Since our fearless leaders in Washington – despite levels of bipartisan intransigence hitherto unknown to the people of America – were able to narrowly avert fiscal disaster, let’s turn our thoughts to the Affordable Care Act.
Healthcare.gov, the home of the ACA, has had a pretty tough couple of weeks.
I have tried, intermittently for nearly three weeks – and as recently as Friday – to create a profile and check out what’s available.
No luck.
The administration tells us it’s because of the crushing “demand.”
(“Demand” is an odd choice of word here. People are being forced to go to the exchanges by the federal government under threat of fines. That’s not demand. That’s compliance.)
Semantics aside, I have trouble buying into the excuse that the problems are being caused by a lack of server space because too many people are trying to sign up.
I think it’s website design and structure – the application code – not server space, that’s the problem.
If the site was working properly and just overloaded, the fix would be rapid. It’s easy to add more server space. My guess is, the site won’t work regardless of how much space there is on the server. It’s not like the information they’re asking for – name, address, Social Security number, number in household, do you smoke? – takes up a lot of space or computing power anyway.
I bet it wouldn’t work if only a handful of people were logging in. One CNN reporter set her alarm and tried to log in at 3 a.m. on a Sunday. No luck. Seriously, how much traffic could there be at 3 a.m.?
What’s truly troubling is that the system cracked under the weight of several million people just poking around in it.
I highly doubt the vast majority of the traffic to the site was generated by people trying to sign up. My guess is the greatest volume was caused by people like me – somebody just trying to check it out.
Of course, this begs the question: What happens when millions of people really DO try to sign up?
I read somewhere that companies building the  website weren’t necessarily the best software engineers, just the ones who could best navigate the mind-numbing complexity of government contracting.
I am mildly optimistic they will fix it. They’ll figure it out eventually. I mean, they’ve only had three years and spent $400 million so far. But even after it’s working you have to wonder: If the rollout was this convoluted, what’s it going to be like trying to actually obtain health care?
I also read that many people didn’t enroll because they are finding the premiums and deductibles are too high.
And I see where the folks who run insurance companies are freaking out a little bit about all this. After all, a failure of lots of people to sign up in the eagerly anticipated early days of the ACA exchanges is troublesome for them.
Insurance companies are counting on these people for the growth they need to help them comply with all the new mandates from the government, like no pre-existing conditions, no health screenings and lots of additional, mandatory coverages.
Finally, there is another  facet of the ACA which I believe might be the most underreported problem in this entire saga – Medicaid.
When the ACA was passed, it mandated that all states expand Medicaid to provide health care coverage to low-income people.  These are people who couldn’t afford to pay premiums through the ACA exchanges, regardless of how much they were subsidized.
The deal was, the federal government would fund 100 percent of the Medicaid expansion until 2016 and at least 90 percent of it after that. Needless to say, plenty of states were skeptical. They figured eventually the feds would punt all those costs to the states. But too bad for them, it was the law.
Along comes the U.S. Supreme Court ruling on the ACA. The high court, you may remember, upheld the individual mandate as a form of tax, but it struck down the mandatory Medicaid expansions.
Basically, it said the federal government couldn’t force states to expand their Medicaid programs. Let me say that another way: Under the ACA, states were no longer required to expand Medicaid.
This essentially gave an “out” to all those states who saw the likely outcome of Medicare expansion as a state budget buster.
So far, 26 states have opted out of expanding Medicaid.
The net result is that some 30 million Americans – precisely low-income people the law was meant to help – are being left out.
This is huge.
Prior to the ACA, there were 45 million people uninsured. The whole point was to get everybody covered. People who are uninsured drive up the cost of health care by their inability to pay for it. The costs get shifted to those who can pay.
Remember all the talk about bending the cost curve? We were told the health care cost curve would bend downward if everyone was insured.
Maybe so, but as it stands, just the Medicaid piece alone leaves 30 million people uninsured. How many more will simply pay the paltry fine and forego buying insurance in the exchanges remain to be seen.
But when it’s all said and done, we could see a situation where, despite all the machinations and preparations, all the infighting and political posturing, all the expense, we may only add 5 to 10 million people to the roles of those covered by insurance.
Now remember, insurance companies can’t deny coverage to anyone. Do you suppose hospitals and insurance companies will be able to charge less under this scenario? If not, who do you suppose will pay to make up the difference?
Here’s what I want to know.
When that Supreme Court ruling came down, the people running the ACA either knew or should have known what was going to happen. It was a major change in the law that left  a gaping hole in what was supposed to be universal coverage. What did they do about it? Rework it? Delay it?
Nah.
It’s like they just shrugged and said, “Oh well, what the heck. Let’s roll it out anyway.”
It’s as if you were loading up the minivan to go on a family vacation to Florida. You happen to notice a big puddle of oil under the engine and you say, “Eh, no worries, it’ll probably be OK. Let’s just see what happens.”
In both cases, I have a pretty good idea what’s going to happen.
It’s times like this that I wonder whether maybe the goal is to just blow up the U.S. health care system. Then our progressive leaders can tell us how awful and broken things are and that we must install a Euro-style single-payer system.
That’s kind of what they wanted in the first place, wasn’t it?