Klein: Liberals are kidding themselves if they think Obamacare's problems are only with the website

One of Obamacare's most ardent supporters on the left is telling liberals that even if healthcare.gov becomes easier to use, the problems with the law extend much deeper than fixing a website.

Ezra Klein:

A failure in the press coverage of the health-care exchange's rocky launch has been in allowing people to believe that the problem is a glitchy Web site. This is a failure of language: "The Web site" has become a confusing stand-in phrase for any problem relating to the law's underlying infrastructure. No one has a very good word to describe everything that infrastructure encompasses.

In brick-and-mortar terms, it's the road that leads to the store, the store itself, the payment systems between the store and the government and the manufacturers, the computer system the manufacturers use to fill the orders, the trucks that carry the the product back to the store, the loading dock where the customers pick up the products, and so on.

It's the problems in that infrastructure -- indeed, much more than "just a Web site" -- that pose such deep problems for the law.

Klein, whose familiarity with the ins and outs of Obamacare has made his Wonkblog a must read on the law, says there are three categories of problems that could undermine the implementation of the law; "problems with the consumer experience on the HealthCare.gov Web site, problems with the eligibility system, and problems with the hand-off to insurers."

No one quite knows the extent of the problems in each of these areas. No one knows how long it will be until all these systems are working tolerably well. No one has any idea how long it'll be until they're working smoothly. And if that was all this was -- a multi-month delay and a lot of frustration and problems for people trying to sign up for health care -- that would be bad enough. That would be a story worth covering aggressively and constantly until the problems cleared up.

[...]

But that's not all this is. Indeed, if the experience of using the site improved but the back-end problems didn't, it's possible to imagine press coverage moving on. That would be a disaster.

Why? Because the White House has defined "success" in terms that likely won't be realized:

"To the White House, the difference between success and failure is straightforward: They need to entice a sufficient number of young and healthy adults into the new insurance marketplaces that open Oct. 1."

I want to be clear on this: No one said that success was letting kids up to age 26 stay on their parents' insurance plan. No one said it was regulating insurers or covering preventive care. Instead, everyone in the White House shared a singular definition: Success meant setting up the exchanges and attracting enough young people that premiums stayed low.

Klein says the bottom line is that unless about 3 million young, healthy Americans sign up the first year, all sorts of bad outcomes would flow from that failure:

The Obama health-care team expended enormous effort figuring out how to reach those 2.7 million "young-and-healthies." They modeled where they lived. They figured out which television channels they watched and which social networks they used. They learned who their important validators were. ("No surprise," said David Simas, the White House's deputy senior adviser for communications and strategy: "It's Mom.")

The White House was planning a huge campaign to get young people to HealthCare.gov. And they believed that once there, they needed a friction-free Web experience to make sure they purchase health insurance. Older, sicker folks will reload the Web page until they get through, or they'll sign up over the phone. But the White House expected that young folks, by and large, wouldn't tolerate a lot of hassle.

[...]

The problem is precisely that the people who really need insurance will be patient and persistent. The people who don't need insurance as badly may not be. And if that happens, then in year two, costs are going to rise sharply for those sicker, older people left in the exchanges. And Republicans who see Obamacare's problems as a path to success in 2014 won't even think about expanding Medicaid.

This outcome has become known as the "death spiral" as rising premiums force many consumers off their insurance plans which leaves fewer, sicker people to pay into the system. That leads to more premium increases and priobably a flight by insurance comapnies out of the exchanges.

The current guesstimate is that, by the end of November, the exchanges will be running smoothly for the "vast majority of users." That remains to be seen - especially what the definition of "smoothly" actually means. This could also be a totally bogus date as many analysts have said that unless the exchange is working well enough to sign up tens of thousands of people a week by Thanksgiving, Obamacare may fail. So that "end of November" guess might be more wishful thinking than anything based on reality.

Hat Tip: Rich Baehr



One of Obamacare's most ardent supporters on the left is telling liberals that even if healthcare.gov becomes easier to use, the problems with the law extend much deeper than fixing a website.

Ezra Klein:

A failure in the press coverage of the health-care exchange's rocky launch has been in allowing people to believe that the problem is a glitchy Web site. This is a failure of language: "The Web site" has become a confusing stand-in phrase for any problem relating to the law's underlying infrastructure. No one has a very good word to describe everything that infrastructure encompasses.

In brick-and-mortar terms, it's the road that leads to the store, the store itself, the payment systems between the store and the government and the manufacturers, the computer system the manufacturers use to fill the orders, the trucks that carry the the product back to the store, the loading dock where the customers pick up the products, and so on.

It's the problems in that infrastructure -- indeed, much more than "just a Web site" -- that pose such deep problems for the law.

Klein, whose familiarity with the ins and outs of Obamacare has made his Wonkblog a must read on the law, says there are three categories of problems that could undermine the implementation of the law; "problems with the consumer experience on the HealthCare.gov Web site, problems with the eligibility system, and problems with the hand-off to insurers."

No one quite knows the extent of the problems in each of these areas. No one knows how long it will be until all these systems are working tolerably well. No one has any idea how long it'll be until they're working smoothly. And if that was all this was -- a multi-month delay and a lot of frustration and problems for people trying to sign up for health care -- that would be bad enough. That would be a story worth covering aggressively and constantly until the problems cleared up.

[...]

But that's not all this is. Indeed, if the experience of using the site improved but the back-end problems didn't, it's possible to imagine press coverage moving on. That would be a disaster.

Why? Because the White House has defined "success" in terms that likely won't be realized:

"To the White House, the difference between success and failure is straightforward: They need to entice a sufficient number of young and healthy adults into the new insurance marketplaces that open Oct. 1."

I want to be clear on this: No one said that success was letting kids up to age 26 stay on their parents' insurance plan. No one said it was regulating insurers or covering preventive care. Instead, everyone in the White House shared a singular definition: Success meant setting up the exchanges and attracting enough young people that premiums stayed low.

Klein says the bottom line is that unless about 3 million young, healthy Americans sign up the first year, all sorts of bad outcomes would flow from that failure:

The Obama health-care team expended enormous effort figuring out how to reach those 2.7 million "young-and-healthies." They modeled where they lived. They figured out which television channels they watched and which social networks they used. They learned who their important validators were. ("No surprise," said David Simas, the White House's deputy senior adviser for communications and strategy: "It's Mom.")

The White House was planning a huge campaign to get young people to HealthCare.gov. And they believed that once there, they needed a friction-free Web experience to make sure they purchase health insurance. Older, sicker folks will reload the Web page until they get through, or they'll sign up over the phone. But the White House expected that young folks, by and large, wouldn't tolerate a lot of hassle.

[...]

The problem is precisely that the people who really need insurance will be patient and persistent. The people who don't need insurance as badly may not be. And if that happens, then in year two, costs are going to rise sharply for those sicker, older people left in the exchanges. And Republicans who see Obamacare's problems as a path to success in 2014 won't even think about expanding Medicaid.

This outcome has become known as the "death spiral" as rising premiums force many consumers off their insurance plans which leaves fewer, sicker people to pay into the system. That leads to more premium increases and priobably a flight by insurance comapnies out of the exchanges.

The current guesstimate is that, by the end of November, the exchanges will be running smoothly for the "vast majority of users." That remains to be seen - especially what the definition of "smoothly" actually means. This could also be a totally bogus date as many analysts have said that unless the exchange is working well enough to sign up tens of thousands of people a week by Thanksgiving, Obamacare may fail. So that "end of November" guess might be more wishful thinking than anything based on reality.

Hat Tip: Rich Baehr



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