(CNN) — President Barack Obama didn’t know of problems with the Affordable Care Act’s website — despite insurance companies’ complaints and the site’s crashing during a test run — until after its now well-documented abysmal launch, the nation’s health chief told CNN on Tuesday.
In an exclusive interview with Health and Human Services Secretary Kathleen Sebelius, CNN’s Dr. Sanjay Gupta asked when the President first learned about the considerable issues with the Obamacare website. Sebelius responded that it was in “the first couple of days” after the site went live October 1.
“But not before that?” Gupta followed up.
To which Sebelius replied, “No, sir.”
I’m having a bit of trouble following the thread. The Administration has defended the PPACA tooth and nails, routinely giving the explanation that it was the signature legislation of the Obama presidency. The president has not been kept informed about the progress of a matter of such vital importance to his legacy? I can only think of a handful of explanations for that:
Plausible deniability.
The president is interested in the details, expects to kept in the loop by his subordinates, but is very poorly served them (a point I’ve made here frequently).
The president really isn’t particularly interested in the PPACA but it does make a handy club with which to beat the Republicans.
The president prefers to sketch out the big picture ideas, leave the details to his subordinates, and his subordinates dropped the ball.
#4 is largely what I meant when I described the job that Barack Obama really wanted as “consultant-in-chief”. Mickey Kaus describes something along the same lines:
But perhaps we elected a President who isn’t interested in how the nuts and bolts of government work–as long as he worries about the big legislation, what goes on in the bureaucratic boxes is a second order problem, right? If that’s what Obama thinks, his health care rollout is, as they say, a teachable moment.
It’s possible to have a “big picture” president and for it work out just fine. Cf. Eisenhower. However, for that to be the case a) the president’s subordinates must take responsibility and b) they must feel empowered to make decisions without the president’s guidance on the details. Every account I’ve ever read of the Obama presidency suggests that neither of those is the case.
As I wrote above, I’m having trouble following the thread.
The computer problems may be fixed in weeks or months — although as the nation learns more about the extent of those computer problems, there's far less confidence that a fix will come soon ... or ever.
But the problems with Obamacare go much deeper than a few million lines of faulty code and a sign-up system that swallows enrollee applications in a single electronic gulp.
The bugs aren't just in the software. They're in the law itself.
Consumers are finally seeing insurance rates and plans. In many cases, insurance premiums, deductibles and co-pays are rising. Illinois officials said premiums here would be lower than expected. But a Tribune analysis of 22 of the lowest-priced plans showed that those plans required huge annual deductibles of more than $4,000 for an individual — and $8,000 for family coverage.
Lower premiums also come with a troubling tradeoff: access to a narrower networks of hospitals and doctors. If people aren't careful in choosing coverage, they may be shocked to find they have to pay much more for out-of-network care to go to their preferred doctor or hospital.
Individuals who already have coverage are learning they can't keep it after Jan. 1. They must choose a new health plan, which may come at considerably higher cost than they're paying now.
I suspect that’s the problem that the software developers had to confront. A computer program is a statement of logic and it’s darned hard to write a program that works well when the underlying reality it’s modeling is itself illogical. When the specifications keep changing, as was apparently the case, it’s that much harder.
In due course we’ll see whether the PPACA actually solves the problem it was intended to solve: enabling more people to have health insurance.
In the Washington Post’s editorial on the president’s comments on the weak rollout of the healthcare exchanges at Healthcare.gov, there’s one thing that they implied but I wish had said outright. The president is continuing to pretend to be an innocent bystander to the actions of his own administration.
There’s something about our system of common law that I fear many people, especially those who have lived under a civil code system, do not understand or at least don’t understand its implications. Our law is not necessarily logical and there’s no requirement that it be consistent or coherent.
Given that preamble, can anyone produce an explanation relying solely on constitutional law that the Tea Party Republicans were acting illegally in refusing to fund Obamacare? Keep in mind Article I, Section 7, Clause 1:
1: All Bills for raising Revenue shall originate in the House of Representatives; but the Senate may propose or concur with Amendments as on other Bills.
I read that as saying that the House of Representatives, in theory the most representative body in the federal government, identifies the spending priorities. Neither the Senate nor the president nor the Supreme Court have any power to compel the House to fund anything.
As I’ve pointed out before, it’s very difficult for a Congress to compel future Congresses. That’s why carefully constructed legislation that extends over any period of time includes trust funds, multi-year appropriations, and so on. They make it harder for a future Congress to undo a past Congress’s work.
I’ve argued against the actions of the House’s Tea Party Republicans but on grounds of decorum, civility, political prudence, and maybe even morality not of law. If there’s a legal argument please make it. Saying “a law was enacted by a past Congress, signed by the president, and upheld by the Supreme Court” is not such a legal argument. It assumes things that are incorrect: that Congresses have the power to bind future Congresses, that past laws can compel the House of Representatives, and that there’s some requirement for our law to be logical, consistent, or coherent.
Obamacare is a multiyear, multifaceted fiasco. It is a case study in how to alienate a country you intend to help. And it could become an intellectual crisis for modern liberalism.
So many errors in just thirty-one words. First, it’s premature to say that Obamacare is a fiasco. We’ll know in due course. Second, liberalism has not existed for decades. Its ideological descendant, progressivism (perhaps what he meant by “modern liberalism”), resembles its parent no more than I resemble the Metro-Goldwyn-Mayer lion. It is more a form of technocracy than liberalism ever was and the rollout of the healthcare exchanges at Healthcare.gov is a perfect emblem of its technocratic approach. It applies the “statue of a rabbit” system to law and government. You know how you sculpt a status of a rabbit? You take a block of stone and cut away everything that doesn’t look like a rabbit. You take a law, ignore everything that’s inconvenient or to which you object, and proceed in continuing approximation to the desired end. How poorly executed or even disastrous intermediate steps may be is irrelevant. It will all be done by the very brightest minds, however.
There’s no crisis here. A crisis will only come if people stop voting for candidates that espouse this approach and I see no signs of that happening.
Later on he does make a good point:
But the failed rollout has already raised ideological issues of broader significance. It has reinforced a widely held, preexisting belief that government-run health systems are bureaucratic nightmares. And it has added credence to the libertarian argument that some human systems are too complex to be effectively managed. Perhaps the problem with Obamacare is not failed leadership but rather the whole project of putting a federal agency, 55 contractors and 500 million lines of software code in charge of a health system intended to cover millions of Americans.
continuing by explaining the barrier that technocratic planning inevitably runs into headlong: inadequate information. However, Mr. Gerson and, I suspect, fans of technocracy don’t fully comprehend the extent of that inadequacy. The very addition of a system will change the underlying structures and institutions the system is intended to address so that it’s inadequate to deal with the problems it was originally intended to solve.
Dana Milbank’s most recent columns is an amusing recasting of the president’s Rose Garden speech speech yesterday as a television infomercial. But wait! There’s more!
The administration created the Web site so the buck necessarily stops with high officials — Kathleen Sebelius, the secretary of health and human services, and President Obama himself — who allowed this to happen. The administration attributes the problems partly to unexpectedly high demand from people eager to compare insurance policies available in their states and partly to technical glitches that blocked or slowed people from submitting applications and erroneous data being sent to insurers. Why the administration failed to anticipate the high demand has never been explained. Nor has it clearly explained the nature of the technical problems — or who in government or among the private contractors is primarily responsible for them.
They noticed something very interesting in the president’s speech, however:
Mr. Obama also made this important pledge to all consumers who tried to apply through the federal Web site and got stuck somewhere in the process: “In the coming weeks, we will contact you directly, personally†to recommend how to complete the application, shop for coverage and pick a suitable plan.
It’s now up to his office to make good on these promises, and there is no reason to believe it can’t be done. The health exchanges in several states appear to be working better than the federal site. And even with the federal site’s problems, some half-million Americans have successfully submitted applications through state and federal exchanges, the first step in the enrollment process.
For every elected official there comes a time to stop campaigning and start delivering. For the Obama Administration, this is that time. Early indications suggest that they intend to stick with their core competency.
I’ve mentioned The Mythical Man Month here before. If you’re not familiar with it, it’s one of the seminal books on project management, particularly software project management. One of the book’s central observations is that adding manpower to a late software project delays it.
There is a coherent reason to think that might be so. As the number of workers on a project is increased the intercommunications time, the amount of time required for the people working on the project to interact with one another, increases. There is a point at which the primary effect of adding workers is increasing intercommunications time.
Human beings are not machines and poorly designed software projects are not styrofoam cups. If you need to produce twice as many styrofoam cups, twice as many molding machines and twice as much material for making cups should do it (ignoring the requirements for increased space, energy, logistics, etc.). Software development projects don’t work that way.
The Obama administration is admitting it has a problem and has called “the best and the brightest†tech experts from the private and public sector to fix the website to the online health insurance marketplace that has been plagued by glitches since it was launched almost three weeks ago. “We’re kind of thinking of it as a tech ‘surge,’†a Health and Human Services Department official tells Politico.
Based on the numbers in this post, I’m beginning to wonder what the net effect of the PPACA will be:
Health plans are sending hundreds of thousands of cancellation letters to people who buy their own coverage, frustrating some consumers who want to keep what they have and forcing others to buy more costly policies.
The main reason insurers offer is that the policies fall short of what the Affordable Care Act requires starting Jan. 1. Most are ending policies sold after the law passed in March 2010. At least a few are cancelling plans sold to people with pre-existing medical conditions.
By all accounts, the new policies will offer consumers better coverage, in some cases, for comparable cost — especially after the inclusion of federal subsidies for those who qualify. The law requires policies sold in the individual market to cover 10 “essential†benefits, such as prescription drugs, mental health treatment and maternity care. In addition, insurers cannot reject people with medical problems or charge them higher prices. The policies must also cap consumers’ annual expenses at levels lower than many plans sold before the new rules.
But the cancellation notices, which began arriving in August, have shocked many consumers in light of President Barack Obama’s promise that people could keep their plans if they liked them.
“I don’t feel like I need to change, but I have to,†said Jeff Learned, a television editor in Los Angeles, who must find a new plan for his teenage daughter, who has a health condition that has required multiple surgeries.
Fortunately, under the PPACA Mr. Learned won’t be denied insurance due to pre-existing conditions.
Just three insurance companies mentioned in the article—Florida Blue, Kaiser Permanente, and Blue Shield of California—account for 579,000 cancellation notices being sent out. That’s more than the 476,000 enrollments the administration is claiming under the law.
The Watcher’s Council has announced its winners for last week.
