ObamaCare Staggers Toward the October 1 Finish Line (2)

By Lambert Strether of Corrente.

Perhaps this will be a useful metaphor to explain how ObamaCare really works:

Imagine you walk into a hospital seeking health care: Perhaps for something major, like heart failure, or something minor, like a broken arm. You sign in at the front desk and explain your situation to the nurse on duty. In response, they reach under the desk and pull out an extraordinary contraption: A combination, it seems, of a miniature steam engine, the Wheel of Fortune, a cuckoo-clock, and a football scoreboard. There’s a crank on the side of it, which the nurse, having rolled up their sleeves, turns vigorously with one arm, while feeding lumps of coal into the steam engine’s firebox with the other. Clutching your chest (or your arm) you notice two doors behind the desk. They have signs which read: Special Limited Facilities, and Service Grand Royale. The cranking stops: The steam engine emits three shrill whistles: The Wheel of Fortune judders to a halt at $500: you hear “Cuckoo, cuckoo”: and see (in lights) 42. The nurse notes these results, consults a large three-ring binder, and points you to the door marked Special Limited Facilities. Or perhaps it’s your lucky day, and Service Grand Royale is yours, all yours!

Yes, that really is how ObamaCare works: ObamaCare is a machine that delivers random results; unfair results, unequal results. The health care will actually be available to you will vary capriciously by past (and projected (and reported)) income, jurisdiction, geography, family structure, employment on Capitol Hill, age, existing insurance coverage, jurisdiction, and market segment. But the suffering from heart failure (or from a broken arm) is the same for everyone, so why isn’t the same health care available to everyone? So, when ObamaCare apologists say that ObamaCare helped some people* — or, when they want to really pile on the emotional blackmail and start taking hostages, they ask “Why do you want my spouse to die?” — ask them “Why don’t you want to everyone to get the help that some do?” or “Why don’t you want everyone to get the help your spouse does”? And if you get a good faith answer, offer to write a joint letter to the editor with them, supporting single payer Medicare for All. (Congressional offices pay attention to Letters to the Editor as, you will find, do your neighbors.)**

Anyhow, miniature steam engines with integrated Wheels of Fortune and cuckoo clock and scoreboard peripherals present significant systems integration challenges. So — and, readers, I know this will surprise you — ObamaCare, bloatware that it is, has slipped yet another deadline, with 32 days before enrollment begins. Reuters:

Exclusive: U.S. delays deadline for finalizing Obamacare health plans

The Obama administration has delayed a step crucial to the launch of the new healthcare law, the signing of final agreements with insurance plans to be sold on federal health insurance exchanges starting October 1.

Well, that’s a concern, since the Exchanges are supposed to enable plans to be compared.

The reason for the hold-up was unclear [obfuscated]. Sources attributed it to technology problems involving the display of insurance products within the federal information technology system.

Peters said only that the government was responding to “feedback” from the companies, “providing additional flexibility and time to handle technical requests.”

Coming at a time when state and federal officials are still working to overcome challenges to the information technology systems necessary to make the exchanges work [32 days before launch with three (3) years of implementation], some experts say that even a small delay could jeopardize the start of the six-month open enrollment period.

It makes me wonder if open enrollment can start on October 1,” said a former administration official who worked to implement Obama’s healthcare reform.

Of course, administration apologists are already starting to prepare the fallback position: The launch date doesn’t really matter!***

“But having everything ready on October 1 is not a critical issue. What matters to people is January 1, which is when the coverage is supposed to start. If that were delayed, it would be a substantive setback.”

Uh huh. So there are “substantive” deadlines, and, I suppose, non-substantive deadlines. Alrighty then.

Meanwhile, the sort of people who invent such obfuscatory verbiage are profiting mightily from the rental extraction opportunities created by the very artificial complexity they themselves created (especially the cuckoo clock makers). From The Hill:

ObamaCare has become big business for an elite network of Washington lobbyists and consultants who helped shape the law from the inside.

More than 30 former administration officials, lawmakers and congressional staffers who worked on the healthcare law have set up shop on K Street since 2010.

One might almost imagine these glowing prospects had something to do with single payer being systematically kept off “the table.”

Major lobbying firms such as Fierce, Isakowitz & Blalock, The Glover Park Group, Alston & Bird, BGR Group and Akin Gump can all boast an Affordable Care Act insider on their lobbying roster — putting them in a prime position to land coveted clients.

Veterans of the healthcare push are now lobbying for corporate giants such as Delta Air Lines, UPS, BP America and Coca-Cola, and for healthcare companies including GlaxoSmithKline, UnitedHealth Group and the Blue Cross Blue Shield Association.

Ultimately, the clients are after one thing: expert help in dealing with the most sweeping overhaul of the country’s healthcare system in decades.

“Healthcare lobbying on K Street is as strong as it ever was, and it’s due to the fact that the Affordable Care Act seems to be ever-changing,” [Ivan Adler, a headhunter at the McCormick Group] said. “What’s at stake is huge. … Whenever there’s a lot of money at stake, there’s a lot of lobbying going on.”

So, the very things that make ObamaCare a technical disaster and a project manager’s nightmare — the triaged requirements, the slipped deadlines, the crazy pants secrecy — are, from K Street’s perspective, a gold mine, a veritable fountain of information arbitrage and billable hours. Good to know.

Finally, AFL-CIO’s Richard Trumka throws the membership under the bus. (For those who came in late, “Mistakes were made” is a classic Beltway non-apology apology, the key point being that questions of good faith don’t enter. Anybody can make a mistake!) The Hill:

AFL-CIO President Richard Trumka on Thursday said “mistakes” were made [!!}in the writing of ObamaCare.

Nobody could have predicted that a statute crafted by a health insurance company vice president wouldn’t take organized labor’s concerns into account!

“It still needs to be tweaked,” said Trumka, who pointed to the possibility that union members will lose their health insurance because of the inability of some union plans to qualify for federal tax subsidies.

ObamaCare’s failures are systemic, a consequence of its complex steam- and cuckoo clock-powered system of eligibility determination; “tweaks” are not the answer. As they say in the Navy: “You can’t buff a turd.”

“We have been working with the administration to find solutions to the inadvertent holes in the act,” Trumka said. “We are working to try solve problems, just like they tried to solve problems with employers, with large business and small business groups.”

“Problems” which Obama fixed immediately for business, and not at all for you. Are you sensing a pattern? Bueller? Bueller? Bueller?

For my money, the only way to get anything out of Obama at all is to threaten him: That’s what the gay bundlers and the Hispanics did before election 2012, and they got something, however pathetically inadequate. Trumka didn’t do that, and so of course he gets nothing, and so his membership will suffer. Well done, all.

NOTE * Ursula LeGuin had something to say about this mode of thought in Those Who Walk Away From Omelas.

TROLL PROPHYLACTIC ** Yes, ObamaCare will help some people; a program so large could hardly fail to do so; ObamaCare isn’t HAMP, after all. Of course, that’s not the issue.

NOTE *** Sarah Kliff frames the “deadlines don’t matter” argument this way:

Oct. 1 [can be viewed as] a completely arbitrary date, one that never shows up in the text of the Affordable Care Act and that has little bearing on the health law’s success or failure.

The space between October and December is viewed, by many standing up [insiderese alert] the health care law, as as soft launch: the time to make their new Web sites live, sort out the kinks and get the site in prime condition for the beginning of 2014.

The Affordable Care Act never set an open enrollment period. It directed the secretary of Health and Human Services to set “an initial open enrollment.” HHS Secretary Kathleen Sebelius’s agency set Oct. 1 through March 31 as the initial period when Americans purchase coverage.

Open enrollment begins in October, but any health insurance coverage sold on the marketplaces cannot take effect until Jan. 1, 2014. So, on the exchanges, there’s no difference in when you begin to receive coverage whether you buy it this Thanksgiving, Christmas or New Year’s Eve.

So it’s when coverage begins that matters, and not when choice begins? Bollocks. Insiders don’t have to worry about what their fate will be under ObamaCare or the exchanges. The rest of us would like to know our fate under the Exchanges sooner rather than later, so we can plan our lives accordingly. The choice deadline was supposed to be October 1, and choice is substantive. The promise was made by Sebelius, and now the Democratic nomenklatura wants to weasel out of it because they can’t deliver.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Riccardo Cabeza

    The accurate metaphor of how republican health care works is, “You Get Nothing”.

    Liberals wanted single payer. Tea-nihilist conservatives in congress would only allow the far right republican policies of the Heritage Foundation.

    ObamaCare is a vast improvement over the republican policy of Please Just Die Quickly.

    Don’t like ObamaCare? Put the richly deserved blame on conservatives and until Single Payer arrives, write a ‘Thank You’ note to the democrat of your choice.

    1. Lambert Strether Post author

      “Until single payer arrives.” Don’t you regard that recommendation as rather… passive? Do you think single payer will drop from Heaven, or as a gift from Democrats to their grateful populace?

      1. Cassiodorus

        Of course all of the Dem pseudo-liberals expect single-payer to magically appear before their eyes, just as they expect a Democrat majority in Congress to magically appear before their eyes. The idea that their party has sold out their ideals doesn’t occur to them even when it’s shown to them a thousand ways.

      2. JaaaaayCeeeee

        Well, a thank you card perhaps to each of the 6 or 7 Dems who voted yea, knowing it was bye-bye to career and pension? Although this is intended as a factual statement, it is not an endorsement of CreakyCare, or expectation that Bernie Saunders will live to see Harry Reid move single payer forward.

  2. Jim Haygood

    “But having everything ready on October 1 is not a critical issue. What matters to people is January 1, which is when the coverage is supposed to start. If that were delayed, it would be a substantive setback.”

    Ha ha, right! Just like there’s no need to have tax forms in January, when you can do it all on April 14th, as long as it gets mailed by midnight.

    Of course, if everyone signs up for their mandatory Oboogercare on the evening of Dec 31st, there could be a large scale ‘drunk dialing’ problem, and anything could happen.

    Like most incompetents, Obugger surrounds himself with other incompetents who at least won’t outshine him. Thank god for HHS Sec Kathleen Syphilis, who can be thrown off the bus for not whipping the hapless coders hard enough (though I maintain that their mission is as impossible as colonizing the sun).

    1. petridish

      When I read “Why Your Startup’s Culture is Secretly Awful” in yesterday’s links, I immediately thought about Obamacare, particularly this bit about “Are deadlines a form of management “microagression”? From the article:

      “In a negative power scenario, deadlines often come from outside the team that’s actually creating the technology. Often the people who set deadlines don’t understand the process of building software and all of the things that can go wrong. When deadlines get really destructive is when people outside the engineering team use deadlines to try to influence the engineering team, since they don’t have any other means of doing so. Marketing departments who are like “We don’t know how to work with the engineering team so instead of finding ways to productively work together, we are going to give them some date to deliver to make them move faster in order to incentivize them.”

    2. charles sereno

      Jim, every time I see your comments, I think of Jake Chase. We all need a touch of honest-to-god brashness. I pray he’s in good health. If so, I hope he comes back (I did). He’s missed.

  3. petridish

    “As they say in the Navy: ‘You can’t buff a turd.'”

    As they also say in the Navy: “Proper prior planning prevents piss poor performance.” It’s known as the 7-P Principle.

    And so, as the hard October 1 deadline becomes soft, the Obamacare exchanges flail forward to crash head-on into that iconic American phenomenon known as “the holiday season.”

    Proper. Prior. Planning.

  4. Bridget

    “** Yes, ObamaCare will help some people; a program so large could hardly fail to do so;”

    When the data becomes available, it will be an interesting exercise to divide the hundreds of billions spent by the numbers of people helped.

  5. Jim Haygood

    The 7-P of Obamunism:

    Piss Poor Planning Prevents Proper Prospective Performance

    Onward to Baghdad, errr … Damascus!

      1. Ms G


        “Just send them to the Exchanges” ~ new phrase for “to hell with xxx” or “go die”.

    1. petridish

      In contemplating the hard/soft deadline dilemma, it occurs to me that we may have a pill for that–a little blue one.

      Further contemplation, however, suggests that instead of Viagra, Cialis might be a better choice. That way the deadline can be ready when you are.

      I wouldn’t know what to do in the event that the deadline stayed firm for longer that 4 hours, however,–I am currently uninsured.

  6. charles sereno

    This is what I picture living in Maine is like (never been there). You get this thick booklet from your bank, insurance company, etc, and it’s all written in large fineprint which makes you wonder why you never learned about that in college. You happen to mention that to your neighbor and she says there’s this guy she knows, Lambert by name, who’s fluent in fineprint. If he doesn’t answer the door, look for him in the garden.

    1. MaroonBulldog

      “The rest of us would like to know our fate under the Exchanges sooner rather than later, so we can plan our lives accordlingly.”

      Plan your lives? Whatever do you mean? What are you talking about?

      The concept of planning a life, or planning anything, is entirely foreign to the people who brought us this fiasco.

  7. LAS

    This year, when the firm I worked for went out of biz and I had not yet gotten a new position … I signed up for this Healthy New York HMO – which seems on par with the new health exchange type insurance programs, with these higher deductables.

    During a regular check-up, my physician recommended an echocardiogram and ECG stress test at the local hospital to follow up on an abnormal ECG result.

    What’s interesting to me is how the HMO handled these referred expenses, the stress test and echo. Basically, they got the hospital to lower their charges by half, but then on account of their annual deductables, I have to pay the entire bill for each. So, in essence the value of the insurance was not in re-imbursing me, but in getting me a lower, “insider” cost (which is probably at least still the actual fair market value in any other country than ours).

    Is this how the future will be? That basically we’ll be paying insurance companies to get us lower costs but mostly we’ll be paying the medical expenses ourselves anyway. I’m not sure if that’s real “insurance” or “insurance against excess prices”.

    1. Alexa

      You nailed it, LAS. And the answer is simple: “Repeal Obamacare, and start over.”

      The PPACA is an “end run” around MFA–not a path forward to achieve universal healthcare via a system like Medicare.

      1. Alexa

        Yes, “cost shifting” to the “consumer” is one of many pernicious outcomes of the enactment of the PPACA (intended by the PtB, of course).

        We now “enjoy” the dubious privilege of footing an annual health care bill of (just under) $25,000.

        It’s called a “consumer driven health plan.”

        The extraordinary “two track out of pockets” that were implemented in 2013, were due to the requirements of Obamacare according to Mr A’s employer. (Especially the requirement that employers cover young people up to Age 26 on their parents’ plans.)

        Now, this figure does include our share of our insurance premiums for 2013.

        We shudder to think what the deductibles, co-pays, maximum out-of-pocket expenses and premiums will be in 2014–if his employer even decides to continue to offer health insurance.

        [Especially since we will continue to have catastrophic medical bills, and must again meet the maximum out-of-pockets.]

        So now his company is considering completely “bailing out” of the business of providing health insurance for their employees and children and non-working spouses, due to the PPACA.

        But, hey, they have been “a leader” (cough, cough) in “health care innovation”–their words, not mine, LOL!

        After all, they were one of the first very major corporations to drop “working spouses.”

        Yeah, I’d say that “the American People” (as a whole) will be taking a major “haircut,” once this law is fully implemented.

        And my guess is that any “tweaking” will be to put MORE cost cutting measures on the general public.

        As a matter of fact, THAT has already been stated by many health care experts that I’ve heard (on C-Span).

        This is only Stage One: “Roping as” as many unsuspecting participants into the PPACA as possible.

        Stage Two: “Cost containment.” Translation: Cost shifting to the health plan beneficiaries–individuals and families.

        “Repeal Obamacare,” before it’s too late! ;-)

    2. Ms G

      Thank you, LAS. This is very instructive and I believe you are exactly right that your “Healthy” NY policy is the sort of “skinny plan” that most Exchange policies will turn out to be.

      Especially if patients (cough, customers) will be forced by PPACA’s new “hard deadline” to pick a policy, any policy by the stroke of midnight on December 31, 2013, hopefully not via a drunk dial or sleepy head.

  8. clarence swinney

     Wall Mart + Home Depot
    Smithfield + Tyson
    Conglomerate ownership=Bad News for Job
    Big Banks
    5 control 48% of deposits—10%=80%
    doubled control since 2000
    Insurance companies have monopoly power
    Food, inc. dominates food processing
    Toothpaste—Colgate-Palmolive and Procter & Gamble
    70% of the market
    Anheuser-Busch-Inbev and Miller Coors—80% all beers
    Dean Brands controls Pet Dairy, Mayfield and Horizon
    70% of milk produced in New England
    Dean accused of collaborating with Dairy Farmers Of America
    a giant company that buys milk from independent farmers and provides it to Dean for processing and distribution, to drive down the price farmers are paid while inflating it’s own profits
    Almost 80% of all the corn in America and 95% of soybean seeds contained patented genes produced by only Monsanto/
    Pet Food
    fFve of the top six independent brands including those marketed by Colgate-Palmolive, Mars and Procter and Gambled relied on a single contract manufacturer-Menu Foods as did seventeen of the top twenty food retailers that sell “private-label” wet pet foods.
    The Menu Foods covers products that had been retailed under 150 different brands.
    A dozen car makers sell hundreds of different models. Two thirds of the iron ore in all is most likely produced by three firms which are trying to merge.
    Toyota came out strongly in the General Motors bailout as it knew if that giant failed it would knock man of their materials suppliers.
    Macy and Bloomingdales are units of a Holding company, Federated.
    Federated has bought up Marshall Fields, Hechts, Broadway and Bon Marche’
    Today, that Holding company controls roughly 800 outlets all over America.
    A recent study of mergers, found that in four out of five cases. The merged firms increased prices on products ranging from Quaker State Motor Oil to Chex brand cereals.
    In January 2009, Pfizer the world’s largest drug company, paid $68 Billion to buy Wyeth.
    They announced they planned to buy Schering -Plough
    In the years after 1981, America’s biggest mergers took place when Reagan all but abandoned Antitrust enforcement
    Many firms adopted a winner-take-all approach.
    Prior to 1981, for example, General Electric invested heavily in R&D seeking to compete in as many markets as possible. After 1981, it pulled back.
    No need to innovate let others do it then buy them. Cisco gobbled up more than 100 companies.
    Intel has leveraged its 90% share of the computer microchip market to impede it’s only real rival, Advanced…

  9. just_kate

    I love your reference to Ursula LeGuin’s tale which is so so relevant to these sad times.

  10. optimader

    steam engine’s firebox = Obama(doesn’t)Care’s Virtual Improbability Drive

    indeed, good hat tip

    1. ambrit

      Dear optimander;
      I had this perversely funny vision of bureaucrats feeding copies of the Constitution into the steam engine firebox. Then the cuckoo clock chimed Thirteen O’Clock. Funny though; I didn’t wake up afterwards.

      1. optimader

        Yes Ambrit, 13 o’clock…Your subconscious has fidelity.

        Thirteenth stroke of the clock or “thirteen strikes of the clock” is a phrase, saying, and proverb to indicate that the previous events or “strokes to the clock” must be called into question. This is illustrated in the fictional case of “Rex vs Haddock” in which a remark by one of the parties is compared to the thirteenth stroke of a clock: not only is this thirteenth strike itself discredited, but it casts a shade of doubt over all previous assertions.[1] This proverb puts forth the notion that if just one of someone’s proclamations is wrong, or something of a process is wrong, then all the previous items are called into question if they are correct and accurate. In a legal case then it brings forth the notion that perhaps none of the party’s entire claims are valid, given that one of them is obviously wrong.[2]

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