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Shoot For the Moon

May 18th, 2014 - 4:29 pm

Sarah Kliff, formerly of the Washington Post, dissects the  failure of Obamacare in Massachusetts.  In article titled “How Massachusetts screwed up Obamacare” she describes how they “shot for the moon” and missed. The irony was the Massachusetts seemed to have all the elements of success. It had the RomneyCare system; it was a blue state; it is one of the information technology centers of America.

Massachusetts pioneered universal health care in 2006. Under then-Governor Mitt Romney, it was the first state to guarantee access to insurance — and drove its uninsured rate down to just 4 percent.

Which makes it baffling that Massachusetts did arguably the worst of any state in implementing Obamacare. Like a handful of ardent Obamacare supporters in other states, Massachusetts officials tried to pull off an ambitious launch — and failed badly.

Yet it did so badly that the Commonwealth is junking the site, essentially scuttling the ship. Kliff does not blame Obamacare — for how could that be defective? — instead she blames the incompetence of the Bay Staters, theorizing that the existing system simply got in the way of the more perfect one.

Massachusetts needed to toss out the paper applications it had used for years. This turned out to be more difficult than it sounds.

“In some ways it’s harder to rehab your house when you’re still living it,” Jon Kingsdale, the Connector’s first executive director, says. …

After pioneering universal coverage in 2006, Massachusetts was quick to embrace the Affordable Care Act. It was among the seven states that the Obama administration awarded an “early innovator” grant, to develop models for the new, all-digital marketplace that other states could replicate.

Massachusetts’ wanted to build a more complex marketplace than other states were attempting. For example: the state’s health reform law gives residents more generous subsidies to buy health insurance than the federal law. So officials decided the state should keep paying more, using its own state funding. That meant Massachusetts was layering on another level of financing — and another level of complexity.

“We shot for the moon, and we missed,” M.I.T. health economist Jon Gruber, who is a member of the Health Connector’s board of directors, says.

There were three agencies working on the launching the new exchange: MassHealth (the state Medicaid program), the Connector, and Massachusetts Medical School. One audit report from December 2012, which showed the project already behind schedule, cited “inefficient communication” between those three agencies as one reason for the delays.

“There wasn’t a single point of management,” Gruber says. “It was poorly set up and it was this horrible combination where the contractor would get different orders, and would do none of them.”

And the result was fiasco.

“Screens were disappearing, information wasn’t there, people thought they had submitted an application but it actually hadn’t gone through,” says Amy Whitcomb Slemmer, who runs the consumer group Massachusetts Health Care for All. …

“If you were applying for unsubsidized coverage, it was error-prone but you could get through,” says Iselin. “If you were applying for subsidized coverage, all you could do is enter your application. Aside from the intake, we had no exchange website.”

Kliff unfavorably compares the Massachusetts site to Healthcare.gov which was ‘largely fixed by December’. But that’s not correct. It isn’t fixed. As yesterday’s post noted, Healthcare.gov’s backend is largely imaginary.  In fact Amy Goldstein and Sandhya Somashekhar of the Washington Post say it’s handing out money uncontrollably, like a broken ATM machine.

The government may be paying incorrect subsidies to more than 1 million Americans for their health plans in the new federal insurance marketplace and has been unable so far to fix the errors, according to internal documents and three people familiar with the situation.

The problem means that potentially hundreds of thousands of people are receiving bigger subsidies than they deserve. They are part of a large group of Americans who listed incomes on their insurance applications that differ significantly — either too low or too high — from those on file with the Internal Revenue Service, documents show. …

the federal computer system at the heart of the insurance marketplace cannot match this proof with the application because that capability has yet to be built, according to the three individuals.

Like a cash machine that has no idea how much a customer actually has in its account, the Federal government is handing out tax money in subsidies to people who declared a lower income on their Obamacare application than on their tax return.  And the Obamacare site is powerless to detect it.

The inability to make certain the government is paying correct subsidies is a legacy of computer troubles that crippled last fall’s launch of HealthCare.gov and the initial months of the first sign-up period for insurance under the Affordable Care Act. Federal officials and contractors raced to correct most of the technical problems hindering consumers’ ability to choose a health plan. But behind the scenes, important aspects of the Web site remain defective — or simply unfinished.

All those broken State Health sites running for shelter to Healthcare.gov are going to migrate their data into a bucket without a bottom.  The administration is going to impose a $250,000 fine on anyone who lies on an Obamacare application. The fine will be reduced to $25,000 with a good explanation for an honest mistake.  But as the Blaze points out, some Obamacare Navigators have been advising applicants to lie.

The Urban League of Greater Dallas has reportedly fired one person and suspended three others after an undercover video from James O’Keefe’s Project Veritas caught Obamacare “navigators” advising a potential applicant to “lie”and provide false information to get a lower premium and more subsidies.

Where did it fail? Kliff suggests that Obamacare’s failure in the Bay State is largely a failure of implementation. But maybe it is mostly a consequence of a bad design. Obamacare is 2,000 page monstrosity whose complexity defies implementation.  It’s a one size fits all system designed to “fundamentally transform” 1/6th of the US economy. What could go wrong?

Obamacare Flowchart

Obamacare Flowchart

Practically anything. The problem with all-or-nothing undertakings is if they fail, they fail completely. The Krell Machine goes haywire and the Forbidden Planet explodes. Obama should have known this, but chose bet to everything on the venture. Kliff seems to think Obamacare will sail serenely on. But perhaps the only difference between Healthcare.gov and the Massachusetts Connector is that Healthcare.gov hasn’t run out of money yet. When it does then, as in the movie, you have to be at least 100 million miles away to survive the blast when the Krell furnaces overload.

Recently, a think tank close to the president has called for a Czar to take over the program. “Obama supporters call for ObamaCare czar to avoid another rollout disaster”.

The White House acknowledged Saturday being open to a proposal for President Obama to appoint a chief executive to oversee the Affordable Care Act — an ObamaCare czar — following the Department of Health and Human Services handling last year’s disastrous rollout.

The idea is being proposed by a group of healthcare experts that wants a new chief executive officer to oversee the ObamaCare online health-insurance exchange and to ensure the overall program is ready before the next open-enrollment period, which begins in six months. …

The proposal was released this weekend by the Center for American Progress, founded by John Podesta who left the think tank earlier this year to become a White House senior counsel.

The idea is supposedly to take the Healthcare.gov site away from the federal government and put it in the hands of the better-suited private sector.

Coming as it does from Podesta’s shop it likely represents the White House’s deepest fears as if they knew they were sitting on a timebomb and had to put the requisite distance between Obama and Obamacare before it all went up.

The great virtue of the Health Care Compact concept advanced by Leo Linbeck is that it is incremental and diversified. It doesn’t put every egg in one basket, and isn’t founded on a single controversial, immutable piece of legislation passed without a single Republican vote.  That approach alone may give it several key advantages and may hold key lessons for the Obamacare alternatives now emerging. A more subsidiary approach can only ever partially fail and since different states can experiment with different approaches, it is far more likely to strike gold than Obamacare, which is digging a hole to China in one fixed place. What Obamacare reaches when they dig deep enough should give one pause.


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Top Rated Comments   
After the last 5 years we Americans have been subjected to a litany of abuses. That of course applies mostly to the middle class, what is left of it and those clinging on in the nether world between middle class and abject poverty. The uncontrolled costs were of course part of the plan as part of the bait and switch. Get people signed up whether they lie about their income or not. Get them signed up whether they are legal or not.

The IRS is there to act as a arbiter of who is going to be asked to come in for a health care audit and who aint. As we have seen the treatment of the Tea Party with their pleas for a balanced budget and a constitutional government it clear how that is going to go.

They say that any law no matter how small or petty in offense, such as jay walking, sooner or later will require men with guns to come and enforce them.

Based on the known facts, I am not kidding that I believe that the IRS will operate more and more like a Gestapo. No, they don't have to send you to internment camps, that was so last century. They instead will bleed you until you are broke then deny you health care. The white glove will take on a new nuance as illegal aliens are guaranteed a pass while the tax payers with an unacceptable voting record will be pointed the way of the audit, bankruptcy and to an early grave. And unlike the Jews, the IRS can charge the victims for their gold teeth.
17 weeks ago
17 weeks ago Link To Comment
Management by third rate lawyers. When the rocket turns earthbound their immediate reaction is, Who do we blame? Bart Simpson would show more professionalism. His father would be more honest.

Let me throw an idea out there so wild and crazy that as the Blogfather says, it just might work. Basic medical care is a good or service like any other, so for basic care, semi annual checkups and cuts bruises colds etc, just do a fee for service. Here is the key fact that all the drama in the world cannot change. Nothing will ever lower the costs for basic care for the vast majority below what it would be under a fee for service system. That is called the market. That covers the great bulk of medical care for the great bulk of the population.

There are a few special cases where the government subsidizes the system by providing health care. Active duty military, service connected disabilities for veterans and care with sliding copays for other veterans, and Amerindians under treaty provisions, that may need a closer look, and merchant mariners, and immigrants needing inspection at the border. Those last three are the job of the Public Health Service. It makes sense to me to extend the merchant marine model, which is legitimate since it goes back to 1798, to cover astronauts and civilian space merchants mariners.

What is left? The truly indigent and the catastrophic conditions. The first can and have been taken care of by charity more efficiently than any government can provide a service. The later is the role of insurance. If we isolate the cases that are not covered by a fee for service system, which is what we had before WW-II when most hospitals were built in America, then the problem suddenly is much less overwhelming. It is almost certain that restoration of a fee for service for basic healthcare, with supplementation by charitable and largely local government services, would dramatically reduce costs.

Who would lose under the proposed system? The SEIU would lose, as would the vast army of unskilled coders billers lawyers and paper shufflers the current system generates..
17 weeks ago
17 weeks ago Link To Comment
All hat check ticket, no cattle, looking for another cash cow to rustle up. And he needs a new Czar to help find the ticket. Another MacGuffin for the narrative. Not sure if the hat, or the check is the MacGuffin, but in this Narrative, it's MacGuffins all the way down.

What angers me to the bone is the low rent grifters populating the Org chart of this clustered duck. They are now in some control over 1/6th of a multi-Trillion dollar economy. And need a think tank to point them in the general direction of how to actually siphon off the monies available. A Beneficent Corporate entity to manage the process properly. The process that 'only' Govt is equipped to handle fairly. Just not working yet.

They have tasked themselves with being a middle man/broker. They don't even have any end product/service to deliver. In their minds. Sarah Kliff is a clueless True Believer. Yes! We can! At some point. In the fairly near future, I am fairly, nearly sure.

In the not too distant future, the true Grim and Determined types will show up. Maybe not a Lenin, or a Stalin, Mao or Pol Pot type. But someone who isn't lazy. Who doesn't care about cocktail parties with celebrities or nice vacations. A relentless, evil power for the sake of Power soulless git.

Will gut the Elite Govt Aristocracy from the inside. The rest of us shant fair any better either.

Unless we the people, who have a clue, manage to incrementally yank these malevolent mediocrities driving the bus, back away from the chasm awaiting.

This comment recognizes the malevolent Mediocres are also working their super intelligent Wondrous Insights on the Military, World Order/Politics, the rest of the economy, edumakayshuns, etc. etc. Just don't want to take up anymore space.
17 weeks ago
17 weeks ago Link To Comment
All Comments   (46)
All Comments   (46)
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Massachussetts' failure to implement ObamaCare illustrates why liberal schemes fail so often. Liberals try to build a house from the roof down. Conservatives build a house from the ground up. Unless liberals perfectly execute construction, the project completely fails. If conservatives imperfectly execute construction, they still have a pretty good foundation to finish. Incremental construction trumps Big Bang construction.
16 weeks ago
16 weeks ago Link To Comment
"The fine will be reduced to $25,000 with a good explanation for an honest mistake."

LOL Accepting that subsidy just got interesting, especially for anyone named Liberty.
17 weeks ago
17 weeks ago Link To Comment
Above: "The administration is going to impose a $250,000 fine on anyone who lies on an Obamacare application. The fine will be reduced to $25,000 with a good explanation for an honest mistake."

Is that right? Someone shows that they made an honest mistake, and they are fined $25K anyway? That is the new world of government mercy. The miscreant is fined for the need to investigate, merely because of an error.

Where can I sign up? I am perfect in filling out forms.

17 weeks ago
17 weeks ago Link To Comment
I've said it before and I'll say it again:

In ALL aspects of ObamaCare, the possibilities for adverse selection are truly mind boggling.

Think of the true costs of ObamaCare as the mother of all hot potatoes. All the players in the game

doctors
hospitals
patients
insurance companies
states
employers
(and others?)

are incentivized to get rid of the hot potato as fast as they can. They don't really care who ends up with burned fingers, so long as it's someone else.
17 weeks ago
17 weeks ago Link To Comment
Darwin: Natural Selection

Obama: Adverse Selection

The Ultimate Adverse Selection: Taxpayer chooses to get sick and die in peace.
17 weeks ago
17 weeks ago Link To Comment
0bama is The Stainless Steel Rat of the grasping American Nomenclatura.
Thank God he's lazy.
17 weeks ago
17 weeks ago Link To Comment
We're so lucky that Obama was merely incompetent. The American people were completely hoodwinked by the MSM. Obama could have been a full blown Manchurian candidate with a carefully designed strategy. Instead, he's Bozo the Clown with no coherent plan causing random damage while receiving applause from brain damaged moonbats.

After Obama goes away, the credibility of both the MSM and the moonbats will have gone to zero. It will be a historic opportunity to rebuild.

p.s. Harry Harrison was the greatest.
17 weeks ago
17 weeks ago Link To Comment
Loved those books.
;^)

"After Obama goes away, the credibility of both the MSM and the moonbats will have gone to zero. It will be a historic opportunity to rebuild."

If only...There are historic levels of moron to overcome first.
17 weeks ago
17 weeks ago Link To Comment
FWIW?
My Firefox (Mozilla) is not picking up BC's blog posts past http://pjmedia.com/richardfernandez/2014/05/14/taskforcesmith/

I can see the newest posts on IE and Chrome


What the hell's going on with PJM, again?
17 weeks ago
17 weeks ago Link To Comment
Just as a data point, I use Firefox. During the Great PJM Self-Inflicted Collapse; it went wonky, but for the last couple of days PJM in general [with the exception of one comment the post author removed :-)] and BELMONT in particular have worked. Mind you, every site visit is a possible brand new adventure.

Subotai Bahadur
17 weeks ago
17 weeks ago Link To Comment
:-)

I'm pretending all my troubles are over in Chrome, 'cause IE is too slow to endure.

Remember when there were sane rules for responsible HTML writers?
17 weeks ago
17 weeks ago Link To Comment
I use Pale Moon as a browser, which is a copy or derivative of Firefox.

On my browser, the main PJM page hasn't changed for I don't know how many days now. I began to wonder if PJM is in financial trouble or something. This only happens at PJM (but not at Instapundit, which is a separate PJM site.)

At your indirect suggestion, Old Doug, I tried the Opera browser. Suddenly, with Opera, PJM is up to date.

So whose screw-up is this, Firefox/Pale Moon or PJM?

More: I can't even comment using Pale Moon. Had to go to Opera.
17 weeks ago
17 weeks ago Link To Comment
"There was an error saving your submission."

That's a new one for me, so changes may be being made.

I thought Pale Moon was a Microbrew, but I have an old version of Opera installed, so maybe...

I do suggest copying your comment prior to submitting to the PJ G_ds.

---

New new thing: Reply button disappeared in IE, Opera, and Chrome.

Time wasted so far today: 90 Minutes and counting.
17 weeks ago
17 weeks ago Link To Comment
PJM.

The only question is whether they think it's a feature or a bug, but they're not the kind to kiss and tell.
17 weeks ago
17 weeks ago Link To Comment
I'm going to volunteer for the next test of the Russian booster.
17 weeks ago
17 weeks ago Link To Comment
As is usual with mainstream conservatives, the point is missed. It's like the scene in "Robocop" where Ronnie Cox jacks up Miguel Ferrer in the restroom. After explaining the point of the robotic police program is to make money and not to provide effective law enforcement, he lists the many profit opportunities and ends by shouting "Who cares if the damn thing works!"

Indeed, who cares? Any problems only mean more money is needed. More Obama voters will be employed and subsidized.
17 weeks ago
17 weeks ago Link To Comment
And the others will be fined into oblivion.
17 weeks ago
17 weeks ago Link To Comment
Ukrainian Prankster at Cannes Film Festival:

http://adamcarolla.com/wp-content/gallery/2014-05-19-rowe/02.jpg

"I was seeking shelter from Pootie Poot"
17 weeks ago
17 weeks ago Link To Comment
(I'm the guy on the left with the correct facial expression...

But I forget the significance of the inverted green flowerpot on my head.)
17 weeks ago
17 weeks ago Link To Comment
O’Bama did not start off deliberately trying to be the worst President in history. No one intentionally seeks to be the worst at anything. If he intended to make the country into a communist paradigm, he was confident that history——enlightened history with revised and improved standards——would judge him kindly. He has acted deliberately in that regard.

However, O’Bama fails on two levels. First, the communist plan for society is inherently defective, and he can’t help that. Second, he and his collaborators are morbidly incompetent. Any goal they pursue would result in poor performance, doubly so when the goal is so tragically wrong to start with.

One of the most obvious roots of O’Bama’s incompetence is his egomania, which is the reason for his mistrust of the military. He abandoned Iraq, despite the fact that it was a fairly stable ally and base in a prime strategic position in the Middle East. The world would look very differently today had he not taken that single stupid decision. One has to ask why he did that? The answer is that his ego could not stand the fact that continued success in Iraq, in the Middle East, and in the world would have depended on continued military judgment and decisions exercised by military professionals. He has to defer to military expertise, as does any President. This he can not do. He is, therefore, inherently incapable of employing a key element of American power as a stabilizing factor in the world.

Hence, he was doomed to fail in international affairs. For this he was applauded as recipient of the Nobel Peace Prize as the world socialist/communist community revealed its destructive folly yet again.
17 weeks ago
17 weeks ago Link To Comment
The situation in Iraq was difficult if they did not want to give immunity to US troops. It would have taken major diplomatic (sic) efforts to get an agreement we wanted, for unknown return on investment, and probably with ongoing problems. It just fit in too many ways with Obambus' personal credo of doing nothing and running away and letting someone else fix things.

Could we have done anything to get an actually friendly government in Iraq that would have granted immunity and happily agreed to US bases there for the duration? Perhaps, but many bad steps were already taken under GWB.
17 weeks ago
17 weeks ago Link To Comment
My recommendation was to build a base near to the port along the Iraq - Kuwait border. Make it an American free fire zone then negotiate ROE in other areas as needed. Want US forces to clear out AQ in Iraq out of Tikrit? Fine write an agreement that waives existing ROE temporarily. Can't blame the Iraqis for wanting to exercise national sovereignty. Certainly the light worker could have come with flexible terms. No, Obama just wanted to take a big dump on GWBs legacy.
17 weeks ago
17 weeks ago Link To Comment
I'd like to know more than I do (which is basically zero) about how the real (back-room) negotiations went, but I assume that if Obambus had known or cared about it, something could have been worked out. But he had a tee time, and was happy to just get Iraq off his plate - as his special salute to GWB but also fulfilling his life's work as an anticolonialist.

Bases optimally placed to strongly support Israeli raids into Iran would have to be placed elsewhere, further north and out in the desert. OTOH something like that could be set up in days or hours, if all parties cooperated. And that cooperation would be more likely if we had more of those bases there - we are after all still in Kuwait (aren't we?). And of course at this point the party least likely to cooperate - is the USA under the Obamanation. So maybe it just doesn't matter. Maybe it's better we DON'T have those bases after all, as having them might encourage Obambus to have the US military shoot down any Israeli attack. As it is, a few bribes and the Iraqi military, such as it is, might just take the afternoon off.
17 weeks ago
17 weeks ago Link To Comment
" Kliff does not blame Obamacare — for how could that be defective? — instead she blames the incompetence of the Bay Staters, theorizing that the existing system simply got in the way of the more perfect one."

-her treatment of the subject just about perfectly mirrored by the scenario of four pothead sophomores sitting around the dorm room and having the revelation that communism really can work if only it will ever be managed and administered correctly.

Buffoonery.
17 weeks ago
17 weeks ago Link To Comment
Buffoonery the Empire Slayer
17 weeks ago
17 weeks ago Link To Comment
" But as the Blaze points out, some Obamacare Navigators have been advising applicants to lie."

-my heavens, how utterly reminiscent of LYING ACORN advisers and the housing collapse. probably the same bunch.
17 weeks ago
17 weeks ago Link To Comment
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