It’s been a ‘Catch-22’
The web designers will tell you: when it comes to websites, good design can’t mask bad ideas.
I’ve been thinking about that for the last six weeks as I’ve confronted, with waning trust morphing into enraged frustration, the remarkably complicated corridors of The Patient Protection and Affordable Care Act (popularly known as “Obamacare”). The problems in the roll-out of this ersatz reform are generally known and, depending on who’s talking, have led to irritated calls for fixes or have been cited as proof that anything the government does that is socially responsible is a communist-inspired train wreck.
After nearly 20 years of Internet work, I know that all major web-based projects launch with problems, some of them crippling, and I know they can all be fixed. There is nothing extraordinary about Obamacare’s website problems except the shrill reaction they’ve provoked. This is to be expected. The “looks good, sounds good but can’t do anything right” tag that underlies the controversy is one of racism’s trustiest refrains and this is a President who has been battered by those kinds of comments.
But dwelling on the technical side of the web-site break-down is a mistake because it draws attention from the more important problem unmasked by the roll-out and the complexity of these websites: Obamacare isn’t a health-care program, it’s a corporate bail-out. It’s not about avoiding or treating people’s health problems, it’s about avoiding and treating the collapse of the insurance industry.
The websites have run into problems because they are a kind of “Amazon” for health care and they weren’t ready to do that. Soon they will be ready and the technological problems will disappear but the most important social problem — a health care system that has nothing to do with caring for people’s health — will remain.
My own experience, a frightening and painful process, demonstrates this truth. I am 64 years old, a member of the demographic group that most needs Obamacare, and I am not being allowed into the program. Let me tell you the story, starting with a bit of background.
I live in New York and our state is a full participant in the ACA: we have a marketplace, our own website system (called “New York State of Health”), a help system…everything the President wants us to have. While I’m still functional, energetic and in otherwise decent health, I have a few conditions that require medication which I take, in large quantities, every day. I take the pills, I’m fine. I don’t, I get sick. Their cost, without insurance, is prohibitive. I need insurance and my current insurance will expire at the end of December. Since Obamacare will take on most of my insurance company’s customers, it is now not cost-effective for my insurer to continue offering non-ACA insurance. So, because of Obamacare, they’re canceling my policy at the year’s end. I’m currently on Social Security (my only source of income) but I can’t get Medicare until March, 2014 when I turn 65.
So I need Obamacare coverage for three months and, about six weeks ago, I went to my local library in Brooklyn to meet with a “navigator” from the State’s ACA help system staff to get that coverage.
Navigators guide you through those Obamacare corridors — basically helping you fill out all the on-line forms. My navigator, a competent and pleasant fellow, did the on-line forms with me. After a half hour of form-filling, he pushed the submit button and the website shook its head. “You are not eligible to purchase insurance from the marketplace”, it said. That’s Obamacare-speak for “you can’t get Obamacare”.
My navigator frowned and got on the phone with the State people from the department that manages the program and they explained that their site was temporarily malfunctioning. “Wait until tomorrow”, he told me, “It will be fixed by then and you’ll be able to go to the marketplace and select your policy.”
I was relieved. But when I checked the site the next day, the message was the same and so I called the State number myself. I spoke to a pleasant woman — everyone’s pleasant in this story — who explained to me that my income level was low enough to qualify me for Medicaid, the low-income medical insurance program. I told her I didn’t want that; I wanted Obamacare. She instructed me to uncheck a box on one of the pages of the site and wait a day.
I was more anxious but still believing so I did as she said. No change when I checked the next day.
I called again, this time speaking to a fellow (equally intelligent and pleasant). Oops!, he said, there’s another box on another page on the form that was checked and they were evaluating me for Medicaid as a result. Uncheck that one, he explained, and wait another day. Now I was anxious to the point of paranoia but I followed his instructions.
The next day…no change! I started to panic. I can imagine living with all kinds of problems but not getting my meds isn’t one of them.
So I called a third time and was told that, like it or not, I qualify for Medicaid; Obamacare marketplace isn’t an option. I have to wait for my Medicaid to kick in, which it will before my current insurance expires. I hung up with my already blazing paranoia still blazing: if I unchecked the boxes, thereby indicating I didn’t want Medicaid, would it still kick in? Would a government whose greatest creativity is applied to not taking care of people who need care give health coverage to a guy who unchecked his boxes?
I called my navigator; he didn’t return the call. So, after a week of waiting, I did what any seasoned activist would: direct action. I waited for the day I knew the navigator came to my local library and then literally invaded his turf. He recognized me immediately (probably feeling guilty at not having called me), apologized for not calling and brought up my account on the website.
He quickly identified the problem. “You should qualify for whatever you want,” he told me (I’m quoting him as best I remember), “But the people who design the system don’t always take everything into consideration. Since you only need coverage for three months until you start Medicare, you can’t get Medicaid. That’s for a year or more. And you can’t get Obamacare because you qualify for Medicaid.” I asked the obvious question, “That’s like a catch 22, right?” I guess I should be grateful the guy understood the term “Catch 22″ because he nodded, “Exactly”. he said.
What am I supposed to do then? I think my voice was shrill by then. Go to a broker, he said. You have any names, I asked, thinking this a reasonable question. No, he said, we don’t deal with brokers. Just Google for insurance brokers.
I then embarked on a quest for an insurance company that can sell me insurance for three months and soon encountered a problem. Unlike companies in the states that refuse to set up a marketplace for Obamacare (like Florida, where my younger son lives), the insurance companies in New York State are all doing what my outgoing insurance company did: getting out of the private insurance business. It is just not profitable for them.
I finally filed a form with Blue Cross/Blue Shield which pretty much has to insure anybody who can pay their premiums and I’m hoping they will let me pay a premium that is 20 percent higher than what I’ve been paying for insurance that doesn’t compare to what I had but at least covers my medication. I’m waiting for the response and I’m scared. I’m also angry because the website that was supposedly working, New York State of Health, failed me and the program supposedly designed to give me health insurance excludes me. I am not able to get something the law says I’m supposed to have.
How could it be this way? This is a program designed to address the inability of so many people in this country to access a resource, health-care, that is among the most developed and abundant in the world. How can it just let people like me fall through the cracks? There’s a technological version of that question: why did those websites fail?
The answer is easiest when one envisions the program that could have been most easily handled by the Internet: single-payer health coverage, the kind that most major capitalist countries have. To make that work all you would need would be a site that signs you up and a back-end (the hidden works of a website) that would assign people to their groups, take their information and steer them to practitioners. Such a site could be designed by any competent web design team in a month and that’s no exaggeration.
But the Obamacare sites have to address another problem that is their priority: how do you save the imploding health-care insurance industry. With premiums rising steadily, a population that can afford them less and less, and a medical establishment that is mired in the culture of charging three and four times what services really cost (even in this price-bloated system), the health-care insurance industry is facing a self-destructive crisis. It’s losing its market and, if not saved, it could force a collapse of the entire health-care industry.
Like most capitalist service industries, it can’t make adjustments to avoid such a crisis even if it sees it coming — which it probably does. It needs some power to intervene and perform market magic: expanding the number of customers, lowering the level of risk to companies and maintaining premiums at “affordable” levels…all without any cost to the industry.
Obamacare to the rescue! With Obamacare the market explosively grows as physicians and hospitals handle more paying patients. Providers don’t face the dreaded “bad debt” that represents a significant percentage of most doctors’ and hospitals’ balance sheets. They avoid the inevitable protests and lashes as things fall apart. And they look good from a public relations standpoint. In short, they avoid the inevitable demise of their industry and they do it without paying a penny through a program that is financed on the backs of some people who will pay more for their insurance mixed with some government subsidy coming from our taxes.
To make this happen, ACA needs a network of websites that constitute an insurers’ bazaar that must handle a variety of tasks starting with processing one’s eligibility and age (since age is critical for insurance policies). It must then offer a broad selection of policies from dozens of companies, process the one you pick, send your information to that company, arrange premium levels, get your coverage started on time and then double-check everything to make sure it’s all legit and functional. The National site broke down because it wasn’t ready to handle this complexity but it’s the complexity, and not the website, that’s the issue because the complexity reveals the program’s real purpose.
In fulfilling that purpose, it’s brilliant. It saves the industry, covers a lot more Americans, forces lots of people to pay higher premiums and comfortably hides the fact that it forgets some of the people it is supposed to take care of. That’s why the President never said he would insure everyone — just reduce the number of “uncovered”. A significant part of that “uncovered” is younger people who often don’t buy health insurance and will now prop the program up. Obamacare has been clamoring for them to “join the pool” injecting new money into the industry’s coffers and costing a lot less (since they’re very low-risk).
Then there’s people like me: the “transitioning population” — often weak, many of us hampered by conditions that forced us into earlier retirement, with fewer years in which to make a ruckus. Our death doesn’t mean a whole lot to our government so we’re iced from the program.
It’s the kind of political genius that has characterized the remarkable record of this this brilliant, cynical politician’s Administration. The historians will long be explaining how this President has done what he has. He has allowed 25 million unemployed people to stay unemployed and 50 million to stay below the poverty line while boasting (with media support) that he has “rescued” the American economy. He champions himself as a progressive, provoking vicious attacks by the increasingly brazen right-wing, while he throws activists in jail, hasn’t put together a public works program and considers cutting Social Security payments.
He has projected himself as the President who ended wars while continuing attacks on Afghanistan and Iraq and spreading those attacks to several other neighboring countries — using computer-guided drones, reminiscent of a science fiction movie — to kill people every day. He has been lauded as a protector of democracy while supporting a coup in one Latin American country and outrageously refusing to recognize elected governments in others because they differ with his policies. He has claimed to be the President of transparency (the Twitter King) while nursing, developing and expanding the most intrusive domestic and international Internet-based spy system in human history.
Is it any wonder that his “health care reform”, the “signature program” of his Administration, is one giant corporate bail-out that turns its back on millions of Americans because they’re too old and rips off millions of young people because they’re too healthy ?
The technology of Obamacare will be fixed — techies can fix anything on-line. The websites will work, the applications will be processed and the inane screeching chorus from right-wingers about how the technology failures mean we should scrap public health care insurance completely will fade away. The fact is that many Americans who couldn’t afford health-care up to now will now be able to. That, when all is said and done, is a remarkable achievement and the President has every right to take credit for it.
But the greater outcome of that achievement is that Barack Obama has, once again, bailed out an entire industry — this time, the health care insurance industry: a cornerstone of the greediest and most destructive capitalism on the planet. Because that’s his focus, he will turn his back on millions of us and over-charge millions more. And he will hide that ugly truth and probably look good in the process instead of taking “credit” for that too, as he should.
Alfredo Lopez writes about technology issues for This Can’t Be Happening!