Obamacare And My Discontents

 

Actually, my first discontent is with the mainstream media. As others have noted, the art of journalism has devolved into thoughtless reporting of what people say, without evaluation of whether what is said is truthful, factual, or from a reliable source. Fairness has become letting each side say what it will, and treating each side as equally valid, or as equally culpable. Of course, this is not the case.

 

With Obamacare, reporters who aspire to a touch of journalism might do well to consider the following:

 

Obamacare will provide health insurance for about 30 million previously uninsured people. Is this a good thing? Undoubtedly, yes. Will it cost more? No. Routine medical exams and preventive health care definitely will be cheaper than emergency room health care.

 

Obamacare requires insurance for people with pre-existing conditions, who now either are denied coverage, or charged huge fees. Is this a good thing? Yes, as those who need health care will get it. Will it cost more? Yes. People with pre-existing conditions will require more service than the general population.

 

Obamacare eliminates annual or lifetime limits on benefits. Is this a good thing? Yes, for the small proportion of people with extraordinary health needs. Will it cost more? Yes, of course.

 

Obamacare eliminates gender discrimination in insurance rates. Is this a good thing? Yes. Will it cost more? Not likely, as rates will be set for the overall population to cover any differences in costs between the genders.

 

Obamacare provides that preventive health care services are included in base insurance rates, without extra charge. Is this a good thing? Yes. Will it cost more? No. Preventive health care lowers costs over time.

 

These five points are major elements of Obamacare. Those who oppose it should be required (1) to articulate truthful, factual and reliable arguments for their positions, and (2) to explain how they propose to achieve these five “good things” with reasonable alternatives.

 

Republican opposition to Obamacare has been consistent for over four years. However, is there a clear vision of what they would propose to replace it? Not yet. And if not, why aren’t journalists demanding those proposals, or at least regularly noting their absence? If opposition to Obamacare is all there is in the Republican vision, then we have to ask if we want to return to an insurance system which leaves 30 million uninsured, denies insurance for those with pre-existing conditions, caps annual or lifetime benefits without regard to need, continues gender discrimination in rates, and abandons preventive health care in favor of expensive emergency room treatment. Is anyone really prepared to argue in favor of the old system?

 

My second discontent is with the apparent incompetence of the Obama administration. How could they have failed to implement the law effectively? It doesn’t take a lot of research to uncover example after example of failure and cost-overruns in large-scale Federal software development. With this history, how could the administration fail to closely manage the web site programming? It is not simply that out-sourcing this project to the private sector was a mistake. Perhaps it was, but with Republicans pushing for years for the virtual elimination of in-house programming expertise in favor of out-sourcing, and with Democratic acquiescence, there is no way of telling whether government employees could have done better; there aren’t enough Federal programmers left. It should be clear by now that the private sector isn’t necessarily cheaper or smarter than civil servants. Isn’t it time to consider rebuilding Federal expertise?

 

What is clear is that neither Obama, nor his staff, nor Sibelius, nor her staff, were paying enough attention to the details of the web site development. It is not even clear whether there were enough people at hand with expertise in managing such contracts.

 

The web site can’t be fixed in one month. I predict that will take many months to patch the programs to a reasonable level of functionality. The media will report the daily score of who is winning and who is losing, what is working and what is not. But in the bigger picture, achieving the five “good things” discussed above is far more important than the software failures along the way. Keeping our eyes on the goals is one way to overcome inept media, cynicism and opposition.

 

My third discontent transcends Obamacare. George H. W. Bush and his people were ruthless and smart in pushing through their agenda. They paid attention to detail. They were focused on the bottom line. They ignored distractions in pursuing their goals. Examples include executive orders promoting: pro-faith initiatives (EO 13198 and 13199); and anti-union provisions (EO 13201 and 13202)*; and withdrawing from the Anti-Ballistic Missile Treaty and the Kyoto Protocol on greenhouse gas emissions, all in the early months of his first term. Obama pushed through Obamacare, a heavy lift to be sure, but what else?

 

In the long run, I suspect that Mr. Obama’s time as President will be tagged with a lack of interest in following-through. Inspiring speeches are great. Inspiring results are greater. It takes a bottom line manager to deliver on promises. Perhaps Mr. Obama should hire a Chief Executive Officer to run his high priority domestic projects?

 

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* http://www.archives.gov/federal-register/executive-orders/2001-wbush.html

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1 December 2013

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Published on Huffington Post

 

Canceled Health Insurance? No Problem!

 

Watching the birth of Obamacare was like going inside a restaurant’s kitchen: we didn’t want to know that much about the process. We were revolted by the buying and selling of votes. We watched extortion by the last “undecided’s” in Congress. We couldn’t understand the complex, cobbled-together mess of a final law. No wonder about the reaction, especially from the right.

 

BUT: the goal of near universal health coverage still is right for the country, and in the absence of reasonable alternatives which accomplish the goal, we have to work with what we have. Thirty million uninsured depend upon it. All of us need the improvements brought by the law, such as coverage for pre-existing conditions.

 

No surprise that the web site does not work, or that it will take too long to fix. I managed Federal IT projects for years, and continually wondered at government-wide projects poorly managed, and over budgets and schedules. Plus, the frequent lack of common-sense and expertise by contractors.

 

So, here we are with insurers canceling coverage for many, with no immediate replacements.

 

No problem! Here is a fix which could be implemented quickly: emergency legislation.

 

O All those whose insurance is canceled immediately and automatically will be enrolled in Medicare (waiving the age requirements).

 

O Insurance companies will be required to send copies of their cancellation notices to Medicare, for processing of Medicare accounts and cards.

 

O Continuous coverage will be guaranteed, including payment for services required before Medicare processing is complete.

 

O People will be able to use their cancellation notices as interim Medicare cards.

 

Now, all we need is a willing Congress...

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13 November 2013

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Published on Huffington Post

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Disinfectants And Public Health

 

Disinfectants: Marketing disinfectant products by raising public fear of bacteria runs counter to improved public health. We have evolved in a bacterial environment, and our immune systems depend upon bacterial infections to stay strong. Promoting a goal of 100% bacteria-free environments encourages disinfectant use. However, constant use will lead to resistant bacteria, and potentially great health hazards. Items such as antibacterial soaps in public wash rooms need to be banned, and people need to be told the truth about overuse of disinfectants.

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Saturday, March 15, 2008

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High Quality Health Care For All

 

Most of the discussion of controlling health care, Medicare, and Medicaid costs focuses on reducing benefits, or artificially capping payments. Neither of these approaches addresses the need for quality health care for all Americans.

One problem with the current health care system is that medical professionals generally are paid for “piece work,” for example, by the operation. This encourages both long hours and higher volume activity, neither of which improves the quality of service. We need a new paradigm.

Medical professionals should be salaried, with comfortable pay rates. Their work loads and hours should be cut as well. A new group of medical professionals should be recruited and trained, to make up for the reduced work loads. The government should pay for their medical education, under contracts which require one year of public service work, for each year of training.

By substantially increasing the number of medical professionals, we could reach the goal of high quality health care for every American.
 

Saturday, March 15, 2008