Why Obamacare Web site crashes; a modest proposal to end the shutdown crisis; and more on the healthcare dilemma.

View 794 Monday, October 14, 2013

“Transparency and the rule of law will be the touchstones of this presidency.”

President Barack Obama, January 31, 2009

 

Christians to Beirut. Alawites to the grave.

Syrian Freedom Fighters

What we have now is all we will ever have.

Conservationist motto

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This is still pledge week for KUSC which means that it’s also the Chaos Manor subscription time week. I don’t regularly bug you about subscribing to this site, but when KUSC does a pledge drive I gently – well usually gently – remind you that this site runs on the Public Radio plan: it’s free, and I don’t have advertisements, but it remains open only if it gets enough subscriptions to make me want to keep it open. It has done so for years. If you have not subscribed, now would be a great time to do it. Unlike KUSC I don’t ask for a hundred a month, or anything like that. The information is at http://www.jerrypournelle.com/paying.html or you can get there from the stuff over on the right on this page. If you do subscribe and haven’t renewed in a while, this would be a great time to do that. Now, I’ve bugged you.

I was on TWIT this week, and you can find the broadcast at http://twit.tv/show/this-week-in-tech/427.  I was on with Rob Reid and Larry Magid, and of course Leo LaPorte.

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This from Forbes today:

Obamacare’s Website Is Crashing Because It Doesn’t Want You To Know How Costly Its Plans Are

clip_image004Avik Roy, Contributor

A growing consensus of IT experts, outside and inside the government, have figured out a principal reason why the website for Obamacare’s federally-sponsored insurance exchange is crashing. Healthcare.gov forces you to create an account and enter detailed personal information before you can start shopping. This, in turn, creates a massive traffic bottleneck, as the government verifies your information and decides whether or not you’re eligible for subsidies. HHS bureaucrats knew this would make the website run more slowly. But they were more afraid that letting people see the underlying cost of Obamacare’s insurance plans would scare people away.

HHS didn’t want users to see Obamacare’s true costs

“Healthcare.gov was initially going to include an option to browse before registering,” report Christopher Weaver and Louise Radnofsky in the Wall Street Journal. “But that tool was delayed, people familiar with the situation said.” Why was it delayed? “An HHS spokeswoman said the agency wanted to ensure that users were aware of their eligibility for subsidies that could help pay for coverage, before they started seeing the prices of policies.” (Emphasis added.)

http://www.forbes.com/sites/theapothecary/2013/10/14/obamacares-website-is-crashing-because-it-doesnt-want-you-to-know-health-plans-true-costs/

I haven’t had time to analyze this, but the fact that Forbes is publishing it is significant. It makes sense: the cost of Obamacare for younger middle class employed is going to be dramatically higher than what they are paying now – this as a consequence of the rise in premiums due to having to accept older people with pre existing conditions – as those who have managed to sign up have discovered. Whether this was a factor in the web designs I do not know. But it is interesting.

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‘When a government shutdown falls in the forest, Americans should listen very carefully. The government is telling you something profound and important about how it understands the power relationship between them and you.’

<http://www.nationalreview.com/node/361057/print>

Roland Dobbins

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A Modest Proposal

I will repeat my suggestion: restore the debt limit and pass a continuing resolution in which the baseline budget for every department is 99% of what it spent last year. Each and every budget item can then be increased in a normal budget but by a separate vote: the default is you get 99% of what you got last time. This I think can be absorbed without disaster;p and it turns the budget directive in the right direction. Critical programs can be increased as needed; in fact make it easy to restore them to the full 100% of last year by a simple voice vote – but no more than twenty items on any vote, and restoring them to the 4% base line increase would take a separate, one item per vote, vote.

I know it won’t happen but it would seem to me a way out of the dilemma.

More later. And remember this is subscription drive week. If you haven’t subscribed, this is the right time to do it.

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A West Coast practicing cardiologist on the Obamacare web crashes:

 

I’m bemused by the Forbes article.

One may go to the state sites, which is where one should be looking for prices anyway and where healthcare.gov directs you. If you hit the apply button on healthcare.gov, it directs you to pick a state. I tried both California and Oregon and they worked.

I’ve not signed up as I have insurance coverage through work. I’ve had multiple patients tell me they have signed up in the last week. No idea if they really did.

The prices in Oregon, at least, are quite reasonable.

Give it a try…you can log into the site, fill out no information and get accurate prices.

http://www.coveroregon.com/

or pick any state:

https://www.healthcare.gov/what-is-the-marketplace-in-my-state

I worked with Oregon,

If I pick a 31 year old male with a 30 year old wife and a 10 year old child making 40,000/year, they would choose from 48 plans ranging from a low of 312/month to a high of about 738/month with a monthly credit of 185. Thus the low cost was 312-185= 127/month to 738-185=553. I’d suggest those prices are fair.

I did the same info with BC/BS and got prices that ranged from 157 to >900.

I had to apply on the BC/BS site with my personal information.

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To continue my earlier message, once you get to an income level above what the AKA covers, you are in the range of "normal" insurance…..which you get from a business or from an individual purchase.

That purchase should not have much to do with AKA, unless you presume that the insurance companies are all raising prices to "compensate for the AKA". That has not been our experience with our corporate insurance plan, but that is a sample of one. I’d find that a bit difficult to believe with 42 plans competing in Oregon for AKA business.

Or am I not understanding something Mr. Roy is saying in the Forbes article…that’s certainly possible.

 

M

My own thoughts on this have led me to wonder how it makes political sense, and remind myself of Napoleon Bonaparte’s maxim. 

Talk show hosts have been saying you have a better chance of finding Bigfoot in your back yard than actually signing up for an ObamaCare package and purchasing it. 

I spent the day taking Roberta to Kaiser and getting our flu shots, and waiting for her at her appointment. I was reminded once again that it is certainly possible to have a medical organization that is efficient, pleasant, charges enough in co-payments to discourage frivolity but not so much that you simply can’t pay it – and do all this in a pleasant environment where the employees do not all seem as if they wish they were somewhere else. This generates an atmosphere of civility and everyone is polite.  If they could clone Kaiser I would think that might be the solution to the health care problem.

About thirty years ago I did a symposium with the senior medical faculty of a major medical school/teaching hospital on why the cost of medical education was so high. The position of the school medical staff was that good medical school professors are hard to find and they have admitted about as many highly qualified students as they can manage; admit more and the quality of education would suffer. They were worried about the steeply rising costs. Most of them are certainly retired by now, but it would be interesting to have a new symposium on the subject.

I have also noted that the Army is very good at taking educated young ladies out of social science majors and turning them into very good operating room technicians often equal in skill to physicians in many of the other countries of the world. Once again they are using officer class students with high adaptability but the program works. In the case of my daughter she qualified but then was sucked up into a line officer candidate school, but it was pretty clear that the Army machine worked quite well; of course an operating room technician is not an emergency room physician, but many of those in the military would be damned good candidates for the post and I doubt it would take the Army as long as it does medical schools.  That, however, is hypothesis and generalization from a few cases.  I do think that if part of the TARP funds had been invested in raising the quantity of those going through health care training, many of our health care problems wouldn’t exist.  Of course if some of it had been used for roads and bridges and other of those ‘shovel ready’ jobs we wouldn’t be having so many infrastructure problems.  God knows there was enough money shoveled out the door on the Keynesian theory that if the government spends money it helps the economy.  If some of that had been invested intelligently in infrastructure and health care professional education – but then that is asking a bit much of politicians, isn’t it?

And that, of course is the real debate here.  If the US health care system all worked as well as Kaiser does, we would have other things to talk about;  but our experience is that governments only know how to build armies and bureaucracies, and even there the bureaucracies then to crepe in and take over the armed services from the top – and Pournelle’s Iron Law of Bureaucracy always prevails.  http://www.jerrypournelle.com/reports/jerryp/iron.html

 

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