Due to an enormous volume of Chinese comment spam my web host has blocked comments at my site. I’m working with them on it.

Update

Comments have been re-enabled.

I’ve done quite a bit of work on the site and things might be operating oddly until caches have been cleared, etc.

One of the things that I’ve done is that I’ve tried to block all IPs originating in China. We’ll see how it works out.

I hope to have new content some time this afternoon.

Testimony from Centers for Medicare and Medicaid Services Deputy Chief Information Officer Henry Chao must have sent chills down the spines of some House Democrats:

A key player in the development of the Obamacare website acknowledged Tuesday that up to 40 percent of IT systems supporting the exchange still need to be built.

The revelation from Centers for Medicare and Medicaid Services Deputy Chief Information Officer Henry Chao occurs as the administration works to meet its Nov. 30 deadline to shore up the website.

“It’s not that it’s not working,” Chao told lawmakers at an Energy and Commerce oversight subcommittee hearing. “It’s still being developed and tested.”

Financial management tools remain unfinished, he said, particularly the process that will deliver payments to insurers.

The part of the system that Mr. Chao is talking about are the “back office” functions, the portions of the Healthcare.gov iceberg that are below the surface.

I wonder if he’s ever heard of the ninety-ninety rule. 40% may require more than 90% of the total development time.

What’s the relationship between burning mouse scat and understanding the reasons for human obesity? That’s what this article is about. Looks like they’ve taken the first steps in disproving the simple thermodynamics theory of weight gain scientifically.

If you think that I’m critical of Chicago Mayor Rahm Emanuel, you should see what Kari Leydersen has to say about him:

Many pundits describe Emanuel as the epitome of the modern centrist neoliberal Democrat. The North American Free Trade Agreement (NAFTA) is often viewed as a symbol of neoliberalism, a global socioeconomic doctrine with intellectual roots in Chicago. Emanuel was a key architect of the trade agreement, which ultimately cost tens of thousands of U.S. jobs and brought social and economic devastation to Mexico.

To the extent that Emanuel genuinely wants to make the world a better place for working people, he thinks market forces and business models are the way to do it, and he clearly (and perhaps rightly) thinks that he understands these institutions far better than any teacher or crossing guard or nurse. From that viewpoint, the messy attributes of democracy—sit-ins, protests, rallies, people demanding meetings and information and input—simply slow down and encumber the streamlined, bottom-line-driven process Emanuel knows is best. But many regular Chicagoans see injustice, callousness and even cruelty in this trickle-down, authoritarian approach to city governance. They see the mayor bringing thousands of new corporate jobs subsidized with taxpayer dollars while laying off middle-class public sector workers like librarians, call-center staffers, crossing guards, and mental health clinic therapists. They see him closing neighborhood schools, throwing parents’ and students’ lives into turmoil. They see him (like Daley) passing ordinances at will through a rubber-stamp City Council, leaving citizens with few meaningful avenues to express their opposition to policies changing the face of their city.

Read the whole thing. I have never understood who Emanuel’s constituency was. Low information voters?

One more quick point about fixing Healthcare.gov. I know that lots of fans of the PPACA are banking on the idea that once Healthcare.gov is fixed everything will be just peachy and everyone will be overwhelmed by how much they like the new regime.

I wonder if they’ve considered that once Healthcare.gov is fixed whatever structural problems the PPACA has might be revealed more quickly. Unforeseen secondary effects have a way of biting you in the butt.

In his column at the Washington Post, Dana Milbank points out something that casts doubt on whether the president’s promise that Healthcare.gov will be working for “the vast majority of users” by the end of the month, the reluctance of the president or his surrogates to define what they mean by “the vast majority of users”:

A “vast majority” would presumably be somewhere between a bare majority of 51 percent and an overwhelming majority of, say, 99 percent — but officials had refused to say. My Washington Post colleagues Amy Goldstein and Juliet Eilperin solved the mystery, reporting over the weekend that a vast majority, as defined in secret by the Obama administration, is 80 percent.

Carney, at his briefing Monday, didn’t deny the figure but did his best to qualify it with all sorts of asterisks and fine print about metrics and baskets and site stability and users’ experiences and navigators and channels and something about a continuum. Sticking closely to his written notes for the briefing, he explained that although some of the 20 percent who couldn’t get HealthCare.gov to work would have technical troubles, others might have complicated circumstances or would simply prefer to sign up on the phone, in person or even by mail.

Nedra Pickler of the Associated Press pointed out that if Amazon or Kayak couldn’t serve 20 percent of their customers, “they probably wouldn’t stay in business very long.”

“You’re looking at that statistic simplistically,” Carney informed her.

When people start parsing every thing you say, wondering what you actually mean, I think it’s an indicator of a certain lack of trust.

IMO what the Administration should be concerned about most is that rather than ensuring that the web site works for “the vast majority of users” the website developers will focus their attention on making it work for “the typical user”. Search for the typical user continues.

This morning I had an early morning appointment with a client. After our meeting a VP of the company came up to me and said, “Knowing your interest, I thought you’d like to know that our company group plan is a casualty of the PPACA.” It was one of the “Cadillac plans”. He continued, “They just don’t care about us.” Meaning the folks in Washington.

Time is a limited resource. Devoting time to selecting and choosing a new company healthcare insurance plan takes time that won’t be used for getting more sales, developing new products, or making the business operate more efficiently. It will be interesting to see what effect, if any, the new regime in healthcare insurance has.

At this point I don’t think I have a single client who hasn’t been compelled to devote substantial time to Sarbanes-Oxley, HIPAA, or the PPACA.

If enacting the PPACA means that there is now a right to healthcare in the United States, it’s not because most Americans believe that it’s the government’s responsibility that everybody have healthcare insurance:

PRINCETON, NJ — The 56% of U.S. adults who now say it is not the federal government’s responsibility to make sure all Americans have healthcare coverage continues to reflect a record high. Prior to 2009, a clear majority of Americans consistently had said the government should take responsibility for ensuring that all Americans have healthcare.

or that the PPACA’s popularity has convinced people that healthcare is a right. Indeed, not only do a majority of Americans believe that the government has no responsibilty to ensure that everybody has healthcare insurance, the percentage of Republicans, independents, and Democrats who believe that the government does not have that responsibility has increased since 2009. The trend is downward.

People in different countries believe in different things. In Russia people are uncomfortable with differences in incomes that people here aren’t. In France a broadly-defined “equality” is a high value in a way it isn’t here.

IMO some of the reasonable objectives of the PPACA have popular support. For example, I strongly suspect that most people see rescission, arbitrary cancellation of insurance, as unjust. A law banning rescission other than in cases of fraud could have been written in a paragraph.

At National Journal Josh Krashaur does a pretty fair job of laying out the road ahead for the PPACA, particularly from a political standpoint. The short version is that a) Healthcare.gov better be usable pretty darned quick and b) that had better be the extent of the administrative problems with the healthcare exchanges or we will have nothing more than ongoing political damage control from here on through 2016. We may have that anyway.

The rest of this post will be sort of rambling. I haven’t really thought it out completely. It should be obvious to anyone who’s paying attention that healthcare costs are increasing out of control. Even with the decline in their rate of increase they’ve just slowed down to increasing more than twice as fast as incomes and revenues rather than three times as fast or more. Today we’re issuing bonds to pay for healthcare expenses. There are lots of good reasons to issue bonds but paying operating expenses isn’t one of them.

So, how can healthcare costs be brought under control? I think there’s general agreement that there will need to be some sort of change in allocation of scarce healthcare resources. If you don’t like the idea of that, you’ll probably call it “rationing”. If you do like it, you’ll probably think of it as “letting market forces work”.

As I’ve written before, there are basically two different ways of allocating resources: by fiat or via a market system. The starkest example of a fiat system is Soviet Russia. Commissars decide how much of each good will be produced and at what price it will be sold (if any). Sometimes they get it right. Very little of the good remains on the shelf and nobody who wants the good is forced to do without. More often they produce far too much or too little; the fiat prices are too high or too low; people go without.

Market systems have been commonplace for thousands of years. You can see them in operation at any farmers’ market. When the vendor selling at the market are actual farmers rather than middlemen, that is.

Most real systems for allocating resources combine the two systems. Our healthcare system is such a hybrid.

All of the plans that have been discussed for reforming our healthcare system are such hybrids. The largest difference among them is not so much whether they think that influencing how consumers make their purchasing choices is the way to control costs as to who they think the consumers/buyers of healthcare services are.

The plans produced by Republicans have tended to think of patients as the consumers who must learn to economize. For the PPACA it’s some combination of insurance companies, consumers, providers, and government.

My view is that the primary consumers of healthcare are providers and no system that does not start with incentives for providers to economize has a chance of reducing costs.