Granted, the initial rollout of the online insurance exchange signup program was a mess. Any new computer system has its shakedown period and crazy kinks to be resolved. But this was a technology project that personified bad management. Truth is, governments – federal, state and local – have never been very good at technology development. The IRS spent decades trying unsuccessfully to upgrade and integrate their systems. The Veterans Administration and the Department of Defense are currently trying to integrate their systems to share medical records between veterans and active military personnel; so far a disaster going nowhere.
There are many reasons for government technology failures and shortcomings, many of which I have seen firsthand as a former IT professional in the public sector. Not bad people, but bad conditions. Too many constituencies to please; too much intractable “business as usual” thinking; inadequate leadership and decision-making authority; and all too typically, insufficient funding. Add in the interconnection complexity of the new Obamacare insurance exchanges across the country, and you have a very difficult technology system to be developed and installed under high visibility. Good technology project leadership would have: gotten support and advice from technology people in the insurance private sector who create such websites every day; lined everyone up with a solid project plan; given clear marching orders to all involved; and provided adequate, if not overwhelming, resources. Especially given that the Affordable Care Act is this president’s signature legacy accomplishment. In private industry, HHS Secretary Kathleen Sebelius would most certainly have been summarily and deservedly fired for this poor outcome.
Unfortunately, the list of people vested in ACA’s failure is long: doomsday naysayers; untruthful politicians; CEOs now blaming Obamacare as the excuse for reducing employee benefits that they have been wanting to do for a long time; hypocrites who argue that private industry is best qualified to fix health care shortcomings that they created in the first place. But the website will get fixed. People will then sign up for new insurance. Most people whose policies have been cancelled – often polices that should never have been sold due to their deceptive coverage limitations – will find new affordable policies, if not cheaper and with greater benefits, to replace their lost coverage. And the full impact of the changes to the odious practices of the health insurance companies – e.g. preexisting conditions, limitations on coverage, caps on benefits – will become cemented in. If all of the noisy objections would quiet down, then by the end of 2014, and certainly by the 2016 presidential election, the ACA would finally have become simply “the law and practice of the land.”
The byproduct of this continually inane and hysterical debate is what thereby has been ignored in the national conversation. I.e. the real health care issues facing America. Issues such as the continually escalating cost of delivering our health care. The hidden rate schedule that is inexplicable and non-comparable among health care institutions. The absence of a rational discussion about health services and death decisions for the elderly. The lack of “buyer selection” in choosing health solutions and providers due to unpublished rates and a multi-tiered byzantine web of providers looking to be paid. A system that rewards doing more tests / more drugs / more surgery rather than prevention of illness. A for-profit industry – often masquerading as “benevolent non-profit or charitable institutions” – that increasingly measures success not by the good health of its clients but by the salaries and dividends that it returns to its insiders. A system of insurance coverage for medical costs that is tied to one’s employment status, and the generosity (or not) of the individual employer. It is an industry that is misdirected, with excessively layered costs, funded by backroom deal-making, with an uninformed buyer floundering in the marketplace.
Health care skills and knowledge in America may be second-to-none in the world. But in covering our population, providing access to these services, and paying reasonable charges based upon quality/price market competition as is required of most all other industries, our health care industry is an overwhelming mess. America is “a country that pays too much and gets too little from its health care system, whose costs, at nearly 18% of GDP, limit [its] ability to grow and invest and compete globally. Compared with other developed countries, the U.S. has more uninsured, fewer doctors per capita, and lower life expectancies.” (TIME, “Race For The Cure,” 12/2/2013)
These are the real issues that need thoughtful, deep, and forward-looking discussions. But they are discussions that are not happening on a national scale. And they will not happen as long as “medical news” focuses only on grandiose announcements of scientific research results, political game-playing, and a rallying cause for the anti-government disaffected.
Almost two-thirds of personal bankruptcies in America are attributable to health care debt. Millions of people avoid seeking needed health care because of high costs and personal affordability. Real people are suffering or dying for lack of access to adequate care. When the Affordable Care Act finally settles in, when the media moves on to the next big disaster or controversial story, when the politicians find the new big fundraiser topic, when the din of this cacophonic noise finally quiets down, when all the distractions finally go away – will anyone then start the badly needed, serious conversation about health services and its delivery systems in America?
It is about issues of substance, not bumper stickers or theatrics. It is a conversation worth having. It is a conversation worth having now.
© 2013 Randy Bell