'This Is Political Malpractice': Inside Views of the Health-Care Mess

Why the president's latest promise may be as ill-founded as his original one
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On the policy screw-up now dominating the headlines, two notes from readers in a position to offer judgments. First, from a tech veteran named Connie Revell:

I was recruited by the administration as an expert on government reform, and I had a terrible experience before leaving in 2010.

What is interesting now is the perfect parallel between my experience then and the bomb of the ACA launch. Specifically, I was asked in late 2010 to assist in the introduction of a website, Performance.gov. This was a nightmare, especially for someone like me, long accustomed to working in teams.  I would edit content, only to have it second-guessed and overruled by unnamed others. But my boss got more and more agitated as the web site failed to go on line at the deadline date, and finally she screamed at me to go into the White House and stay until we got the okay to proceed. Meanwhile, chains of command and bureaucratic morass conspired to doom the web site even as my bosses fought ever harder to launch it. I ask you to check out the product of this angst-- Performance.gov-- as evidence of the inability of the federal government, even at the highest levels as currently constituted, to produce an effective web site. [JF note: For what it's worth, the Aviation Digital Data Service, a federal product, is indispensable and superb. For years I have also made my estimated tax payments etc through a very effective federal site, EFTPS.]

Our web site was small potatoes compared to the crucially important ACA.gov. But it was a precursor of the disaster to follow. We had no ability to create the team dynamic needed to develop a modern web site; we were stuck in the ancient culture of the federal government, further hampered by the addition of contractors, and there was NO hope of getting our web site online. The ACA web site was complex times 1,000, and I cannot imagine a scenario in which this could have worked under any circumstances. If you throw in the active and constant efforts of the GOP to sabotage the effort, you end up with zero chance of success.

I only wish the culture there had allowed top people to know that even launching a relatively innocuous web site like Performance.gov was impossible in that political culture. That might have been an early warning that fixes were required to launch the crucially important Obamacare site. But early warnings -- as when the CIA warned Bush officials of an imminent  Al Queda strike-- are often overlooked when most needed.

Now, from a former health-insurance executive who is a Democrat:

I am appalled that Obama’s advisers, in trying to get him out of the jam created by promising that the insurance companies would not kick anyone off a plan they liked, allowed him to go out there and promise to fix the problem by allowing the insurance companies to continue offering the old plans for another year.

It’s repeating the exact flaw from the first pledge: in order for the promises to work, both rely on totally voluntary actions by the insurance companies!  No government official can force an insurer to offer any policy, ever.  There are some options governmental players can use to force insurers to comply with certain requirements once they do decide to issue a policy or a plan — but that presumes that the carriers have decided to offer a plan.  No one — President, governor or insurance commissioner — can force an insurer to offer a plan in the first instance.

So Obama’s political advisers are telling him to fix a problem caused by implicitly promising that insurers will continue to offer certain plans by ... promising that insurers will resume offering certain plans.

It is not unlikely that the insurers will behave that way — it is impossible.  Even if they wanted to do this, which they don’t  (who wants the headache and expense of offering a bunch of small little plans for a dwindling number of policyholders when the business is shifting to a new and much larger arena with much better economies of scale)  they actually physically, logistically and legally can’t do it. 

Issuing a health care plan is incredibly difficult, cumbersome and complex. Launching a new plan requires at least a year of hard work and prep — designing the benefit, underwriting it, getting the actuarial work done, getting the state rate filing process accomplished including time for a rate appeal, making sure the right network of providers are in place ... on and on it goes.

Bottom line is that the fix the president just promised can’t happen until January 2015, even if it was a good idea, which it is not. And even if the issuers wanted to keep offering the old plans, which they don’t — something we know to a 100% certainty because they dropped these grandfathered plans even though they already are currently free to continue to offer these plans.

Obamacare allowed the issuers to continue the grandfathered plans — and the plans chose to drop them instead. So now the president announces that the plans can re-offer the grandfathered plans they were already allowed to offer, but chose to drop. Which the plans not just won’t, but can’t do, making the president again look like a liar.

This is political malpractice — the president has just made another healthcare promise on which he cannot deliver. And just like the first time, he appears to have no clue that he is doing so.  This is going to be like chickenpox — the first time, it is bad enough. But when the same virus comes back the second time you get shingles, a much worse and more painful condition.

It’s almost as if no Democrat has ever worked in the health insurance industry or at least the White House isn’t checking with them. You’d think the political and communications advisers would want to get the policy part right to make sure the reality would match the message, but they appear oblivious.

So weird.  Potentially devastating and entirely self-inflicted.

OK, a bonus entry: from a software person who thinks that this is all so bad that maybe it is sabotage:

This editorial is from SDTimes [Software Development Times] a fairly respectable trade rag for software development. They offer an interesting perspective/theory on why healthcare.gov is failing.  I haven't seen this notion advanced anywhere else, but the technical aspects are plausible. Anyone can have their own opinion as to whether the insurance companies are doing this deliberately. 

I can't assess any of this first-hand but the ferocity of the judgments, from people (a) in a position to know and (b) sympathetic to the administration is sobering. 

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James Fallows is a national correspondent for The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Carter's chief speechwriter. His latest book is China Airborne. More

James Fallows is based in Washington as a national correspondent for The Atlantic. He has worked for the magazine for nearly 30 years and in that time has also lived in Seattle, Berkeley, Austin, Tokyo, Kuala Lumpur, Shanghai, and Beijing. He was raised in Redlands, California, received his undergraduate degree in American history and literature from Harvard, and received a graduate degree in economics from Oxford as a Rhodes scholar. In addition to working for The Atlantic, he has spent two years as chief White House speechwriter for Jimmy Carter, two years as the editor of US News & World Report, and six months as a program designer at Microsoft. He is an instrument-rated private pilot. He is also now the chair in U.S. media at the U.S. Studies Centre at the University of Sydney, in Australia.

Fallows has been a finalist for the National Magazine Award five times and has won once; he has also won the American Book Award for nonfiction and a N.Y. Emmy award for the documentary series Doing Business in China. He was the founding chairman of the New America Foundation. His recent books Blind Into Baghdad (2006) and Postcards From Tomorrow Square (2009) are based on his writings for The Atlantic. His latest book is China Airborne. He is married to Deborah Fallows, author of the recent book Dreaming in Chinese. They have two married sons.

Fallows welcomes and frequently quotes from reader mail sent via the "Email" button below. Unless you specify otherwise, we consider any incoming mail available for possible quotation -- but not with the sender's real name unless you explicitly state that it may be used. If you are wondering why Fallows does not use a "Comments" field below his posts, please see previous explanations here and here.
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