The head of the state’s beleaguered health insurance
marketplace, which was once a national model, broke down in tears Thursday, as
she described how demoralizing it has been for her staff to struggle with a
broken website that has left an unknown number of people without coverage...., the executive director of the Massachusetts
Health Connector, wept at a board meeting, where it was disclosed that 50,000
applications for health insurance are sitting in a pile, and have yet to be
entered into a computer system.
Now this is the state that had the infrastructure in place
and had something working. They claimed 97% enrollment. So why change, simple
the ACA. The result is a catastrophic collapse of the system. No computer
access and apparently all those fellow “executives” managing all the paper
work.
Now previously this individual, showing her exuberance in how well the
ACA would be accepted, stated[2]:
How will the ACA, the national health care overhaul,
affect the Connector? It really strengthens the Health Connector in a number of
ways. As I mentioned, a very important part of what we do is to offer subsidies
to a certain part of the population to help them pay for health insurance. The
ACA expands that opportunity, so there will be more people able to access
subsidies through the exchange. For example, low-income workers who currently
have access to employer insurance but are unable to afford it will be eligible for
subsidies. The ACA also makes major investments into the exchange so we can
update our technology. Our goal is to offer a significantly better user
experience, an easy-to-navigate process.
Now the State Web site states[3]:
Before joining the Health Connector, ... was Director of
Contracting Strategy Analytics at Tufts Health Plan in Massachusetts,
where she worked extensively on health care reimbursement issues and
payer-provider collaboration initiatives. ... started her career as a
management consultant with McKinsey & Company and subsequently Deloitte
Consulting, where she served a wide variety of clients in the health care
industry. ... graduated from Peking University of China and earned her M.B.A.
from Harvard Business School.
Yes, a Harvard MBA. I guess the new strategy for Harvard is
that if you can’t get the web site to work you just break down in tears. Never
saw that at MIT but after all we had to make things work. So here we have a
case of how we take a “manager” and place them in a task which requires some
technical capabilities and apparently they collapse. Even Mankiw bemoans the
problem[4].
One of the themes that we have all heard over the past
few years is that President Obama's healthcare reform is merely bringing the
kind of changes Massachusetts had under Governor Romney to the nation. If that
were really true, you would think that these national reforms would have
minimal impact on the state of Massachusetts.
On the other hand we have Gruber from MIT still arguing for
the benefits of the ACA predicating it on the benefits of the Massachusetts
Plan[5].
He comments when criticizing the CBO report stating that 2.5 million or so will
drop from the workforce, and he like so many other Left leaning folk see that
as a positive opportunity. After all who really wants to work? Gruber states:
Mulligan—like so many of the law’s critics, in and out of
the economics profession—gives a more one-sided view. He talks only about the
marginal tax rates. A reader who relied exclusively on his column would have no
idea the CBO cited multiple reasons for the shrinking workforce—and that some
of these reasons were utterly defensible.
Ironically, while making a surprisingly moral case against examples of
100% tax rates, he ignores the moral case for leveling the playing field by breaking
the link between work and insurance, so that workers are not chained to jobs
where the value of their compensation is well below their disutility of
working. The Affordable Care Act, like any major reform, has its virtues and
its flaws. The best economists, like the best public officials, are the ones
who deal with both.
But the Massachusetts problem is not an Economics problem. Frankly
there are no Economics problems, unless we are discussing political philosophy.
Reality has met that philosophy. The web site and all its environs just do not
work. Now I have done large scale computer system developments since 1967,
starting with the Apollo mission and moving on from there. They are really
tough things and need good people. Oftentimes in today’s world the Beltway
Bandits who end with the job are the lowest bidders, and look at these jobs as Golden
Geese to feed them again and again. That is they never really finish, just get
more change orders.
Reality is not economics. You do not draw two intersecting
lines and jabber about some gross behavior principle which most likely will be
disproved in a decade or so. Reality is making something work. Engineering is
reality, Science is reality, Medicine is Reality, and even Law has elements of
reality, especially when up against a jury.
Massachusetts shows a frightening example of what can happen
even in the most experienced and most friendly environment. It already had 97%
covered, but not by the ACA.
[1] http://www.boston.com/lifestyle/health/blogs/white-coat-notes/2014/02/13/facing-application-backlog-insurance-marketplace-chief-breaks-down-tears/jeWUxJyrG9tx3lnkuJ4iCJ/blog.html
[2] http://www.bostonglobe.com/business/2013/07/20/hot-seat-with-health-connector-jean-yang/GMXAFtLV0URopJFLOoYGvN/story.html
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