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[ NNSquad ] Night of the (Obamacare) Demons

                       Night of the (Obamacare) Demons


To be clear at the outset, I strongly support the objectives of the
Affordable Care Act (ACA - "Obamacare") especially in terms of the
goals of stopping long-standing insurance company practices of
refusing to insure persons who weren't completely healthy -- and
dropping them as soon as they became ill.

The lack of any kind of universal health care coverage here in the USA
not only makes us essentially unique among developed countries, but a
laughingstock of the planet. If you're rolling in dough, the US may
have the claimed "best health care system in the world" -- but only by
leaving vast numbers of persons behind and runaway costs that keep the
lucky practitioners of the medical-industrial complex happily shopping
at the local equivalents of Rodeo Drive in Beverly Hills.

Drug costs here are often obscenely more expensive than in the rest of
the world, to a degree that seems no less than criminal.  Lack of
routine health care means that people don't get help until they're so
sick they are often beyond help, and hospitals rake it in at emergency
rooms and stick every taxpayer with the cost of uncovered persons who
couldn't pull a wad of Franklins out of their pockets while being
wheeled in.

The US health care and medical insurance system has become a bloated,
middleman-laden nightmare.

The right way to fix this, of course, would have been with a
single-payer system of some sort, as used in most of the world.  Not
perfect by any means, but the results speak for themselves when you
see how far down the ladder the US is in terms of most health care
outcomes compared with other countries (we pretty much rate as a
third-world nation in key respects in this context).

But single-payer would likely cut out the insurance companies, who
have paid their politicos the big bucks for many decades to make sure
they remained entrenched.  And naturally, single-payer would also
trigger calls of SOCIALISM -- you know, like, uh, Medicare.

So we find ourselves now in the cusp of ACA -- a plan that seems to
have been designed to encompass both lofty goals and the most abysmal
details and implementations pretty much imaginable.

There are so many reasons for this mess, and so many people to blame,
that I won't even try to get deep into this aspect.

But we know that the GOP and their masters in the "We gotta stop that
uppity black Kenya guy claiming to be president" Tea Party Confederacy
("duh South will rise agin'!") did everything they could to stop,
repeal, damage, thwart, and otherwise spit on ACA and all the people
it could have helped.  GOP governors made sure they waited until the
last minute to officially proclaim that they were going to screw their
own states' citizens by dumping them onto the federal insurance
exchange, while related rules and regulation kept morphing and piling
up until the last minute, making implementation a continuously moving

To be sure, we can't blame the GOP and their monstrous allies for the
entire situation.  Democrats -- as usual -- didn't have the backbone
to push for the changes really needed -- like single payer.  And their
pockets have also been lined with insurance company moolah pretty much
forever as well.

Federal procurement policies, seemingly written in such a way as to
make the probability of any large information technology project
failing horribly as lofty as possible, have done it yet again this
time as well, making the federal ACA site a predictable disaster from
the word go -- in terms of design, load, performance, security, and ...
well, you know the drill.  I've been working with IT one way or
another my entire adult life. I've never seen such a godawful mess
before. And I've seen some pretty impressive messes.

But even many related non-governmental sites are currently hosed.  You
can't get into the websites of many major insurance carriers today --
they're so badly designed and overloaded, often saturated with
elementary coding and interface errors.  Redirects lead nowhere.
Single pages try to serve three megabytes of text, grinding browsers
into the dust.  It goes on and on.

And since I'm concentrating on mostly technical issues here -- which
in theory can and will be fixed eventually -- I will but mention in
passing the utterly confusing and panic-inducing framework of policy
and fee changes associated with ACA, enough to make many individual
insurance buyers who don't get insurance from employers more likely to
have a stroke on the spot than anything else.

Ironically, it is possible that if all this were working right, the
actual benefits of standard plans and premium subsidies would put many
people in a better position than they were pre-ACA, no doubt about it.
But the reality for now is that the entire system is largely in
extreme disarray, and even after the reported nearly half a billion
lines of code are working more or less properly, some people are still
going to be royally burned by the insurance companies who managed to
keep themselves firmly in the catbird seat under the new regime.

Some of the best technical minds on Earth have now converged to try
get the federal ACA website working by the end of this month --
they'll likely succeed in some significant measures at least.

But the sense of utter and total confusion among persons most affected
by these changes is palpable, and when you combine this with the
currently mandated penalty regimes for not having insurance and all
the other complicating factors, the possibility of a technical and
policy implosion of a magnitude never before seen in US government
history seems very real.

And here's the worst part.  There's really comparatively little that
can be done right now to avoid potential disaster that isn't already
being done.  The die is cast.  Supercilious "eat the poor" monsters
like Ted Cruz have performed with their usual hideousness in
furtherance of their hopes that all we "little people" go splat
against the wall at lightspeed.

Yet hope springs eternal, even in the face of these kinds of obstacles
and odds.  The websites will be fixed eventually -- to some level of
practical usability anyway -- and continuing pressures may force
delays and changes in a variety of associated rules and regulations.

And one thing -- a very positive aspect at that -- is utterly clear
amid this Kafkaesque landscape.

There is no going back to where we were.  The days of insurance
companies dropping the sick and only being willing insure the healthy
are gone in this country forever.

There is thankfully no return possible to that particular inner circle
of hell, and even if the best we can do in the short term with ACA is
push out a few notches to less punishing circles we'll still have the
last laugh against the evil players who wish to drag us back into that

Who knows?  In the long run, we may even escape insurance hell
entirely, and prove that our legislators care as much about the people
of the USA as they do global geopolitics and caviar.

But don't hold your breath.

Lauren Weinstein (lauren@vortex.com): http://www.vortex.com/lauren 
Co-Founder: People For Internet Responsibility: http://www.pfir.org/pfir-info
 - Network Neutrality Squad: http://www.nnsquad.org 
 - PRIVACY Forum: http://www.vortex.com/privacy-info
Member: ACM Committee on Computers and Public Policy
Lauren's Blog: http://lauren.vortex.com
Google+: http://google.com/+LaurenWeinstein 
Twitter: http://twitter.com/laurenweinstein
Tel: +1 (818) 225-2800 / Skype: vortex.com
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