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David A Graham:

Officially, [Kathleen] Sebelius made the decision to resign and was not forced out. And while that may be narrowly true, she was clearly out of favor in the administration. With Sebelius leaving, the White House can try for a reset on healthcare, just as benefits are beginning and the law seems to be back on track. And her departure might offer the Democrats some political distance from Obamacare's turbulent launch ahead of the midterm elections.

Even though enrollment spiked just before the March 31 deadline and reached the 7 million goal the White House had originally set, Healthcare.gov was a tremendous embarrassment for the Obama Administration. Though the president had suggested buying insurance through the exchange would be like shopping on Amazon, the site wasn't nearly ready when it went live: The exchange melted down with even moderately high numbers of users, data weren't transmitted correctly, and major parts of the site's infrastructure still aren't built.

All true, all fair. But there's also 7.5M signups, and that'll be what folks remember 30 years from now. In the meantime, Sebelius will be remembered for the bad along with the good.

Jonathan Cohn:

On Thursday morning, Kathleen Sebelius testified before Congress and announced that Obamacare signups had reached 7.5 million people.

On Thursday evening, news broke that Sebelius was stepping down as Secretary of Health and Human Services.

Maybe Sebelius and her supporters hoped that the morning news would put a more positive spin on the evening’s. If so, they were very, very wrong. The first sentence of the New York Times article on her resignation described a “stormy five-year tenure marred by the disastrous rollout of President Obama’s signature legislative achievement, the Affordable Care Act.” Expect more of the same in the coming hours and days.

Sebelius deserves at least some of that treatment. The technological failures of healthcare.gov during October and November—and the failure to anticipate a wave of private plan cancellations—represented low points for the cause of health care reform, the Obama presidency, and liberalism more generally. HHS was in charge of Obamacare implementation and Sebelius was in charge of HHS. In one of her many grueling sessions of congressional testimony, Sebelius said that critics should hold her accountable for those failures. They are now doing that—actually, they've been doing that for some time. That opening Times paragraph is what accountability sounds like.

More politics and policy below the fold.

Ezra Klein:

Kathleen Sebelius is resigning because Obamacare has won
Brian Beutler:
The Affordable Care Act's enrollment comeback has confounded conservatives in many ways. The realization that there happens to be popular demand for something as self-evidently grotesque as Obamacare has given rise to a palpable cognitive dissonance on the right. A growing recognition among Republicans that they can't bank on organizing the midterm campaign around relentless Obamacare opposition has party elders looking at contingency plans (even if they haven't exactly gone back to the drawing board).

But most importantly, it has thrown the conservative health policy community for a loop, and completely wrong-footed Republicans in Congress who were hoping -- against considerable odds and a well-worn historical pattern -- to craft an Obamacare alternative that both passes the laugh test and doesn't create a significantly lower level of welfare. If enrollment had sputtered, that task would have been considerably easier. The fact it surged in March, and continues to grow today, measurably limits their options. And to that end, Talking Points Memo wins our quote of the week award for scoring this anonymous reckoning from a GOP congressional aide.

If you want to say the further and further this gets down the road, the harder and harder it gets to repeal, that's absolutely true. As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act. ... To make something like that work, you have to move in the direction of the ACA. You have to have a participating mechanism, you have to have a mechanism to fund it, you have to have a mechanism to fix parts of the market.
Michael Hiltzik:
Sebelius is faulted, for the most part deservedly, for presiding over the initial failure of the website. The exact nature of her dereliction is murky, however; so many of its moving parts broke down it's still hard to say what could have been avoided and how. Jonathan Cohn argues in the New Republic that although Sebelius had experience as a regulator in Kansas and as a political leader with a record of bipartisan collaboration, "what Obamacare needed more was a deft, aggressive manager." He asserts that "Sebelius did not grasp the severity of tech problems at healthcare.gov until the day it went live and crashed."
Actually, we may have to wait for Sebelius' memoirs, if she writes them, to know when she recognized the severity of the problems. But it's probably more fair to say that what Sebelius needed was a "deft, aggressive manager" of the technological rollout.
A technology wonk might have had the website working better, but would have been utterly unable to navigate the ideological shoals through which Obamacare has had to sail. There probably aren't too many political figures who could have dealt with the relentless assault on the ACA with as much equanimity as Sebelius mustered. The record of the last six months suggests that even a flawless launch of HealthCare.gov would not have stemmed the attacks on the law. After all, it's operating fine now; have you heard a single Republican acknowledge that?
The new normal, from the Tennessean:
Later, TriStar filed a claim with BlueCross BlueShield of Tennessee for more than $44,000 for Klar's care. Under his Network S plan with BlueCross, Klar has a deductible and coinsurance of roughly $1,500 each. Beyond that, he pays 20 percent of the overall bill. BlueCross pays the rest.

Representatives from TriStar say that Klar's high out-of-network care bill is due to a policy change that BlueCross implemented last year to shift more of the cost of care onto members.

But the insurance company is saying that $44,000 is too high for anybody to pay for out-of-network emergency care. BlueCross suggests in the lawsuit that a reasonable amount to charge is around $9,500, which is about 200 percent of what Southern Hills would receive for treating a Medicare beneficiary for the same condition.

Klar's case highlights a new shift in the nation's health care system. As customers increasingly switch to plans that require members to shoulder more of the cost of health care, people are beginning to see behind the curtain of the hospital billing process.

In this case, BlueCross is stepping in. The idea of an insurance company taking legal action against a provider on behalf of a member is a novel one. "I got out of law school 42 years ago this May, and I've not seen it before," said Klar's lawyer, Gary Blackburn. "I think it's unusual."

Greg Sargent:
The Republican position — that the law can’t work by definition – is essentially an admission that Republicans simply don’t support doing what Obamacare sets out to do: Expand coverage to the number of people the law hopes to cover, through a combination of increased government oversight over the health system and — yep — spending money. The GOP focus on only those being negatively impacted by the law, and the aggressive hyping of cancellations into “millions” of full blown “horror stories” – combined with the steadfast refusal to acknowledge the very existence of the law’s beneficiaries — is, at bottom, just another way to fudge the actual GOP position: Flat out opposition to doing what it takes to expand health care to lots and lots of people.

Sometimes Republicans are candid about this position, such as when Paul Ryan forthrightly admitted that once Obamacare is repealed, its popular provisions should not be restored because it would be too expensive. Others, however, recognize the political problem here, and continue to say they support Obamacare’s general goals while declining to detail how a replacement would accomplish them. The problem for Republicans is that they want to persuade folks that they, too, support these general goals — hence the perpetual promise of vague alternatives — but this posture is fundamentally incompatible with the idea that Obamacare cannot work by definition, because there’s no alternative way to accomplish those goals at the law’s scale.

Originally posted to Daily Kos on Sat Apr 12, 2014 at 04:30 AM PDT.

Also republished by Obamacare Saves Lives.

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Comment Preferences

  •  Thanks for a terrific roundup, Greg! (47+ / 0-)

    Greatly appreciated. If assigning blame for the ACA's screwed-up rollout is the name of the game, shouldn't the El Stupido Web site contractor come in for some of it?

    But no, it's so much easier to blame the woman. I fully expect that if Mrs. Clinton runs for president she'll be blamed for Fukushima, Katrina, and Hurricane Sandy, even though. she had nothing to do with any of them.

    "Religion is what keeps the poor from murdering the rich."--Napoleon

    by Diana in NoVa on Sat Apr 12, 2014 at 04:43:38 AM PDT

  •  this is packaging vs content (6+ / 0-)

    this whole campaign touting the millions of Americans who've signed is not equal to knowing if the ACA will actually improve people's lives as opposed to the times when we got insurance (tax free benefit btw) from employers or even gov't sponsored for the poor.

    enrollment means lots of customers for insurers. but what kind of care will be available? what will happen to those who are under insured?

    the numbers are simply a veneer. how has access to health care and the care given itself improved?

    the quality and real care afforded (or not) to people: that's what will be remember in years from now.

    this game of words and selling the package and ignoring the value of the contents is really getting tiring.

    “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” Buckminster Fuller

    by pfiore8 on Sat Apr 12, 2014 at 04:48:05 AM PDT

    •  let's look at the substance of your comment (37+ / 0-)

      which I think is misguided.

      There are three aspects of reform: access, quality and finance. ACA attempts to address all three, in ways that are far deeper than"veneer".

      What kind of care? American health care. It was deliberately constructed in a rather complex way to preserve as much of existing plans as possible, while eliminating junk plans by raising standards (done, with delays, and with politics - you can keep your plan and all that).

      Access? You can't argue with a straight face (unless lying to yourself) that this doesn't improve access. That's what it means to have millions insured who were not insured before. For starters, preexisting conditions are no longer a barrier.

      Quality? Lot more to do, but there's a good deal of evidence based medicine built in to ACA. For starters, and for future measurements:

      Providing Free Preventive Care. All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Effective for health plan years beginning on or after September 23, 2010. Learn more about preventive care benefits. See the full list of covered preventive services.

      Preventing Disease and Illness. A new $15 billion Prevention and Public Health Fund will invest in proven prevention and public health programs that can help keep Americans healthy – from smoking cessation to combating obesity. Funding begins in 2010. See prevention funding and grants in your state.

      Cost? Upfront cost are high, but overall health care spending has moderated, a closely tracked figure attributed to many things including ACA.

      What it isn't is single payer. That would have been better, but that's not what could or did pass. In any case, single payer would not have addressed quality any more and maybe less than ACA (devil is in the details). it might have been better for access and cost, but that does not take away form what ACA does.

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Sat Apr 12, 2014 at 05:03:07 AM PDT

      [ Parent ]

      •  ACA is phase I (9+ / 0-)

        Single payer is phase II.

        We already have single payer universal health care for a segment of the population. Let's expand it to everyone.

        The sales pitch will be much easier after a couple years of ACA. The ACA does have faults and glitches, which could be fixed, as Kos pointed out the other day, but only if the Repubs embraced the ACA.

        They won't. This makes single payer all the more likely as the next step.

        Phase II is ready for launch!  Medicare for all!

        Join Essa in a revolt against the gods. Continue the fight, Causality.

        by rbird on Sat Apr 12, 2014 at 05:43:03 AM PDT

        [ Parent ]

        •  I think everyone knows instinctively (7+ / 0-)

          …that the ACA is a rest stop on the journey toward health care as a human right.

          All other nations in the world are sharing this journey. This aspect of future history is already visible in the distance as the future unfolds.

          We will continue on toward human decency and conscious respect for the life of all human beings. And among other things, that means universal health care as a part of being alive.

          •  Well said (3+ / 0-)
            We will continue on toward human decency and conscious respect for the life of all human beings. And among other things, that means universal health care as a part of being alive.

            Join Essa in a revolt against the gods. Continue the fight, Causality.

            by rbird on Sat Apr 12, 2014 at 07:00:57 AM PDT

            [ Parent ]

          •  Instinctively? (3+ / 0-)

            What in the world makes you think that the insurance companies are going to give up their gravy train?

            I think the ACA will make the achievement of universal health care more difficult.  Coupled with the SC decision on political donations I don't see the gravy train for the insurance companies going away any time for generations.

            The banks have a stranglehold on the political process. Mike Whitney

            by dfarrah on Sat Apr 12, 2014 at 07:15:44 AM PDT

            [ Parent ]

            •  Like other industry models that don't attend ... (3+ / 0-)
              Recommended by:
              wishingwell, Pluto, rbird

              ... to changing circumstances, health insurance companies, no matter how big and powerful, will change and wither.

              For better or worse, their own actions will control less and less of their business. As their profit steams become more shallow, they're likely to change beyond what we recognize today.

              Apt phrase: Time wounds all heels.

              2014 is HERE. Build up the Senate. Win back the House : 17 seats. Plus!

              by TRPChicago on Sat Apr 12, 2014 at 08:13:14 AM PDT

              [ Parent ]

              •  How are they supposed to (0+ / 0-)

                wither when more and more people are forced to pay them?

                Medical insurance companies are bullish right now, that's how optimistic the 'markets' are about their continued success.

                When is the withering to take place?

                The banks have a stranglehold on the political process. Mike Whitney

                by dfarrah on Sat Apr 12, 2014 at 09:15:11 AM PDT

                [ Parent ]

                •  I gather you'd say, Never. But I'll say, When ... (1+ / 0-)
                  Recommended by:
                  rbird

                  ... when their margins get increasingly squeezed.
                  ... when other more flexible business models move into "their" marketplace(s).
                  ... when technology empowers reforms in areas the "established carriers" regard as sacred aspects of the insurance trade.

                  To be specific, when non-insurance providers of health services (modernized clinics, perhaps?) offer their own programs disassociated with patients' health insurance and a receptive government accepts them as trial programs.

                  I'm thinking you want something better than ACA. So do I. But for now, ACA is the field we work in. Shooting criticisms at it that don't contain suggestions for improvements won't make ACA better. For now, I don't think that will weaken ACA much, but it will play up to the Naysayers - more prevalent today than Single Payer advocates are - who want to kill it.

                  2014 is HERE. Build up the Senate. Win back the House : 17 seats. Plus!

                  by TRPChicago on Sat Apr 12, 2014 at 09:49:56 AM PDT

                  [ Parent ]

                  •  I'm for single payer. (0+ / 0-)

                    And I would think that there would be a market for deeply discounted medical services provided by medical providers sick of dealing with insurance companies that people who are sick of insurance companies might use.

                    But I don't see any of this type of business being established.

                    And when I consider if this is possible, I think of another innovative guy who took on an entrenched industry and lost: Tucker.  Or more currently, Tesla.  But Tesla seems to be breaking through.

                    The banks have a stranglehold on the political process. Mike Whitney

                    by dfarrah on Sat Apr 12, 2014 at 11:49:08 AM PDT

                    [ Parent ]

                    •  Amazon. (0+ / 0-)

                      2014 is HERE. Build up the Senate. Win back the House : 17 seats. Plus!

                      by TRPChicago on Sat Apr 12, 2014 at 12:35:21 PM PDT

                      [ Parent ]

                      •  I don't see the comparison. (0+ / 0-)

                        I would think an amazon type business would make for a much easier startup with low costs/low entry barriers compared to medical services and auto manufacturing.

                        I thought of Tucker because I was thinking along the lines of businesses that need bricks/mortar, equipment, a lot of special supplies [metal, medical] and have high barriers to entry.

                        With a medical business, one would need bricks/mortar up front, medical equipment, highly skilled people at the beginning [you couldn't just wing it with a few programmers and order fulfillers], have the knowledge to handle extensive compliance issues, etcetera.

                        Amazon is really nothing more than a fulfillment company using already established infrastructure for its major function, delivering goods.

                        Well, I take that back; I'm sure Amazon likely has liability issues related to the security of customer information and maybe some of the funds transfers regulations apply to Amazon.

                        The banks have a stranglehold on the political process. Mike Whitney

                        by dfarrah on Sat Apr 12, 2014 at 04:31:11 PM PDT

                        [ Parent ]

                        •  One business model largely displacing another, (0+ / 0-)

                          ... is my comparison. And the book selling industry is evolving still, morphing up the chain into publishing and sideways into related and new businesses.

                          I think insurance - and operations that would serve as substitutes for it - could exist just about anywhere with minimal bricks and mortar. It's not the delivery of medical services at issue, but coverage for costs. That seems to me to be math, actuarial sciences and computers ... and some keen insights and new thinking into the basic businesses affecting medical services.

                          2014 is HERE. Build up the Senate. Win back the House : 17 seats. Plus!

                          by TRPChicago on Sat Apr 12, 2014 at 09:11:38 PM PDT

                          [ Parent ]

          •  Other nations are (0+ / 0-)

            sharing in the journey?

            Most of them have left us in the dust.

            The banks have a stranglehold on the political process. Mike Whitney

            by dfarrah on Sat Apr 12, 2014 at 09:28:16 AM PDT

            [ Parent ]

        •  Back on planet earth (0+ / 0-)

          The insurance industry wrote the ACA and required the administration to negotiate over aspects of the bill.  The ACA is making the insurance industry even more profitable.  Thus they have more cash for lobbying.  

          So now, out of the goodness of their hearts, they are going to permit single payer to pass?  They won't even let a public option through congress!  

          What the ACA does is inoculate the US against single payer.  The health insurance industry is now the foundation of our health care system, underwritten by the Federal Goverment.  It's not going anywhere.

          "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

          by Subterranean on Sat Apr 12, 2014 at 10:26:02 AM PDT

          [ Parent ]

      •  Silver. (4+ / 0-)

        That's the important word.
        70%
        High deductibles.

        Of, shudder, bronze --

        60%
        and even higher deductibles.

        And I have to tell you, without the subsidy, my silver coverage is more than twice as high as my previous coverage.
        Which let me put my college student daughter on my plan just as the law says I can do but my new plan refuses to allow.

        And you're right -- ACA was a gift to insurance companies instead of a fix for American health care. Let's hope there's a phase 2.  I don't think Republicans are going to do that, so Democrats had better get themselves elected if they want to see better health care.

        Not that I've heard anybody actually talking much about better health care, which would be a good start.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sat Apr 12, 2014 at 06:08:38 AM PDT

        [ Parent ]

        •  Lots of people talking about better health care (5+ / 0-)

          and if you're not hearing it, you're not looking very hard.

          1. Preventative care with no copays or deductibles, and funding to community health centers to fill in some of the provider-shortage gaps.
          2. Penalties to hospitals (under Medicare) for people who get readmitted soon after discharge with conditions that result from poor follow-up care; incentives to keep people out of the hospital by keeping them healthier -- such as helping diabetics keep their blood sugar levels even.
          3.  Expanded Medicaid which gives people alternatives to just waiting until things get really really bad and then going to the ER.
          4. In many states, the exchanges also sold dental policies, since poor dental hygiene and infections directly impact overall health.

          This is just a short list. The ACA has a lot of provisions to improve health care, not just enrich insurance companies in the same old same old delivery system. They haven't gotten as much publicity as the breathless attention to "how many people have paid their premiums," but they are real.

        •  Yes, I was reading (1+ / 0-)
          Recommended by:
          Victor Ward

          a doctor's objection to ACA, and she pointed out that the costs are either high up front or on the back end.  And she said that deductibles were as high as $12,000.00 - per year I think!!

          Is she wrong?

          How can a plan that has such a high deductible not be considered junk insurance?

          The banks have a stranglehold on the political process. Mike Whitney

          by dfarrah on Sat Apr 12, 2014 at 07:18:45 AM PDT

          [ Parent ]

          •  That doctor has her own agenda. (2+ / 0-)
            Recommended by:
            wishingwell, askew

            The policy she's referring to is fiction, junk or self-insurance for the very wealthy.

            2014 is HERE. Build up the Senate. Win back the House : 17 seats. Plus!

            by TRPChicago on Sat Apr 12, 2014 at 08:15:54 AM PDT

            [ Parent ]

            •  Oh, she definitely has (2+ / 0-)
              Recommended by:
              Subterranean, dinotrac

              an agenda.  Because nobody at Kos ever has an agenda like other people do.

              conscientious objector to ACA

              Here is part of her agenda:

              I have been an outspoken advocate for a Medicare for all health system. During the health reform process, I did all that I could to push for single payer, including being arrested three times for civil disobedience. I was one of fifty doctors who filed a brief in the Supreme Court which expressed opposition to forcing people to buy private health insurance, a defective product. It pains me to see that the Affordable Care Act (ACA) siphons billions of public dollars to create more bureaucracy and transfers hundreds of billions of public dollars directly to the private insurance industry when I know that those dollars should be paying for the health care that so many in our country desperately need.

              and this:

              The Issue is Access to Care, Not the Number Who Buy Insurance

              and this:

              The Insurance Scam

              And instead of creating a single standard of care, so that everyone has access to the health care they need, the ACA locked into law a tiered system of coverage based on different metals: platinum, gold, silver and bronze. Though they may sound good, it turns out that the upper tier plans are not any better than the lower tier plans in terms of what services are covered or where patients can go for care. The major difference is whether a person chooses to pay more up front in higher premiums and pay less when they need health care (upper tier plans) or chooses to gamble on staying healthy and pay less up front, risking higher out-of-pocket costs if they need care (lower tier plans). This is essentially a pay-now-or-pay-later scheme.

              So, yes, she certainly has an agenda.

              The banks have a stranglehold on the political process. Mike Whitney

              by dfarrah on Sat Apr 12, 2014 at 09:11:48 AM PDT

              [ Parent ]

              •  How 'bout we stay off ad hominem at each other? (0+ / 0-)

                As you summarize her, she's vigorously single payer. Bless her, for she is someone knowledgeable in her trade and active in advocating sensible public policy.

                My initial point still goes. With your endorsement, I would not accuse her of fictive talk (all too prevalent in the Koch ads), but the insurance policy she's referring to is then one of the other two choices - junk that takes advantage of the poor or catastrophic coverage for the very wealthy.

                Either way, such coverage is an outlier, not a valid criticism of ACA.

                I will join her on the cause of single payer, but not on undercutting Obamacare in the process. That ACA ship, for now, has sailed. Let's make it work as well as it can, and pave the way for improvements and a better plan in a future more receptive Medicare for everyone.

                2014 is HERE. Build up the Senate. Win back the House : 17 seats. Plus!

                by TRPChicago on Sat Apr 12, 2014 at 09:32:18 AM PDT

                [ Parent ]

              •  Those are great quotes (0+ / 0-)

                thanks for injecting some reality into the ACA discussion.

                "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

                by Subterranean on Sat Apr 12, 2014 at 10:31:49 AM PDT

                [ Parent ]

        •  Yep (0+ / 0-)
          ACA was a gift to insurance companies instead of a fix for American health care.
          ACA serves corporate interests, and one of the side effects is fewer uninsured Americans.

          Single payer, or even a public option, would have resulted in far cheaper health care, and far more people left without coverage.  The ACA as it was passed was not the law one would conceive if the goal was to cover the most Americans for the the best value.

          "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

          by Subterranean on Sat Apr 12, 2014 at 10:30:05 AM PDT

          [ Parent ]

          •  I will steal that sentence: (0+ / 0-)
            ACA serves corporate interests, and one of the side effects is fewer uninsured Americans.
            I am pummeled on a regular basis for saying that I think ACA is a steaming pile of crap that happens to do enough good things to be better than the previous status quo.

            I like the way you put it better.

            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

            by dinotrac on Sat Apr 12, 2014 at 06:33:49 PM PDT

            [ Parent ]

      •  actually we don't need preventive care, we need (0+ / 0-)

        our gov't to regulate industry to make sure the food we get isn't making us sick. or that industry isn't allowed to contaminate our water supplies (WVa anyone?).

        this whole health care thing is really beside the point. without accountability, enforcement of laws, policy, and legislation, this is really just ... packaging. and wait for it. because this kind of legislation will have NAFTA - like language that only gives more power to industry and sticks it to the consumer. wait for it. really. and remember where you read it.

        we are being made sick. and the poorer we are, the fewer options are given but junk food, living with questionable water supplies... not to mention stress, pollution and you know, things like Fukushima and it's impact.

        so let's get ourselves straight. shall we? health care is bullshit because it has very little to do with outright health and lot of making money on very poor handling of our natural lives.

        “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” Buckminster Fuller

        by pfiore8 on Sat Apr 12, 2014 at 09:25:09 AM PDT

        [ Parent ]

        •  heh (2+ / 0-)
          Recommended by:
          TFinSF, bfbenn
          this whole health care thing is really beside the point
          No, actually it's not. it's the entire point.

          Is it the only point? of course not, and far from it. So what? That's a discussion for another day (or today in another place), but/and even if the system worked perfectly (which it does not) there'd be a whole lot of other stuff, as you point out, to work on.

          Still, you wandered into a health care discussion. I'm afraid that's topic A.

          "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

          by Greg Dworkin on Sat Apr 12, 2014 at 09:47:35 AM PDT

          [ Parent ]

    •  We'll, a few things: (12+ / 0-)

      Preventive care is boosted in the ACA. 26 separate preventive care exams are now free. As a Medicare recipient I can receive a free well care visit. Closing the donut hole means fewer folks going w/o meds.

      Once some of the ACA health care delivery provisions kick in full force: accountable care orgs, Medicaid homes, paying on value rather than volume and the readmission penalty are all features that should improve care.

      I do think that at some point - like now - focus will have to be placed on ensuring robust networks so folks can receive the services the various plans promise.

      •  Boosted in that more people now have coverage. (1+ / 0-)
        Recommended by:
        Victor Ward

        Not boosted for most people because most employer-provided coverage, which remains how most people are covered -- already handled preventive care exams free or for a small co-pay.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sat Apr 12, 2014 at 06:10:01 AM PDT

        [ Parent ]

        •  raising standards for everyone (10+ / 0-)

          and trying to make the 20% get as good coverage as the 80% (without severely disrupting the 80%) was the plan.

          So claiming no big deal because most were not affected is both true and a sign of success.

          "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

          by Greg Dworkin on Sat Apr 12, 2014 at 06:15:59 AM PDT

          [ Parent ]

          •  Except that it doesn't (1+ / 0-)
            Recommended by:
            Victor Ward

            Silver and bronze plans are inferior to most employer-provided coverage. Definitely better than nothing and closer than before.

            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

            by dinotrac on Sat Apr 12, 2014 at 06:17:08 AM PDT

            [ Parent ]

            •  not true for everyone (5+ / 0-)

              in any case, amongst the 'not changing' opinionof the law is this changing opinion.


              These changes are a result of a shift in Republicans' views. Republicans are now more likely than in the prior survey to predict the law's long-term impact on their family will be negligible and less likely to believe it will be harmful. Perhaps with more of the law's provisions now in effect, and little evidence it has actually hurt their healthcare situation, Republicans' views may be more informed by their experience rather than their negative opinions about the law more generally.
              http://www.gallup.com/...

              "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

              by Greg Dworkin on Sat Apr 12, 2014 at 06:49:58 AM PDT

              [ Parent ]

      •  There's also the preventative care you don't see (7+ / 0-)

        like the provisions to eliminate healthcare associated infections (those nasty staph infections people pick up in  hospitals, eg.) which include both grants to the states to work with the infection preventionists and penalties for hospitals with too many re-admissions.  This doesn't get much press, but the data in some states indicates that with a little, er, motivation for the hospitals, those infection rates are in fact dropping.

        If you think you're too small to be effective, you've never been in the dark with a mosquito.

        by marykk on Sat Apr 12, 2014 at 06:45:47 AM PDT

        [ Parent ]

    •  We should wait for the data on the efficiency of (14+ / 0-)

      the various Death Panels to come in....;-)

      •  I'm waiting for the videos, myself. :) (1+ / 0-)
        Recommended by:
        Stude Dude

        "If you're going to go down with the ship, make it a submarine." - Wayne Shorter

        by Oliver Tiger on Sat Apr 12, 2014 at 05:35:52 AM PDT

        [ Parent ]

      •  We need some death panels, and I don't think (0+ / 0-)

        ACA provides them, mostly because it does dinkus for improving actual health care.

        Too bad, too. An intelligent approach would identify effective v non-effective treatments and throw out the crap.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sat Apr 12, 2014 at 06:11:15 AM PDT

        [ Parent ]

        •  indeed (8+ / 0-)

          (btw, not so easy to know). But that's built into ACA. Which you conveniently ignore every time you complain no one is looking at quality.  That's balderdash, but it's also applicable for a series of intiatives that parallel but are not ACA.

          Look up PQRS as one major example.  it's complex, hard to navigate, doesn't have enough pediatrics, but it's a start and an example.

          Look up EMR and meaningful use.

          "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

          by Greg Dworkin on Sat Apr 12, 2014 at 06:19:55 AM PDT

          [ Parent ]

          •  I don't conveniently ignore so much as dismiss. (0+ / 0-)

            On a scale of 1 to ACA -- which is huge, the quality part is dinkus.

            Real?
            Sure.
            Useful?
            Of course.

            But dinkus.

            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

            by dinotrac on Sat Apr 12, 2014 at 06:29:57 PM PDT

            [ Parent ]

            •  I'm confident you really don't understand (0+ / 0-)

              what I posted.

              "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

              by Greg Dworkin on Sat Apr 12, 2014 at 08:41:46 PM PDT

              [ Parent ]

              •  OK. Medicare and medicaid build in some (0+ / 0-)

                quality measures and even offer financial incentives. Not a bad thing g,at least not if they're set up well (in case you don't know what I'm talking about, please reference lucent technologies for incentives gone horribly wrong).

                Is it possible to apply meaningful control to medicare and not the rest of health care without further reducing the availability of good doctors to Medicare patients?

                LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                by dinotrac on Sun Apr 13, 2014 at 03:12:06 AM PDT

                [ Parent ]

                •  best way to apply meaningful quality to medicare (0+ / 0-)

                  is to improve the quality of health care. medicare does not exist in a vacuum.

                  Availability takes care of itself once the standard is set. The real availability issue is aging boomers, and there are some things built into ACA to address that as well.

                  The ACA authorizes funding for additional medical residency training programs through the Health Resources and Services Administration (HRSA) and the ACA’s own Prevention and Public Health Fund. It requires that Medicare-funded residency training slots be redistributed from hospitals that are not using them or that have closed, to hospitals seeking to train additional residents. It also includes provisions designed to increase physician productivity and the volume of physician services available. The law encourages care coordination—in medical homes and accountable care organizations, for example—and expands the non-physician workforce that can augment or substitute for physician services.
                  http://www.rwjf.org/...

                  Whether that's enough (likely not) remains to be seen. But the concept is built into the law.

                  "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

                  by Greg Dworkin on Sun Apr 13, 2014 at 04:12:24 AM PDT

                  [ Parent ]

                  •  No. The best way is to eliminate altogether, and (0+ / 0-)

                    provide true universal care.

                    There should be no "this care" or "that care".

                    In the meantime, it is better than nothing -- and that's not damning with faint praise. As we get older, most of us would have a hell of a time getting any kind of coverage at all.

                    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                    by dinotrac on Sun Apr 13, 2014 at 08:29:08 AM PDT

                    [ Parent ]

    •  We need top notch people (2+ / 0-)
      Recommended by:
      rl en france, Victor Ward

      Runnung ACA for the next few years to insure its launched properly. Many experts have already weighed in against meddling and modifying the program until its fully implemented.

      Sebelius' replacement is a Wall Street/Corporate type. We'll be best served if she keeps her hands off ACA and allows the experts to continue the rollout without outside interference from pols, vendors, contrsctors, etc.  That doesn't seem likely.

      Obama is nearly 3/4 of the way into his terms in office. As it winds down perhaps we would all be better served if he focuses on something else, like fixing the economy and creating jobs and leaves ACA to the experts.  Tell the marketing guys in the WH to STFU with their sexist BS before they further alienate women voters.

      Money is property, not speech. Overturn Citizens United.

      by Betty Pinson on Sat Apr 12, 2014 at 05:42:24 AM PDT

      [ Parent ]

      •  What does it mean to keep your hands off ACA? (1+ / 0-)
        Recommended by:
        Victor Ward

        With problems remaining -- and there are problems -- somebody has to get their hands dirty.

        If my income doesn't rise and take me out of subsidyland, I would really, really like to put my daughter on our family plan next year instead of having to buy her a separate policy.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sat Apr 12, 2014 at 06:13:11 AM PDT

        [ Parent ]

        •  Hands off ACA policy and rules changes (1+ / 0-)
          Recommended by:
          Victor Ward

          No special deals to get red states to sign on.

          No more tinkering with big employer rules and deadlines.

          Neolibs didn't want health care reform and when they finally acquiesced to public pressure, they let corporations create an extremely complex plan, a Rube Goldberg contraption.   They're stuck with it for now. They can't adjust one part without screwing up another.  

          They've made enough changes already that risk the timeline for profitabililty and cost reduction.  Allowing the Walmart woman to cut special deals with red states could really screw things up.

          If she sticks to marketing and BS, we should be safe for now.

          Money is property, not speech. Overturn Citizens United.

          by Betty Pinson on Sat Apr 12, 2014 at 07:26:06 AM PDT

          [ Parent ]

      •  managerial skills are crucial (7+ / 0-)
        "If you can run OMB you can run anything" Alice Rivlin on #Burwell #Sebelius http://t.co/...
        @BrookingsMed

        "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

        by Greg Dworkin on Sat Apr 12, 2014 at 06:21:01 AM PDT

        [ Parent ]

        •  Most people with good managerial skills (1+ / 0-)
          Recommended by:
          rl en france

          don't work on Wall Street or in the private suites of corporate America.  I'd venture to say any department head/physician of a major comprehensive health care provider has far better management skills than anyone on Wall Street or in the Fortune 100.  The people running any major county public hospital system are probably better qualified.

          Better to have someone who, you know, actually knows something about health care.   They need more docs at HHS, fewer MBA's.    

          Howard Dean or someone similar would be an excellent choice, if people were interested in, you know, excellence.

          Money is property, not speech. Overturn Citizens United.

          by Betty Pinson on Sat Apr 12, 2014 at 07:31:12 AM PDT

          [ Parent ]

          •  Here's a good example (1+ / 0-)
            Recommended by:
            pfiore8

            I was going through a year of chemo and radiation at a major cancer center during the run up to the Y2K changeover.  I noticed the little stickers on everything, including the electrically powered digital IV pump that ran semi- toxic chemo into my veins (hey it worked).   When I asked my med onc about it, he explained that, by early 1999, they had already changed, updated and tested every single computer, piece of equipment, electrical system, etc. in their entire multi-site system to ensure a smooth transition.

            It went off without a hitch, there and in thousands of other hospitals across the US.

            Put a doctor in charge of HHS, and no, not Zeke Emanuel.

            Money is property, not speech. Overturn Citizens United.

            by Betty Pinson on Sat Apr 12, 2014 at 07:47:36 AM PDT

            [ Parent ]

          •  Yeah, so long as that industry creation does NOT (0+ / 0-)

            ... believe in the fee for service model for most medical care.

            If we doubt that Wall Streeters make the best Secretaries of the Treasury and heads of securities regulatory agencies - with good reason! - why would we trust hospital administrators to head up ACA?

            Actually, I agree with you, but I'd want to give your nominee a lie detector test and surround her or him with others.

            2014 is HERE. Build up the Senate. Win back the House : 17 seats. Plus!

            by TRPChicago on Sat Apr 12, 2014 at 08:22:47 AM PDT

            [ Parent ]

            •  That's why you have trusted patient advocates (0+ / 0-)

              on board for review, oversight and voting on changes.

              Trusted, trained patient advocates played a big role in helping develop many parts of PPACA.  I volunteered a little time myself.   The health care advocacy community will not sit on the sidelines.  That said, those teams, health care experts and consumers, work well together.  Adding a bunch of Wall Street types who bring nothing to the discussion and whose loyalty is to personal profit don't have much to offer.

              Money is property, not speech. Overturn Citizens United.

              by Betty Pinson on Sat Apr 12, 2014 at 08:29:58 AM PDT

              [ Parent ]

    •  bucky built the fascinationg geo dome, but it did (0+ / 0-)

      not make anything obsolete and is mostly a curiosity so far. ACA is making the plight of the poor and working poor and those with pre-existing conditions much better, not obsolete but closer to being so.

    •  And why are people (1+ / 0-)
      Recommended by:
      pfiore8

      acting like the enrollments are amazing?

      The law was compulsory, just like state laws that require car owners to buy insurance.

      So let's break out the champagne because people buy car insurance as required by state law!

      And you're right - it's way to early to assess the impact of the law, although it's clearly helping some people now.

      The banks have a stranglehold on the political process. Mike Whitney

      by dfarrah on Sat Apr 12, 2014 at 07:12:19 AM PDT

      [ Parent ]

  •  Sebelius (41+ / 0-)

    I'm not huge on Sebelius (in part because of her stated opposition to single payer), but I have been irritated by the media framing of her departure as being a "result of failure." Most of the department heads from Obama's first term (Chu, Jackson, Solis, LaHood, Geithner, Panetta, Clinton, among others) have already left. Their jobs are quite stressful, and many--understandably--don't want to stick around for another term. Sebelius couldn't bail out because she had a job to do, which was to see the ACA through the end of its initial implementation. And that's what she did, and I give her credit for that.

  •  It's not at all equivalent (9+ / 0-)

    for the media to create the same kind of uproar and environment surrounding Sebelius' work and subsequent resignation with that of Michael "Heck of a job" Brown's from FEMA following Hurricane Katrina for example.

    Unlike "W" and most other GOP presidents, President Obama shouldered the ultimate blame for the website failures rather than "allowing" a sacrificial lamb to resign.  But, hey that's how the Dems roll.

    As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them. John F. Kennedy

    by JaxDem on Sat Apr 12, 2014 at 05:11:02 AM PDT

  •  Last week's NYT business section reported on (10+ / 0-)

    A balky rollout of a new "magical band" at Disneyworld. This band, worn on the wrist, once synched to your reservation and credit card serves as a room key, charge card and scheduling device. Their rollout had a few glitches and now the Disney investment community is getting a little antsy as Disney said more bands in use means more revenue.

    One would probably not expect Disney to flub a relatively easy electronic rollout (easy compared to the ACA) but they did.

    Doesn't make the ACA rollout any less fraught but a useful reminder that big changes are nevertheless easy.

  •  I think the (10+ / 0-)

    Tennessean article is amazing- an insurer suing a hospital for charging their client too much?
    There is a link in that article to the Tampa Bay Times investigation of HCA:

    • The overcharging starts the moment patients arrive, with a special "trauma response" fee that gets billed on top of every treatment and procedure. HCA's cover charge goes as high as $33,000. The rest of the state's average: $6,754. Then, the company charges more than other hospitals for imaging scans, lab tests and drugs.

    • The higher bills are not the result of having more seriously injured patients. When it comes to severity of injury, HCA patients are, on average, the same as the state as a whole.

    • HCA's trauma fees are especially high for people with minor injuries. For patients whose injuries are least likely to be fatal, HCA's six trauma hospitals have charged more than $29 million in response fees alone. That's more than the state's 20 other trauma centers combined.

    http://www.tampabay.com/...

    This could be an unexpected bonus of the ACA, with the profits cap on insurance companies, they're going to be really looking at their payouts from now on, I imagine.

    People in FLORIDA might be more familiar with HCA:

    HCA owns 45 hospitals in Florida, more than any other company. In the late 1990s, the Nashville-based corporation was famously headed by Rick Scott, Florida's current governor, when federal authorities accused the company, then called Columbia/HCA, of fraudulently conducting unnecessary tests and issuing false diagnoses.

    Scott resigned amid the scandal, admitting no wrongdoing. The company later pleaded guilty to 14 corporate felonies.

    Your beliefs don't make you a better person. Your behavior does.

    by skohayes on Sat Apr 12, 2014 at 05:20:50 AM PDT

    •  Gov Rick Scott depends on Floridians (5+ / 0-)

      to be uninformed, uninterested, ignorant, willfully ignorant or forgetful or some combination of all.  Given that Florida is second only to Maine in calling home to the oldest Americans, the forgetful isn't too much of a stretch.

      This editorial cartoon by Jim Morin illustrates this perfectly.  

      What is being referenced in the cartoon is Scott's rollout of CONNECT, a supposed new and improved unemployment website.  Not only was it a disaster, but DEO knew Florida's failing unemployment website, CONNECT, had problems years before it launched:

      The 10 News Investigators discovered Florida's Department of Economic Opportunity knew there could be problems with the state's failing unemployment website for years leading up to its embarrassing launch on October 15th.

      The $60 million site, called "CONNECT," has halted much-needed payments to thousands of Floridians this holiday season.

      But in June 2012, the DEO threatened to cancel its contract with contractor Deloitte because of repeated missed deadlines.  A letter from the state agency to the contractor indicated the "software development project (had) limited prospects of success."

      Yet the DEO kept Deloitte in-place after renegotiating its contract.  Deloitte promised new managers and a new plan, while the state received $4.5 million in restitution.

      However, when the site was launched on Oct. 15, 2013, the problematic website had disastrous effects.

      As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them. John F. Kennedy

      by JaxDem on Sat Apr 12, 2014 at 05:41:10 AM PDT

      [ Parent ]

    •  One segment of the market (4+ / 0-)
      Recommended by:
      tb mare, wintergreen8694, skohayes, askew

      which, with the help of a little regulation, now has a motive to hold another segment accountable.   Who'da thunkit?

      If you think you're too small to be effective, you've never been in the dark with a mosquito.

      by marykk on Sat Apr 12, 2014 at 06:48:06 AM PDT

      [ Parent ]

  •  Yes, Sibelius was at the helm of the rollout, (12+ / 0-)

    but she was vulnerable to the failures of the private sector contractors who set up the site.  A complex site of this type is a playground for missteps, mistakes, perhaps even mischief.  It is remarkable that a late-arriving cyber commando team was able to fix things as quickly and efficiently as they did.  The early contractors were known to have had their previous failures, yet Sibelius takes the fall.  I give her credit for holding on as long as she did.

    Building a better America with activism, cooperation, ingenuity and snacks.

    by judyms9 on Sat Apr 12, 2014 at 05:32:05 AM PDT

    •  Agree, contractors were the problem (4+ / 0-)

      They dropped the ball several times, lesding to a cascade of problems.

      Taxpayers and conservative pols of every stripe must get used to the fsct that their insisrence on privatizing and profitizing government means they can no longer blame government when something goes wrong.

      Money is property, not speech. Overturn Citizens United.

      by Betty Pinson on Sat Apr 12, 2014 at 05:53:16 AM PDT

      [ Parent ]

      •  HHS managed the project (1+ / 0-)
        Recommended by:
        sprogga

        They insisted on managing the project.  They would not give it up, even though they had no experience managing a project like that.

        Then, they picked contractors with dubious records.

        So, yes, HHS (and Sebelius) is to blame.

        •  HHS was the only choice to manage it (2+ / 0-)

          Thats the way it should have been. No private contractor should EVER be allowed to create or change public policy. Ever. Private contractors are not accountable to the public.

          As far as HHS choosing its ow  contractors for the web site, who knows if that's the case. Recall, HHS was forced to hire a VP of an insurance company to write the rules for PPACA. Sebelius never should have allowed the WH to force that choice on HHS and its not unrealistic to wonder if web site contractor choices were hers as well.

          Money is property, not speech. Overturn Citizens United.

          by Betty Pinson on Sat Apr 12, 2014 at 06:47:13 AM PDT

          [ Parent ]

          •  I don't agree (4+ / 0-)

            with big projects, you need to recognize the limits of your expertise and go outside if needed.

            "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

            by Greg Dworkin on Sat Apr 12, 2014 at 06:53:49 AM PDT

            [ Parent ]

            •  If someone is a great expert (4+ / 0-)

              They can be hired as individuals by the federal government.  They even hired the insurance exec to write rules for PPACA, they didn't subcontract with Wellpoint.

              Private industry should NEVER write or control policy in the role of the government.  That line should never be crossed.  Policymakers must be accountable to the public.

              As far as expertise is concerned, the federal government has a long history of employing some of the best experts in the world, from NASA to medical research to defense.  The federal government needs to return to training and keeping experts within its ranks.  Outsourcing to private contractors hasn't worked very well and it certainly has cost more.

              Money is property, not speech. Overturn Citizens United.

              by Betty Pinson on Sat Apr 12, 2014 at 07:11:00 AM PDT

              [ Parent ]

          •  Well, in the end, HHS had to give up management (1+ / 0-)
            Recommended by:
            sprogga

            and it was "fixed" in less than 60 days.

            So, I think, hindsight shows they never should have managed the project in the first place.

            No private contractor should EVER be allowed to create or change public policy. Ever. Private contractors are not accountable to the public.
            Correct.  The problem was HHS was creating policy out of thin air after parts of the software were already written to previous specs.

            HHS should have had the specs (policy) in place and in stone before one line of code was written by a competent management firm.

            Healthcare.gov has become a textbook example of how not to manage projects.. there's some pretty good analyses you can find from IT and software management organizations and magazines if you care to Google it.

            •  That may be true (3+ / 0-)
              Recommended by:
              sfbaytransplant, judyms9, bfbenn

              and HHS should certainly review how it goes about contracting for web development. That's what happens when you have successive administrations headed by POTUS's with hands-off management styles and low levels of executive experience.  

              There's a lot to be said for management by walking around. Having regular Cabinet meetings and taking a sincere interest in how departments operate can go a long way towards building a quality operation.  Our last two POTUS'es have been fans of the "government is bad, Wall Street is good" school of thought, so we've suffered accordingly.  Next time, lets elect a POTUS who has experience and who actually likes government and wants to make it work.

              HHS should also consider hiring its own in-house project managers instead of contracting the work out.  Agencies need their own experts who are familiar with their operations and with public policy.  Federal outsourcing seems to have reached the point of diminishing returns.

              Either way, the web site rollout  wasn't a big deal, it got blown out of proportion by the GOP and the media and the WH marketers panicked and threw Sebelius under the bus.  We're 3/4 of the way through, counting the days.  Let's focus on a better Dem in the WH next time.

              Money is property, not speech. Overturn Citizens United.

              by Betty Pinson on Sat Apr 12, 2014 at 07:20:34 AM PDT

              [ Parent ]

            •  Does no one get it that this was an enormous (0+ / 0-)

              project that kept getting changed before it was completed?  The Medicaid blocks, the refusal to create state exchanges, the endless shifting in what the site would have to do all occurred as the code was being written.  Facebook released an upgrade that fucked with all mobile users during the "disastrous" ACA rollout.  Apple built a phone with a map app that would send you to East New Jesus, not the mall.  These are companies with lots of IT experience in their specific genres and they fucked up.  

              It worked, it met and exceeded expectations, it did what it needed to do after some tinkering.  It will continue to improve.  It's sort of like real life, you know?  Not quite perfect but it beats the hell out of the alternatives.

              I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

              by I love OCD on Sat Apr 12, 2014 at 08:12:40 AM PDT

              [ Parent ]

              •  in the end it won't matter (2+ / 0-)
                Recommended by:
                I love OCD, bfbenn

                but in the beginning it sucked. it really did.

                if the beginning is your expectation of success, I'm against it.  we can do better. In fact, we did.

                "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

                by Greg Dworkin on Sat Apr 12, 2014 at 09:28:20 AM PDT

                [ Parent ]

        •  that was a bad decision (0+ / 0-)

          to manage it internally. Now comes the accountability.

          "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

          by Greg Dworkin on Sat Apr 12, 2014 at 06:51:24 AM PDT

          [ Parent ]

    •  Wait, what? (0+ / 0-)
      The early contractors were known to have had their previous failures, yet Sibelius takes the fall.
      So she hired contractors with a known record of failure, yet it's not her fault?  Isn't part of an administrator's job to put together the right team to succeed?  

      "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

      by Subterranean on Sat Apr 12, 2014 at 10:38:07 AM PDT

      [ Parent ]

  •  Bad rollout? That is so October. Hasn't the media (9+ / 0-)

    heard that more than 7.5 million people have enrolled? It's like people waiting in line for hours to get a long awaited product, what matters in the end is having the product. People who spent a lifetime to gain access to healthcare just don't care about October. October is only important for the media and Republicans. They have no relevance.

    •  I think most people are skeptical as to (0+ / 0-)

      the meaning of that number.

      By itself, it is impressive.

      But, how many of those people were previously uninsured?  The RAND report says that only 1.4 million were previously uninsured individuals.

      Shuffling people from one plan to another is not that impressive, considering the amount of upheaval in the system to do so.

      •  RAND is one piece of it (8+ / 0-)

        and the part you quoted is only one piece of RAND. RAND says 9.5M as of that date (before open enrollment is done) with CBO guesstimating 13M by year's end and 25M in 2 years, half of the uninsured in America (was 47M).

        Delving into the numbers? Still impressive despite GOP talking points.

        "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

        by Greg Dworkin on Sat Apr 12, 2014 at 06:24:16 AM PDT

        [ Parent ]

        •  I'll believe it when I see it (1+ / 0-)
          Recommended by:
          dfarrah

          And, perhaps I am less impressed than you because I see health "insurance" as something completely different than health "care".

          I think we've had this discussion before.. I see an extremely expensive program that benefits wealthy insurance companies while allowing them to provide narrow network plans to people at outrageously high out-of-pocket amounts.

          Yes, we'll have to wait a year or two to see how this all washes out.. But, so far, I am underwhelmed.

          •  Financial Implications of Out-of-Network care (1+ / 0-)
            Recommended by:
            askew

            I'm really surprised BC is stepping in like this.

            As a former benefits manager I've seen how people don't have a clear understanding of how out-of-network services work. Out-of-network applies not only to doctors and hospitals but also to things like labs. Plus I'd be surprised if there's an anesthesiologist anywhere who belongs to an insurance network.

            Not only are the deductibles higher but so is your share of the bill and the provider can bill you for the balance left after the insurer pays in all but a few states.

            The insurance reimbursement is the big thing. People see that the reimbursement is 40% vs 20% in-network but they often fail to understand that the 40% is based on the "usual, customary, reasonable" and that is substantially more than the negotiated rate.

            It's one thing to make an informed choice to go out-of-network but you clearly don't have that choice in an emergency situation.

      •  Really, coming from the Republicans, (2+ / 0-)
        Recommended by:
        NedSparks, I love OCD

        that is a bullshit argument.
        They did not give one thought to the uninsured when we were trying to get this bill passed.
        Remember Republicans saying that people without insurance can just go to the emergency room for treatment? I do.
        Do the red state representatives and Senators from states like Kansas, Florida and Louisiana give one crap about the uninsured in their own states? No, they don't.

        Your beliefs don't make you a better person. Your behavior does.

        by skohayes on Sat Apr 12, 2014 at 06:40:45 AM PDT

        [ Parent ]

  •  On Greg Sargent's link (9+ / 0-)
    Democratic strategists believe there is low-hanging fruit in the black populations in Arkansas and Louisiana, where Democrats are defending seats, because those states never saw a well-financed and organized get-out-the-vote effort from President Barack Obama’s campaign…Part of that effort is focused on boosting black turnout from traditional midterm levels to something closer to presidential levels in Arkansas and Louisiana, as well as one of the Democrats’ best pickup opportunities in Georgia, and potentially Michigan and North Carolina.

    Your beliefs don't make you a better person. Your behavior does.

    by skohayes on Sat Apr 12, 2014 at 05:36:33 AM PDT

  •  "...try for a reset" ?? (1+ / 0-)
    Recommended by:
    Betty Pinson

    I don't care that the total number of people signing up this first round "confounded conservatives".

    I want the ACA to succeed in the long term, and that means many more younger, healthy people need to sign up than older people with health issues.

    and many more Hispanics have to enroll; apparently the current website just doesn't work for Hispanics. There's cultural, social issues that have to be dealt with, and soon.

    The White House has to do much more than merely "try for a reset". there has to be a total reset, including new methods to sign up Hispanics.

    "We are beyond law, which is not unusual for an empire; unfortunately, we are also beyond common sense." Gore Vidal

    by Superpole on Sat Apr 12, 2014 at 05:37:54 AM PDT

    •  The "reset", I think, is purely political.. (1+ / 0-)
      Recommended by:
      Greg Dworkin

      aimed at 2014 elections.

      Sebelius was seen as the face of ACA, and there was considerable political pressure to put a "new face" on ACA before the elections.

      •  i think that's exactly right n/t (2+ / 0-)

        "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

        by Greg Dworkin on Sat Apr 12, 2014 at 06:24:53 AM PDT

        [ Parent ]

      •  That's Unfortunate if True (1+ / 0-)
        Recommended by:
        JJ In Illinois

        if it's just a political reset for the election; that's a double FAIL. the democrats aren't going to fare very well this fall, regardless of who runs the health department.

        and the ACA is going to fail if it does not sign up numerous healthy people and Hispanics-- this will lead to increased premium costs, the "affordable" part goes away and that's the end of it.

        "We are beyond law, which is not unusual for an empire; unfortunately, we are also beyond common sense." Gore Vidal

        by Superpole on Sat Apr 12, 2014 at 06:37:11 AM PDT

        [ Parent ]

        •  As far as I know, open enrollment is over (0+ / 0-)

          so, I do not see how the numbers can improve between now and the elections.

          Open enrollment for 2015 is not due to start until Nov 15th, after the elections.. I'm guessing that's gonna change..

          •  Medicaid counts, it's part of ACA (3+ / 0-)

            and the enrollment never starts. Also, any life changing events like having a kid lets you enroll any time on the exchanges.

            "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

            by Greg Dworkin on Sat Apr 12, 2014 at 06:52:58 AM PDT

            [ Parent ]

            •  I look at Medicaid separately.. (0+ / 0-)

              Medicaid coverage is temporary.. Necessary?  Yes, under the current system.  But after the economy improves, Medicaid enrollment will be way down.  Unless you buy into the notion that we are creating yet another permanent dependent class.

              •  you can't look at Medicaid separately (0+ / 0-)

                it's a package deal.

                And PS

                You can make Medicaid look dreadful by cherry picking how you define “access.” Or you can take a broader, more nuanced view of “access,” considering also patients’ experience. When you do, you find that Medicaid works pretty well.
                http://blog.academyhealth.org/...

                "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

                by Greg Dworkin on Sat Apr 12, 2014 at 09:30:32 AM PDT

                [ Parent ]

          •  limited ongoing enrollment for life changes (1+ / 0-)
            Recommended by:
            I love OCD

            as well as Medicaid.

            The other number that will improve is the paid premiums, and the number with actual coverage -- anyone who signed up after Mar. 15 does not actually have coverage until May 1. So in the Gallup polls that ask about coverage, their answer is still "not yet."

            I also suspect we will get better reporting of the off-exchange purchases, once the dust settles.

          •  I Get it, But That's Not the Point (0+ / 0-)

            I'm responding to the notion getting rid of Sibelius is somehow a BIG plus for the democrats-- regarding the upcoming midterm.

            I'm calling bullcrap on that.

            "We are beyond law, which is not unusual for an empire; unfortunately, we are also beyond common sense." Gore Vidal

            by Superpole on Sat Apr 12, 2014 at 10:38:10 AM PDT

            [ Parent ]

          •  Open enrollment is over 'BUT' (0+ / 0-)

            6 to 7 million people lose coverage during the year for numerous reasons and they can still enroll [pre-existing condition] and all.

  •  This is all too harsh and means (5+ / 0-)

    …absolutely nothing in the larger scheme of things like life and death.

    The theme of Sebelius blame -- for me -- merely begs the question "what is the topic at hearth that these pundits are avoiding by clinging to an obvious and meaningless cheap shot.

    Revealing round-up Greg. Thank you.

  •  Even the insurance companies (7+ / 0-)

    are rooting for ACA success (well, of course they are $$$) - I found this telling and funny and a symbol of who lost this fight, even in Idaho.

    BOISE -- Representatives from Blue Cross of Idaho gave away a brand new Jeep Wrangler Thursday, as part of an effort to get young adults to sign up for health insurance through the state exchange....(the Good to Go campaign) targeted the so-called "young invincible" population. Those who are 18- to 34-years-old, and are considered vital to the success of the Affordable Care Act.
    http://www.ktvb.com/...
  •  Progress; kid with cancer not denied coverage. n/t (6+ / 0-)
  •  Yeah, 7.5 million signups. (0+ / 0-)

    Probably includes all those jobs saved by the stimulus.

    Still, it's up, lots of people on the expanded Medicaid and others getting subsidies.

    That's good, but it sure does seem a lot like a tweaked and expanded version of John McCain's ideas for a whole lot more grief.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Sat Apr 12, 2014 at 06:01:05 AM PDT

    •  Imagine if the Republicans (7+ / 0-)

      had been willing to iron out the problems and make it a better program, rather than waste time trying to repeal it because Obama?
      Imagine all 50 states expanding Medicaid rather than 24?
      Imagine a 23 year old mother of three still being alive because Medicaid had been expanded in her state and she could have been treated for a heart condition?

      Dill had been bumped off Medicaid because she was making too much money – an estimated $9,000 a year – and had yet to be able to afford a divorce, which might have bettered her chances.
      http://orlandoweekly.com/...

      The same thing is happening in Kansas. And we have a so called Christian as governor of our state, happy to deny the poorest people in this state aid, so he can cut income taxes for businesses.
      (Sorry about the rant, dt, not directed at you!).

      Your beliefs don't make you a better person. Your behavior does.

      by skohayes on Sat Apr 12, 2014 at 06:19:13 AM PDT

      [ Parent ]

      •  I reserve special scorn for Republicans for (0+ / 0-)

        insuring the worst aspects of ACA.

        Remembering that I am not affiliated with any political party --

        I'm not that upset with Democrats over the bill because Democrats will do what Democrats will do and it tends to involve a lot of government, rules, and a big fat mess.

        Republicans really pissed me off for turning away and playing "see plenty evil, so run away and scream loudly."

        Very sad because John McCain gave them a good starting point with his campaing proposals of tax credits (very much like the subsidies, if only there would be front-loaded) and implied move away from employer-provided health benefits.

        Health care was and is a mess.  Running away from the fact does nobody any good.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sat Apr 12, 2014 at 06:41:45 PM PDT

        [ Parent ]

  •  Progress;kid with type1 diabetes not denied.n/t (5+ / 0-)
    Recommended by:
    skohayes, marykk, tb mare, ybruti, askew
  •  Fuck 'em all (17+ / 0-)

    Sebelius was one of the best governors the state of Kansas ever had. Because of her handling of the Greensburg Tornado, an event I was unfortunate enough to experience first-hand, I'm loyal to her to the end.

    The web site failures were technological. So let's blame someone who's never written a line of code in her life, who trusted advisers and contractors to tell her the truth, and was submarined by them. It's telling that once a new crew was on the case, the problems were fixed.

    So fuck her detractors. In an exemplary career of public service, she presided over one failure, a technological glitch, but also its solution.

    That isn't what I'll remember her for. I'll remember that she went to the wall for me and the other victims of the Greensburg Tornado. She even hammered through grants to the victims so we could replace our destroyed cars.

    Join Essa in a revolt against the gods. Continue the fight, Causality.

    by rbird on Sat Apr 12, 2014 at 06:01:47 AM PDT

  •  progress;donut hole closes for elderly. n/t (4+ / 0-)
    Recommended by:
    marykk, Maverick80229, tb mare, askew
  •  Progress;junk/scam plans die off.n/t (5+ / 0-)
  •  progress;working poor can afford coverage.n/t (4+ / 0-)
    Recommended by:
    marykk, Maverick80229, tb mare, askew
  •  frustration (6+ / 0-)

    How long are we going to accept the notion that Obamacare had a disastrous premier?  About half the governors  tried their best to sabotage it, all Republicans badmouthed it, the media played up all possible negatives--and nobody--Dem or R, had a nice word for it.  Creating the largest healthcare start up with such negative press was bound to make a difficult job impossible.  Correcting it in so short a time should be universally acclaimed--it won't be.  Obama should have refused her resignation--told the country she is a hero who saved many lives now,and in the future.

    Actions speak louder than petitions.

    by melvynny on Sat Apr 12, 2014 at 06:06:54 AM PDT

  •  Cliven Bundy (0+ / 0-)

    I'm trying to figure what to make of this. Apparently he may or may not have 20000 Wingers with him, trigger happy to start a revolt against the 20 Feds and that thar Kommie Kenyan.

    I hope that the goverment just silently stands these guys down, without a shot until they get bored and wander back to their real jobs. Surely, some Mom&Pop convenience stores must be missing their oh so Galtian Pop....

    It's weird how Bundy is an instant folk hero among the Wingers on Facebook. One forwarded "Let's play Cowboys and Communists in Arizona!" They're like the questionable politics of my Dad's generation "If there's anything that I don't like it's Communism! And if I don't like anything, it must be Communist!"

    As a survivor of the '80s Farm Crisis, this hits an odd personal note. Where were the Wingers standing up against the bad government policies causing people to lose their farms during the "Keep the grain export the farmers" days.

    Although I'm still sore at the Left for their absense during that time. And opportunist fringe groups like Posse Comitatus(sp?) coming in to fill the vacuum and ruining the movement.

    "If this Studebaker had anymore Atomic Space-Age Style, you'd have to be an astronaut with a geiger counter!"

    by Stude Dude on Sat Apr 12, 2014 at 06:18:44 AM PDT

    •  More like a few dozen (1+ / 0-)
      Recommended by:
      Stude Dude

      The guy's cattle have been confiscated, I believe, so the problem is not all that pressing to the feds right now.
      They can stand around with their guns for a few days and stand up against the tyrannical feds (for a guy who is basically sucking off the federal teat for years) , and then drive home on roads built by those same feds, and file their tax returns on April 15, so they can get their refund.

      Your beliefs don't make you a better person. Your behavior does.

      by skohayes on Sat Apr 12, 2014 at 06:50:37 AM PDT

      [ Parent ]

  •  the NY Times coverage has been (4+ / 0-)
    Recommended by:
    Stude Dude, tb mare, askew, jlmbrnprof

    political and negative, breathlessly repeating every right wing talking point in headlines and brushing aside the enrollment numbers and good news as asides.  The day the deadline was reached, they put three large photos on the front page of exhausted, frowning faces (burying a beaming photo at the bottom of pg 14), and quoting unhappy, frustrated people while minimizing any positive comments.  The coverage that day contained "crashed", "thwarted", "struggled", "snags" and of course "disastrous rollout" while making short shrift of the millions of newly-insured people.  Yesterday's headline and subhead focused entirely on the website "woes" and ignored Sebelius' significant contributions.  

    Between the Times and NPR, I feel sometimes as though I'm getting the news from Fox, instead of reputable outlets.  Not that they should brush aside the negative aspects of the rollout, but that the historic nature of making progress changing our healthcare system should be part of the conversation.  Amplifying technical problems only makes the Herculean task of revamping our healthcare system harder.  

    "It ain't right, Atticus," said Jem. "No, son, it ain't right." --Harper Lee, To Kill a Mockingbird

    by SottoVoce on Sat Apr 12, 2014 at 06:32:22 AM PDT

  •  It is not how you start the game but how you (6+ / 0-)

    finish it, only if you are a Republican and a male, it would appear.

    We all know that "people" hail you as a hero, if in the second quarter, or even in the forth quarter, you turn a horribly executed game around, win,and win big.

    This dedicated Woman had one of the toughest jobs in the Administration, and she still accomplished more than we will ever know that has helped the US to move beyond this Nation's money centered  posture to one which is more  consistent with civilized standards.

    Do Nothing Republicans, Career Centered Democrats and people who make a living writing  inept assessments as though they are the Oracles of Delphi, would do well to step back and see that they have , and are doing more harm to this Country than a thousand  bad roll outs could do.

    If the Big Banks, Corporations, The Koch Brothers, The Supreme Court,MSM, and the Republican Party have no embarrassment for the mess and gross mistakes they have made that they have no intentions of "correcting", then why should Sec. Sebelius and this Admin. not bask in the glory  rather than be ashamed of being the "Come Back Kids"?    

  •  Time will tell (0+ / 0-)

    In addition to what others have said here, that in the long term, we are far better off, there is another aspect to this.  At some point there will be an individual or individuals who will do some in depth investigations into what really happened over the past 4 years in terms of implementing this.  Only then will we know exactly who really did what they were supposed to do and who screwed up.  In other words, the jury is still out.  

    But, imagine if all of congress had taken an interest in implementing this and took the time to know what what going on.  Things would have gone smoother.  The tea party culture of hatred did nothing to help and only wasted time and talent.  

    I am looking forward to November 2014 because I think we are going to do well on election night, if we remember to be progressive Democrats and not tea party lite types.

    •  Actually, many people involved have said (1+ / 0-)
      Recommended by:
      Greg Dworkin

      what went wrong, when, and why, and how it got fixed. Here is a local newspaper story from Middletown CT on a site reliability engineer from a nearby town who was on the five-member rescue team. It is much better researched and written than almost all of the national media coverage.

      Cromwell native part of elite team that fixed ailing Obamacare site

      Almost everybody outside the business, and too many inside, do not even know that there is such a thing as a site reliability engineer. HHS should have hired a few several years ago. In fact, they got reports about the development failures throughout the process, including a stress test the day before launch that showed the site incapable of properly handling more than a thousand users at a time.

      There is a decent though out-of-date summary in the Wikipedia article on HealthCare.gov, with further references.

      The following is drawn from numerous accounts of various parts of the problem and from statements by team members about the solutions.

      The rollout started going wrong decades ago when our current procurement rules were being written to require that contracts be awarded to the lowest bidder with very little regard for competence. This is supposed to prevent corruption in awarding contracts, and it does in a limited and narrow sense, while encouraging other kinds of "Beltway Bandit" corruption based on knowing how to work the system. It has been routine for companies to build systems that don't work, and then to bill for the original work and for fixing it. Or even for failing to fix it, for as long as they can drag the contract out.

      The development work was managed by the Centers for Medicare and Medicaid Services, not directly by HHS and Sebelius.

      Republicans insisted that there could not be a public HHS ACA demo site before enrollments started, so that problems could be found and fixed ahead of time.

      Republicans insisted that no single state could go first, again so that we could have a limited testbed for finding and fixing problems before the national rollout.

      Republicans refused to permit an adequate development and QA budget, so that HHS was not able to organize internal testing.

      Republicans stood in the way of every part of the system, demanding major changes at every opportunity, some of which were accepted, radically changing site requirements.

      SCOTUS killed the state mandate for Medicaid expansion, and Republican governors rushed to refuse it, radically changing site requirements.

      Red states purposefully dithered on setting up their own exchanges before refusing to do so, so that HHS would have as little time as possible to set up the national exchange for them, based on the insurance companies operating in those states.

      Among other problems.

      Several state Exchanges failed far more disastrously than healthcare.gov, notably Oregon and Maryland, both of which were stuck with paper applications. Some have never been fixed at all.

      Miraculously, when the rescue team arrived, they discovered that they did not have to scrap the entire system. It was "almost" working, in a very technical sense of almost. That means that to the users, it was almost completely non-functional, but only because of a moderate number of fixable problems. Enough could be fixed quickly enough to get enrollments back on track. The team triaged those problems, fixing the easiest and most consequential immediately, prioritizing those that could be fixed within the first two months based on importance and on time and other resources needed, and putting the rest on hold. Some were sent back to the original contractors. The lead contractor was replaced.

      The first two groups of problems were solved. HHS and the contractors are still working through the third group. Much of that had to do with communications between backend databases run by HHS and by private insurance companies.

      Many private insurance companies also failed to implement working systems that could accept data from HHS or state exchanges, issue policies, send out bills, or even accept payment. But do you hear Republicans complain about them?

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Sat Apr 12, 2014 at 11:31:32 AM PDT

      [ Parent ]

  •  Wouldn't it be grand if . . . (0+ / 0-)

    . . . . Kathleen Sebelius would return to Kansas and take back the Governorship from the failed Brownback and start rebuilding all the damage he and his TEA Party goons have done to that great State?  

  •  "Wooden" (0+ / 0-)

    I feel bad for Sibelius; I'm sure she's a very nice woman, and she must be competent at some things to have gotten where she is.  But she was the wrong person for this particular job.

    The first "detraction" that appeared in the NYTimes article on her was her disastrous appearance on The Daily Show when  Jon Stewart grilled her on then-current problems (I think it was the "If you like it you can keep it" issue.)  The NYTimes called it "wooden."  I was ABSOLUTELY APPALLED at her performance.  If I remember right, I don't even think Stewart was being fair, but Sibelius was clueless.  I can't believe she would have gone on the show without even preparing an answer to the question that was most certainly going to come up.  I could have thought on my feet better than that.

    She really let the administration down, and after that I had no confidence in her abilities.

    "Nationalism is an infantile disease. It is the measles of mankind." Albert Einstein

    by kelley74ny on Sat Apr 12, 2014 at 10:04:02 AM PDT

  •  With all of the fuss about the numbers (1+ / 0-)
    Recommended by:
    Greg Dworkin

    why does nobody cite brainwrap's ACA Signups Web site, nor his Diary series that I am continuing, in this entire discussion? (BTW, brainwrap has taken the day off, and is at the Detroit Zoo with his kid.)

    Estimated Exchange QHPs as of April 11, 2014: 7.63M

    Estimated Total, all sources: (14.0 M - 34.1 M)

    Individual QHP Range: (7.09M - 15.42M)  •  Medicaid/CHIP (5.23M - 7.29M)

    ESI Range (106K - 8.27M)  •  Sub26ers (1.60M - 3.10M)

    (OFF-Exch. Individual QHPs: 2.07M confirmed; Rand study finds up to 7.8M total)

    (OFF-Exch. Employer-Supplied Ins.: 34K confirmed; Rand study finds up to 8.2M total)

    Back off, man. I'm a logician.—GOPBusters™

    by Mokurai on Sat Apr 12, 2014 at 10:07:54 AM PDT

  •  The NYT wrote an article on Sebelius' (0+ / 0-)

    resignation yesterday and got more than 500 comments, most of them pro Sibelius. It warms my heart that people who read the NYT seemed to understand that she undertook a herculean task despite constant harrassment from repunks and little support from the Obama administration:  http://www.nytimes.com/...

    48forEastAfrica - Donate to Oxfam> "It is better to light a candle than to curse the darkness." Edna St.V. Millay

    by slouching on Sat Apr 12, 2014 at 11:23:45 AM PDT

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