Amid all the tussling over the government shutdown and the debt ceiling, a couple of bombshells went off in the blogosphere that may prove of more enduring importance.
They suggest that there is a nontrivial possibility that Obamacare may implode.
The first bombshell went off on Tuesday, from Ezra Klein of the Washington Post’s Wonkblog.
Klein was one of those young writers who formed JournoList a few years ago so that like-minded Obama fans could coordinate their lines of argument. It was like one of those college sophomore clubs, not really necessary in an age of ready contact through email, but it shows him as a guy inclined to play team ball.
So it’s noteworthy when he writes, “So far, the Affordable Care Act’s launch has been a failure. Not ‘troubled.’ Not ‘glitchy.’ A failure.”
Klein notes that the rollout of the Medicare prescription drug program was also rocky two weeks into the process. But later it got smoothed out.
Klein fears Obamacare won’t. It’s not just a problem of overloaded servers. Everyone knew there would be lots of traffic in a nation of 312,000,000 people. Information technology folks say it’s easy to add servers.
It’s harder to get software systems to communicate. And as Klein quotes insurance consultant Robert Laszewski, “the backroom connection between the insurance companies and the federal government is a disaster.”
The reconciliation system isn’t working and hasn’t even been tested, Klein reports. Insurers are getting virtually no usable data from the exchanges.
Bloomberg.com columnist Megan McArdle, who unlike most Obamacare architects actually worked at an IT firm for a couple of years, sees the possibility of even more trouble ahead.
She points out that the administration delayed writing major rules during the 2012 campaign to avoid giving Republicans campaign fodder.
The biggest contractor did not start writing software code until spring 2013. They were still fiddling with the healthcare.gov website in September.
Instead of subcontracting the responsibility for integrating the software of the multiple contractors, the Centers for Medicare & Medicaid Services decided to do it in-house — “a decision,” she writes, “equivalent to someone who has never even hung a picture deciding they should become their own general contractor and build a house.”
“If the exchanges don’t get fixed soon,” she writes, “they could destroy Obamacare.” You need the exchanges to enroll enough young healthy people to subsidize those who are sick and old, which is one of the central features of Obamacare.
Otherwise, premiums shoot up and up, pushing others out of the system — a death spiral that can continue year after year.
“At what point,” she asks, “do we admit that the system just isn’t working well enough, roll it back and delay the whole thing for a year?” She suggests that if the system can’t enroll 50 percent of its users by November 1, such a hugely drastic step would be in order.
That sounds like a nightmare of the first order — for individuals, for insurers, for employers and for the Obama administration. A far worse nightmare than when Congress in 1989 repealed the Medicare prescription drug plan it passed the year before because of widespread dissatisfaction.
Of course it’s possible this nightmare will not happen. Things will get ironed out somehow.
But if they don’t, who’s responsible? First, a president who is not much interested in how government works on the ground. As a community organizer he never did get all the asbestos removed from the Altgeld housing project.
Politico reports that his “universal heath care” promise was first made when his press secretary and speechwriter needed a rousing ending to a 2007 campaign speech to a liberal group.
Second, lawmakers and administrators who assume that, in an Information Age, all you have to do is to assign a task to an IT team and they will perform it. Cross your fingers, and it gets done.
Third, government IT procurement rules are kludgy. Apple didn’t bid on this. The IT work went to insider firms that specialize in jumping through the hoops and ladders of government procurement rules.
Unfortunately, the consequences of a meltdown are enormous when a system is supposed to be used by everybody. If a private firm’s software fails, it can go bankrupt. No one else much cares.
But if Obamacare’s software crashes, the consequences will be catastrophic — for the nation and for the Democratic Party.