On Pizza Parties and the ACA
Well, I wasn’t going to do one of these political posts again for a while, but the traffic’s been a little slow around here since the last one. So, give the people what they want, I suppose.
There is a brewing controversy over the implementation and bugs found in the www.healthcare.gov system, accompanied by generous helpings of finger-pointing. And there is no doubt that a serious problem with the site exists and needs to be fixed within a tight schedule. Here’s what’s being overlooked in most of these discussions. The website itself was never supposed to exist.
To explain why, I’m going to use an analogy where a business stands in for the U.S. government. Such analogies have myriad problems from an economic standpoint, but they remain popular among a certain group, so here we go:
You’re the CEO of a huge, complex business spanning… we’ll say fifty different semi-autonomous departments. Each of these departments have their own locations, culture, and managers. One day, you decide it would be a great thing to throw a company-wide pizza party. So you go to the Board of Directors to get approval for the party, who votes in favor of it.
So, the company-wide pizza party is a go. But while you know the best pie joint near your office, the other fifty offices are in totally different cities. You don’t know what the other departments like re: pizza. Are they New York style lovers, Chicago, or that mutant California crap? Who knows! You want everyone in the company to get the best pie for their local tastes, so you send a memo out to all of your fifty managers and tell them that the Board of Directors has approved a pizza party and you want them to organize theirs locally to make sure everyone gets what they like. You even release funds from petty cash to pay their costs.
This is when the problems start. Thirty-four of your managers refuse to take the money or organize their own pizza party at the local level. See, apparently they’ve spent the last four years telling their employees that you’re a big jerk who will never do anything nice for them, and they can’t stand the idea of you getting any sort of credit for something their people might enjoy. But by now everyone in the company is expecting a party regardless.
So with just days to go, you’re stuck trying to organize party plans for these thirty-four insubordinate managers who flatly refused to do the job the Board of Directors ordered them to. You still don’t know what everybody wants in each of your departments, so instead of tailoring each party to local tastes and preferences as you had planned, you’re left with no choice but to go online and do a massive Papa John’s order.
Now it’s the day of the party, and the employees under the sixteen managers who DID THEIR FUCKING JOBS have a great time eating pizza from their favorite local joint. The other thirty-four departments are stuck eating Papa John’s, who’s sauce tastes like watered-down ketchup on a good day, and those are the ones who actually got their pizza in time for the party to start. Now two thirds of your employees are angry that their parties were a bust, and your insubordinate managers are busy blaming you for their failures, some because they’re angling for your job when you retire in a few years.
That is what happened with healthcare.gov. Under the ACA signed into law more than three years ago, it was the responsibility of each individual state to set-up their own healthcare exchange. Thirty-four mostly red states refused to do so, despite the fact the law included provisions to pay for the majority of the work. The federal government then had to step in and very quickly design a website that would integrate not only the nearly three-dozen non-compliant states, but a bunch of federal agencies and many dozens of insurance carriers, because remember, all the healthcare exchanges do is drive consumers to private, non-governmental, for-profit insurance companies.
Apple’s website crashes every time a new iPhone rolls out. Diablo III’s servers crashed like an Italian cruise ship the day the game was released. Is anyone actually surprised a hastily-constructed website that nobody in the federal government actually expected needed to be build in the first place is having some trouble early on?
And now I have a shooting-fish-in-a-lunchbox-with-a-gatling-gun prediction. In a year’s time when the real numbers on the effectiveness of the ACA start coming in, and the sixteen compliant states show greater enrollment rates and better insurance premiums than non-compliant states on average, Fox News, Rush, and every other “conservative” mouthpiece will scream and shout about how the President is somehow maliciously punishing red states for voting against him, completely ignoring the fact that their own governors and state houses have been doing everything they can to sabotage the law’s effectiveness, denying better, more-affordable healthcare to their own citizens, just to prevent their political opponents from getting any credit for improving their lives. Wait for it… wait for it…
CORRECTION: It has come to my attention that Utah and Mississippi made the decision late to set-up their own exchanges instead of kicking responsibility back to the feds, bringing the total to eighteen states plus D.C. which have done so. But this still leaves twenty-five states that rely entirely on healthcare.gov, and seven more that are “Partnership” states with a weird hybrid system.