The Milwaukee Journal-Sentinel has come out in favor of delaying the individual mandate of the PPACA:

The Obama administration is claiming that Healthcare.gov is now working well for consumers about 90% of the time, a far better track record than at launch. Jeffrey D. Zients, who was picked by President Barack Obama to lead the repair team, said 50,000 people could use the website at the same time now and that the error rate is less than 1%. Zients and the Department of Health and Human Services haven’t said how many people have actually enrolled in a health plan through the federal website, which manages plans for 36 states including Wisconsin.

And it appears that a huge chunk of the insurance marketplace is still being built. Henry Chao, the chief digital architect for the federal website, estimated that 30% to 40% of the site still isn’t done. He told Congress last month that “the back-office systems, the accounting systems, the payment systems” weren’t ready.

Zients claims the the latest software repairs should improve the “the back end of the system” as well as the consumer experience.

But insurers are right to be concerned. They need to be paid or else claims won’t be settled. Yes, Healthcare.gov’s problems may be forgotten if people who need affordable and reliable insurance coverage begin to get it. And we still believe that Obamacare can work and ought to be effective at reducing the number of uninsured in the United States.

But the system needs to work seamlessly, and it still seems to be a long way from seamless. The administration should acknowledge this reality and push back the start of the individual mandate.

I expect a lot more of these, both from supporters of the PPACA and its opponents, over the next couple of weeks.

However, the title of this conveys my opinion: I don’t think it’s going to happen. Consider: delaying the individual mandate would do nothing to restore the millions of individual and small group policies that have been cancelled already as a consequence of the PPACA. Forward!

Megan McArdle summarizes the status of Healthcare.gov:

Which sums up all of our information about the site, broadly: We don’t know, because the administration doesn’t really have the information we want or any way to get it. It’s clearly choosing the most optimistic metrics possible while ignoring more obvious ones. But even the more obvious ones wouldn’t tell us what we really want to know, which is: Come Jan. 1, or April 1, how many people in the U.S. will have insurance?

The administration undoubtedly has a good count of how many error messages it has gotten. But how many people broke off their visit to the site because it was frustrating them? How many people didn’t visit, and therefore didn’t buy, because they’d heard the site was buggy and insecure? On the other hand, some other number of people haven’t even touched the site yet but will eventually log on, choose a policy and pay for it. How many of each? There’s no way to tell; we’re in uncharted territory.

As I’ve remarked before, ultimately the metric that matters is how many people sign up (and whether enough of them are young and healthy). The Congressional Budget Office projected that 7 million people would get policies through the exchanges in the first year — 2 million switching over from other policies, and 5 million new purchasers of individual policies. Obviously, 100,000 is not very rapid progress toward that goal. But how close should we expect to be?

Sorry to sound like a broken record, but there’s no way to tell. The law’s supporters have been pointing out that Massachusetts got very few people to sign up in the first few months, but it gave people longer to sign up before the mandate kicked in. And I’d have expected a post-Thanksgiving surge, which is apparently what we saw with Medicare Part D, but that obviously didn’t happen on the federal exchange. I’d guess that a minimum of a couple of million people need to buy insurance by Dec. 23, just to replace the policies that were canceled because of new Obamacare rules. HealthCare.gov can probably handle that load, if it’s evenly distributed. But of course, it may not be evenly distributed, and it may not show up at all.

That sounds about right. It’s pretty hard to tell but it certainly appears as though the administration’s primary objective right now is to keep the site not to mention the program limping along until after the midterm elections. That certainly preserves it as an issue.

Even I’m not cynical enough to suggest that’s been the plan all along—that providing insurance to more people was always a minor objective while the major objectives were keeping health care alive as a campaign issue. It would certainly be a unifying theory on the design, structure, and execution of the program conjoined with the public campaign.

In an op-ed in the Wall Street Journal, two former U. S. Secretaries of State outline the problems with the deal with Iran:

For two decades, American presidents from both parties have affirmed that the U.S. is unalterably opposed to an Iranian military nuclear capability. They have usually added a warning to the effect that “all options are on the table” in pursuit of this policy. A clear trans-Atlantic consensus, a decade of International Atomic Energy Agency (IAEA) reports and six United Nations Security Council resolutions have buttressed this position.

The interim nuclear deal with Iran has been described as the first step toward the elimination of Iran’s ability to build a nuclear weapon. That hope resides, if at all, in the prospects of the next round of negotiations envisaged to produce a final outcome within six months. Standing by itself, the interim agreement leaves Iran, hopefully only temporarily, in the position of a nuclear threshold power—a country that can achieve a military nuclear capability within months of its choosing to do so. A final agreement leaving this threshold capacity unimpaired would institutionalize the Iranian nuclear threat, with profound consequences for global nonproliferation policy and the stability of the Middle East.

The Obama Administration itself has characterized the deal that’s on the table as a “first step”, something the Iranians have vehemently denied. For them it’s a last step. Can anyone produce evidence that further negotiations will cause concessions to be forthcoming from the Iranian regime? I’ve already expressed my opinion: any agreement that doesn’t include complete and unrestricted access to international inspectors is nothing more than a joint press release.

On a lighter note “Kissinger and Shultz” sounds like a vaudeville act my grandfather was a part of. Maybe that was “O’Malley and Shultz”.

I wonder who David Ignatius is talking to. He’s ready to proclaim victory over Assad in the rebellion in Syria and onwards to confronting the Al Qaeda rebels whom we would have helped to put in place:

The two tracks — fighting and negotiating — sound good in principle. But the rebels haven’t been strong enough to make either approach work, and the United States hasn’t been ready to provide the necessary additional firepower. There’s more support now for a political settlement at a Geneva 2 conference, but it’s clear that even if Assad leaves, a second Syrian war against al-Qaeda is ahead.

The dominant groups in the rebels clearly meet the definition of Al Qaeda. Explain to me again why we should support the rebellion.

In other Syria news more evidence is surfacing implicating the Assad regime in war crimes. And here’s a timeline of recent action in Syria which really makes me wonder if David Ignatius isn’t getting ahead of himself. Looks to me as though the rebellion is being put down.

In Syria we don’t have a choice between a tyrannical dictator on the one hand and liberal democrats on the other. We have the choice between a tyrannical dictator and violent radical Islamist thugs. Why should we choose one or the other even rhetorically?

I’ve been biding my time on the incipient public pension deal working its way through the Illinois legislature until something has actually been enacted into law. It’s far from a done deal at this point and I don’t think it’s too much to say that, if the present deal can’t pass, no agreement that actually confronts Illinois’s public pension problem has a chance of being passed and Illinois’s only recourse would, ultimately, be bankruptcy.

The broad outlines of the deal are a reduction in public retiree cost of living adjustments, a higher retirement age for younger workers, and delays for younger workers in when they can expect to receive cost of living adjustments. During periods of very low inflation (like the present) that’s probably just fine but what if the circumstances change to double digit annual inflation as we had in the late 1970s?

One of the great ironies of this entire issue is that I would bet a shiny new dime that 90% of those who are complaining about the terrible injustice of this pension deal voted for Blagojevich, a primary architect of our problems. When you go fishing and you don’t catch fish, you’re entitled to complain. However, when you go fishing and you do catch fish, it’s too late to complain that what you really wanted was filet mignon.

One of my misgivings is that in Illinois different public employees are paid from different funds and not all of the funds are in equally bad shape. Unless this deal preserves those distinctions it might well be that Illinois teachers will in effect be paying for the retirements of state government employees which doesn’t quite strike me as just. Additionally, there’s the problem that Chicagoans pay for the retirements of retired Chicago Public School teachers and retired teachers who didn’t teach in the city while Illinoisans who don’t live in Chicago just pay for the retirements of teachers who didn’t teach in Chicago which is obviously unjust. I’m afraid that’s one of those injustices that is hallowed in tradition.

Fred Hyatt produces a timeline of the unfolding disaster in Syria. Read it and weep. Our posture can’t be defended from the standpoint of realism.

You can support the rebels, support Assad, or just butt out. What we’re doing is condemning Assad and providing tepid support for the rebels. That’s not realism. The realist position is the one the Russians are taking: support Assad. Our position is sadism.

I see that the Wall Street Journal has observed the same thing about the HHS status report on Healthcare.gov that I did yesterday:

For instance, the progress report reveals that the website is functioning more than 90% of the time—excluding periods when it is shut down for maintenance. HHS won’t say how often that is or for how long. Why not simply proclaim that it works 100% of the time, as long as you don’t count the times when it doesn’t?

HHS touts other measures of progress—four times as much of this, doubled capacity of that—without revealing the original base. They’ve fixed those 400 bugs but won’t say what they are or how many there are in total. Such statistical ploys are like a business claiming its revenues are twice as high as the last quarter’s, in order to avoid saying if it’s profitable.

It focuses on how hard they’ve worked (inputs) rather than how much of the task has been accomplished (outputs). Whether driving 100 miles is a substantial accomplishment or not depends on the trip. If the trip is 10,000 miles, you’ve barely begun. If it’s 10 miles, you’re lost.

The status report is a political document. It’s clearly intended to convince supporters of what good boys you are rather than informing people on the status of Healthcare.gov. Sadly, however poorly the site functions the PPACA’s supporters will tout its accomplishments and however well it functions its opponents will proclaim it a failure. Where you sit continues to be where you stand.

Pre-bake a pie crust using your favorite pie crust recipe or, in a pinch, a purchased pie crust.

Filling

1 Tbsp. unflavored gelatine
¼ cup sugar
¼ cup water
½ cup lemon juice
1 tsp. grated lemon rind
½ tsp. salt
4 well-beaten egg yolks
4 egg whites
½ sugar
lemon curd

1. Cook the first seven ingredient to custard in a double boiler. This is the hardest step in this recipe. However long you think it will take, it will take longer but don’t overcook it or the eggs will scramble.
2. Remove the custard from heat and allow it to begin to set. It will continue to cook in the pan. You might want to have an ice bath ready for this step. Until it begins to set, begin the next step.
3. Beat the egg whites to stiff peaks with the additional sugar.
4. Spread the baked pie shell with lemon curd.
5. Fold the beaten egg whites into the just starting to set lemon custard-gelatine combination.
6. Let the pie continue to set in the refrigerator for at least two hours.
7. Serve with whipped cream. Real whipped cream!

You can adjust the amount of grated rind you use to your own taste. I grated a whole lemon rind and then probably used two teaspoons of it.

This recipe is an adaptation of Aunt Chick’s lemon chiffon pie recipe. You can’t go too far wrong on cream and chiffon pies if you follow Aunt Chick.

The phrase I used yesterday, “end-to-end”, is cropping up more frequently now in articles about the PPACA and Healthcare.gov, its primary portal. Here’s an example from a New York Times article:

The problem is that so-called back end systems, which are supposed to deliver consumer information to insurers, still have not been fixed. And with coverage for many people scheduled to begin in just 30 days, insurers are worried the repairs may not be completed in time.

“Until the enrollment process is working from end to end, many consumers will not be able to enroll in coverage,” said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group.

If I’d been in unimpeded control of the project, the first thing I’d’ve done is worked out the kinks in an end-to-end manual workflow. Then I’d’ve implemented a polished way of registering by phone that didn’t depend on the web-based system as the present phone system apparently does. Those could be done in parallel with the web development but how the web site could have been thought of us a substitute for efficient paperflow baffles me.

A new issue seems to have surfaced:

Insurers said they had received calls from consumers requesting insurance cards because they thought they had enrolled in a health plan through the federal website, but the insurers said they had not been notified.

“Somehow people are getting lost in the process,” the insurance executive said. “If they go to a doctor or a hospital and we have no record of them, that will be very upsetting to consumers.”

An interesting question will be who is responsible for the system’s mistakes? My guess: the consumers.