn’t mean that the Obama Administration is going to stonewall providing meaningful information about the operations of all of the health exchanges and the status of the enrollment process, and I hope that Sebelius reconsiders her decision and decides to appear.  The websites are a crucial component of the Affordable Care Act, and the federal government has already spent hundreds of millions of dollars on them.  Taxpayers and citizens have a right to know how the system is performing.

In my view, it’s also in the interest of Sebelius and other administration officials to explain what is happening.  If there are problems, identify precisely what they are and describe what is being done to fix them and when the fixes will be completed.  If the enrollment process has some successes to its credit describe what those are.  No doubt friendly members of the House Energy and Commerce Committee will be happy to ask some questions designed to fully elicit the good news, just as diehard opponents of “Obamacare” will be asking tough questions.

As a matter of good government, we should all support requiring administrative officials to promptly testify when Congress calls.  We would all be better off if Congress exercised more oversight over our vast administrative state — from its surveillance programs, to its spending habits, to its error-plagued websites, and beyond — and regularly subjected agency heads to tough questioning about federal programs.  I can’t believe there is anything on Secretary Sebelius’ schedule right now that is more important than appearing before Congress and providing a credible explanation of what is happening with Healthcare.gov and the other health exchange websites.

The Michigan Question

This week was a bye week for the Ohio State football team, so the Buckeye Nation had to wrestle with deeper, almost philosophical questions — like whether it is ever appropriate to root for Michigan.

Normally, the notion of supporting Michigan would be anathema to most Ohio State fans.  They despise the strutting Wolverines and everything they represent.  Asking purists Buckeyes to root for Michigan would be like asking Ted Cruz to do whatever he can to ensure that “Obamacare” is a great success.

This year, though, the issue is slightly different.  The Buckeyes have won every game, but they haven’t looked particularly impressive in doing so.  And their schedule is weak.  It’s apparent that the Big Ten, top to bottom, just isn’t that good this year, and if Ohio State hopes to play in the BCS championship game it needs some signature wins.  Pragmatists argued that if Michigan goes undefeated then Ohio State would gain credibility by beating them.

The debate between the pragmatists and the purists raged in Columbus this past week.  Alas, it was mooted by yesterday’s results, as the Penn State Nittany Lions beat the Michigan Wolverines in four overtimes, 43-40.  Now everything can go back to normal and Buckeye Nation can root for teams to beat the pants off Michigan every week.

The “Glitches” Continue And The Concerns Grow

The continuing saga of the federal government’s Affordable Care Act website is worth following, because it is telling us a lot about how modern government works, and doesn’t work, and what we should believe.

Most people, including me, have focused on the access issues with the Healthcare.gov website — that is, the fact that there are ongoing reports that people simply cannot get on the website and use it as intended, and whether the design of the system in fact works against that.  But there are other issues, too.

For example, how complete and accurate is the information the website is collecting?  Anyone who has filled out a health-care application knows that a mass of information must be provided.  A recent article quoted industry sources who estimated that only one in 100 applications completed on the website contain enough information to actually enroll someone in a plan — which of course is the entire point.  As the article notes, much more serious problems could be coming if people believe they have successfully enrolled, only to be told later that the information they provided was insufficient or lost.

And speaking of information — how secure is the data those lucky people who have been able to use the website have provided?  Health care information and financial information is extraordinarily confidential.  Given the apparent design flaws with the website, why should anyone have great confidence that the designers at least got system security right?  Given the coverage of the problems with the website, are legions of hackers around the world targeting it as an easy potential source for personal information, like Social Security numbers and credit card data?

And finally, there is cost.  Some sources have tried to piece together government contracting data to determine how much the Affordable Care Act websites have cost the taxpayer.  The Washington Post says about $400 million has been committed to the health care exchanges.  The Digital Trends website estimates the cost so far is more than $500 million, with a total cost of more than $2 billion expected.

With costs like this, it’s fair to ask whether we are really getting our money’s worth.  On Thursday, Secretary of Health and Human Services Kathleen Sebelius visited Pittsburgh as part of a nationwide campaign to tout the exchanges.  She assured the audience that the “glitches” were being addressed and the system is getting better every day.  Event planners had brought more than 20 certified health care application counselors to meet with uninsured people, but even the certified counselors couldn’t access the Healthcare.gov website.  So, who do you believe — the bureaucrat who says the system is improving, or the fact that even computer geeks can’t get it to work?

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.

First-Day “Glitches”

Today was the first day Americans could try to access health care exchanges under the Affordable Care Act — known to some as “Obamacare.”

It’s fair to say that the process didn’t go smoothly.  The Chicago Tribune reported, for example, that consumers seeking information encountered “long delays, error messages and a largely non-working federal insurance exchange and call center Tuesday morning.”  It’s not entirely clear how widespread the problems were, and are, but the prevailing theme of the news stories was about difficulties, failures, and frustrations.  As the video above shows, one MSNBC anchor tried to obtain information about options on-line, to try to help viewers understand how the process worked, and was hit with error messages, inability to resolve the issues through an on-line chat session, and finally being put on hold for more than 30 minutes before hanging up because her patience was exhausted.  

The President says there will be problems and “glitches” because we are trying to do something that hasn’t been done before.  I’m not sure that is quite right — there are commercial websites that handle significant volumes of traffic without problems — but his reaction, I think, misses a fundamental point that would not be lost on a businessman.  One of the selling points for the Affordable Care Act was that people could quickly and easily get information about competing health insurance options with a few clicks of a mouse.  Given that pitch, a business would never roll out a website without being absolutely certain that it worked well, because businesses know that consumers can quickly become frustrated — and a frustrated consumer is one that is not likely to come back.  It says something about the government mindset that they would go live with websites that clearly aren’t ready.

The people implementing the Affordable Care Act missed a real opportunity today.  The negative publicity about the websites and their problems are the kind of thing that could become fixed in the minds of the American public, with people coming to accept as conventional wisdom the notion that the websites, and exchanges, are an enormous hassle fraught with delay and failure.  When you’re trying to convince people who aren’t insured to become insured, and you’re trying to overcome the drumbeat of Republican criticism of “Obamacare,” a disastrous first-day roll-out just makes your job immeasurably harder.