Obamacare

Federal Health Official on Hopes for ObamaCare's Insurance Exchanges: "Let's just make sure it's not a third-world experience."

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Photo credit: GovWin a Deltek Network / Foter.com / CC BY-ND

What should we expect from ObamaCare's health insurance exchanges when they go online later this year? Not perfection, that's for sure.

"It's only prudent to not assume everything is going to work perfectly on day one," Gary Cohen, an official with the Centers for Medicare and Medicaid Services (CMS) who is heading up the federal government's exchange implementation, said at a policy meeting put on by the insurance industry. "As we move closer to October, my hopes are the range of things that could go wrong gets narrower and narrower," he said. But, he added, "everyone recognizes that day one will not be perfect."

Congressional Quarterly, which first reported Cohen's remarks, also quotes Henry Chao, the CMS official in charge of the exchange technology, saying that with less than 200 days before the exchanges open, he's "pretty nervous." At this point, Chao officials are just hoping that what they build is mostly functional. "The time for debating about the size of the text on the screen, or the color, or is it a world-class user experience, that's what we used to talk about two years ago," Chao is reported to have said. "Let's just make sure it's not a third-world experience." 

Neither Cohen nor Chao provided specifics about what they thought might go wrong. But Cohen did suggest that some of the state-based exchanges might not live up to expectations. "I think there is some possibility that the type of exchange may be different than what we're looking at today," he said. Along those lines, Cohen seemed to suggest that some of the state-run exchanges might not be ready on time — and the federal government would have to step in and run those exchanges, at least at first. CQ reports that Cohen told reporters that he "hopes" the state-run exchanges will all be ready on time, but there is "contingency planning" currently going on for opening-day problems in case problems arise.

Cohen and Chao aren't the only ones who seem worried about the law's implementation. Last month, a group of Democratic Senators met with Health and Human Services Secretary Kathleen Sebelius to note their concerns about the implementation process, according to The Hill. Separately, Democratic Senator Max Baucus, who played a key role in drafting the law, told Cohen that he was worried about progress implementation of the law's complex technical requirements, which require multiple state and federal databases to communicate seamlessly.

(Via Avik Roy.)

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  1. As we move closer to October, my hopes are the range of things that could go wrong gets narrower and narrower

    Interesting that, at this late date, he’s still just hoping, no?

  2. Yikes! That woman has a longer neck than Anne Coulter!

    1. You should see it when she puts out her dewlap to attract a mate.

      1. Does it look kinda like this?

        1. “Simply stated, we will not stand idly by as the Hit & Run commentariat compares us to a lizard.”

        2. A little bit, but much, much uglier.

    2. What would make you think she’s human?

  3. When things aren’t perfect on day one in the real world, people get fired. See EA’s CEO and SimCity.

    When things aren’t perfect on day one in the state world, people demand more money and nothing else happens.

    1. “and nothing else happens.”

      Doesn’t the dog get shot?

  4. “WASHINGTON ? THURSDAY, March 21, 2013 (MedPage Today) ? Most physicians have a pessimistic outlook on the future of medicine, citing eroding autonomy and falling income, a survey of more than 600 doctors found.

    Six in 10 physicians (62 percent) said it is likely many of their colleagues will retire earlier than planned in the next 1 to 3 years”

    http://www.everydayhealth.com/…..early.aspx

    1. No surprise there. My wife is still in residency and already says she would not advise anyone to become a doctor.

  5. The people who supported this and voted for it should be shot. Pretty much anyone who at one time thought Obamacare was a good idea or “better than what we had” has officially forfeited their right to be taken seriously about anything.

    1. They can’t do single payer all at once. So they have to screw things up so badly that single payer is the only option left.

      Just as they can’t confiscate all guns at once. But they can incrementally add more and more restrictions, knowing full well that they will not reduce violence, until full confiscation is the only option left.

      1. knowing full well that they will not reduce violence, until full confiscation is the only option left.

        Still won’t reduce violence, ceteris paribus.

        1. Reducing violence is not the goal. Disarming the population is the goal.

          1. Reducing future violence against *them* is the goal. Civilian disarmament is the means.

  6. “Let’s just make sure it’s not a third-world experience.”

    Is anyone else a bit disappointed that they’re hoping it’s better than getting diarrhea in Bangladesh?

    1. I’m surprised. How elitist and racist!

      Everything this Administration has done seems aimed at turning us into a third world crap-hole.

      1. By even the most minimal PC standards referring to a “third-world experience” as negative is racist. Had someone not in the administration said that he would be called out.

  7. “I am nude as a chicken neck, does nobody love me?”

    1. Her neck is not naturally that long. Her cortical stack is trying to escape being imprisoned inside the neck of an Obama administration bureaucrat. That is enough of a task to try the conscience of even a sociopathic envoy.

  8. “Let’s just make sure it’s not a third-world experience.”

    Sorry buddy, that’s already baked in. I’m really happy at what a complete clusterfuck this has become. It has exceeded even my wildest dreams.

  9. “everyone recognizes that day one will not be perfect.”

    And, similarly, “no one ever claimed it was a perfect bill”.

    This line of defense is bullshit. These clowns have taken it upon themselves to “govern” with the “laws” they have “created”. It behooves them to get this stuff pretty well figured out before pulling the trigger implementing the life-change.

    But, there I go again. 8-(

  10. “everyone recognizes that day one to day last Obamacare will not be perfect function.”

  11. At this point, Chao officials are just hoping that what they build is mostly functional. “The time for debating about the size of the text on the screen, or the color, or is it a world-class user experience, that’s what we used to talk about two years ago,” Chao is reported to have said. “Let’s just make sure it’s not a third-world experience.”

    You douchebag. If you spent two years talking about the text size and color, of course its a soul sucking vacuum of unworkable misery. I hope you have to navigate its depths to request vacation or do a timesheet for the rest of your miserable life.

  12. The history of large government IT projects pretty much guarantees that the exchanges simply will not be ready in time, and in fact may never work at all. Less complex systems have been abandoned after many years of trying and hundreds of millions of dollars. And if Obamacare fails in that way, it’ll be hard to argue that it’s a failure of the market.

    1. I’ve posted about this before, but I’ll do it again. My retarded state (North Carolina) is in the process of implementing electronic billing systems for Medicaid. This “cutting edge” system is written in COBOL – a 50 year old dead language, and is massively overbudget and overschedule.

      1. The upside of doing it in COBOL is they didn’t spend 2 years worrying about the background colors and the text font.

      2. “system is written in COBOL – a 50 year old dead language”

        Not sure why you think COBOL is a dead language, people still program with it, and a lot of people still use applications written in COBOL.

        http://cis.hfcc.edu/faq/cobol

        1. a lot of people still use applications written in COBOL.

          Mostly because it is cheaper to pay the service fees on the Big Iron than to pay the cost of porting code that has run successfully for 20 years. Porting X million lines of code guarantees the introduction of error.

        2. What do you suppose the average age of COBOL apps is?

          1. And good luck finding anyone under 50 to maintain them.

            1. If you are skilled programmer COBOL is an easy language to pick up. I started out in the 80s programing in C and assembly, and picked up COBOL in a few weeks. There is no reason to assume that an app in a ‘dead’ language like COBOL is less functional than one written in a cutting edge language like Clojure. Under the hood, it is all just bits being manipulated while executed anyway.

              Also, if you have the source code to the original program, COBOL to C is a commonly automated task. I had to do a lot of conversion of Turbo Pascal to C for one project, then supply a C++ wrapper. Most of the code switch was automated with less than a week’s worth of tweaking, and I’m talking about a project that took the original developers over a year to write.

              1. A skilled programmer can pick up any language. But skilled programmers are in short supply and extremely high demand. The likelihood of a skilled programmer wanting to work on this dinosaur is pretty much zero, given the alternatives and the job market.

                There is no reason to assume that an app in a ‘dead’ language like COBOL is less functional than one written in a cutting edge language like Clojure. Under the hood, it is all just bits being manipulated while executed anyway.

                Yes, you can get it to work. But maintenance will be a nightmare. How many vendors are going to support your product or provide components that will work with it? How easily will you be able to find help when something breaks or an OS update fucks up your app? I can go to stack exchange or MSDN and look up any obscure C# or Java problem and find an answer in seconds. How long will it take you to fill a position when someone leaves?

                1. An automated conversion means you are no longer relying on the original source and the compilers built for it if it comes to that.

                  It’s really easier than you are making it out to be. Here is a Java interpreter where you plug in COBOL source and it gets interperted like any other bit code written in Java, Clojure, Scala or Groovy.

                  http://sourceforge.net/projects/universalcobol/

                  The Universal COBOL Compiler (UCC) is a Java-based COBOL to Java bytecode cross-compiler. It’s made up of a COBOL compiler, a Java-based COBOL runtime, and a package for manipulating Java class files.

                  The solution is as easy as knowing what is going on out there.

                  1. “The solution is as easy as knowing what is going on out there.”

                    It’s much more involved than just converting the code from COBOL to . What hardware will it run on? How will you support thousands of users? (not customers… users of the app)? Provide HIPAA-compliant security? Store your data? (a MySQL server? )

                    1. I’m showing you how a language isn’t dead where higher order programming is used to leverage what would otherwise be an obsolete skill set. Is it easier to fire your current staff and replace them? Is it easier to retrain them all? Or is it easier to leverage what you already have? My case has been made in spades. For implementation you have to pay me.

                    2. Fuck, if I wasn’t aware of standard industry practice, you people would convince me I’m not asking for nearly enough money. How is it you get stuck in this mind set where everything is a problem that is going to derail the entire enterprise?

                    3. BTW, look at the examples you give. Why would you be concerned about the hardware once you are using the JVM? It’s designed to sweat the details for you.

          2. Since it was one of the first programming languages, I imagine the average age of a COBOL app is higher than most. Much of our accounting app is coded with COBOL even though it’s not an old app.

      3. Hate to break it to you sunshine, but COBOL is used a *LOT* in circumstances like this. I work for major healthcare provider, and the bulk of the apps (from Membership to Claims and everything in between) is COBOL on mainframes.

  13. You just have to click your heels together three times.

  14. Let’s set that bar really, really low.

  15. Change is inevitable but hope is elusive.

  16. America only has one thing going for it that a third world nation doesn’t: really good marketing. Check out how we’ve learned to sell the slums here: http://www.fakenation.info/ple…..-the-slums

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