The rollout of the Affordable Care act has been abysmal. But the Republican majority in the House of Representatives and in many of the state Capitals is experiencing a self-fulfilling prophesy and is attempting to make political hay out of a situation they helped create. In their ongoing effort to stop the President’s health care legacy legislation, Republicans have unintentionally created a situation which appears to validate their position.
Thirty-something of the fifty odd states have declined to construct their own health marketplaces. Unwittingly, this declination of the opportunity to own the health marketplaces at the local level has contributed to the problem. At the same time, the website for the national healthcare marketplace has been bungled by the companies contracted to design, construct, and maintain. Anyone familiar with the national acquisition system and worldwide advanced care health care systems would not be surprised.
All advanced countries have health systems that require all their citizens have basic coverage. Canada’s health system is not federal at all. The various provinces all act as the insurance company to pay private doctors and private hospitals. Germany is divided into geographic sickness groups. Basic coverage is 50 percent paid by the individuals and 50 percent by the employer community. Basic care is purchased from private insurers who pay the private doctors and private hospitals. Even the UK, which has the only true socialized medicine system, has geographically subdivided their country for health insurance purposes.
The United States high technology infrastructure has suffered dozens of enemy attacks over the last few years. The attacks come from China, Iran, Russia, and a number of other countries. Many of these offensives use a “denial of service” strategy. These attacks work by flooding a computer network with hundreds of thousands of users or emails simultaneously. Eventually, the main brain managing the network says “I can’t take it anymore” and simply shuts down.
A similar situation occurs with the Affordable Care Act because the various states have refused to participate with their own local control over the health marketplaces. Overload the system by not participating and it will fail. Anyone surprised?
Why have the contracted companies bungled their charges? The federal acquisition system is terribly complex. Dozens and dozens of steps and tests and reports and security checks go into the process. All the steps exist because at some previous place in the acquisition of similar products, fraud or poor design or any one of a multiple number of hitches in the acquisition get-a-long have caused the acquiring agency to create a process so that the particular problem encountered can never happen again. This makes the acquisition and design process incredibly expensive and opaque. Kind of like this paragraph.
The Department of Defense acquisition protocol -- assuming that nothing creates a roadblock – takes ten years. The DOD program that records medical records has been in process since about 1990 and is still not fully rolled out.
As one who has participated in the process, the complexity of the health website process makes it more likely than not that a four year development period would be insufficient. Four years ought to be enough to create a website if the government process didn’t trip over itself.
President Obama and his team can be faulted for not realizing the mechanics of the monster they were trying to conquer. Too many compromises were made with too many interest groups which created too many variables. In 2010, the President called for reducing the number of federal data centers. There are almost 300 data centers. About half are in DOD. The resistance to fixing the problem is monumental.
The question answered was “What version health care reform will pass the Congress?” That was no easy task. Every President has tried unsuccessfully to pass health reform since Harry Truman first proposed National Health Insurance in November of 1945. The current affordable care act most closely resembles a proposal put forward by Richard Nixon in the 1970s.
The United States lags behind most advanced countries in life expectancies and other health outcomes, but pays a 1/3 larger portion of GDP than do other countries. America has many fewer doctors per thousand citizens than other nations and many current doctors are approaching retirement. Of about 830,000 licensed physicians in America, the AMA reports that more than 375,000 are 55 years of age or older. And fewer doctors are being graduated than are required to replace the retirees while the population grows. The why of all this will wait for another column.
The right question that has not been either asked is: “How does America provide health outcomes as good as similar countries for a similar percentage of GDP (about two thirds of the cost presently paid)?”