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Life Health > Health Insurance > Health Insurance

On the Third Hand: Notebook

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President Obama seems to have a number of new advisors, and it looks as if they’re telling him to get out more and be friendlier to reporters.

I hope they also tell him to get someone from the National Weather Service to develop a simple, easy-to-update “weather chart” for the enrollment system, and to update the chart every day.

Maybe also copy the public meeting system like the California or the Nevada exchanges use.

Instead of having a big, formal, scary teleconference every month just to unveil a massive collection of enrollment statistics, and make lots of vague, cheerful statements about how well Patient Protection and Affordable Care Act implementation is going, have various department managers talk about what’s actually going well and what’s going right. 

PPACA supporters tend to talk about the law as if it’s the work of God, and opponents as if it’s the work of Satan, but, realistically, it’s an experiment. It’s an awkward test of an idea that everyone’s talked about for ages — What if we had a system that made buying health insurance more like buying airplane tickets online? What would that do?

The PPACA exchange program is as complicated as it is partly because it was designed, in part, by a bunch of impractical dreamers who’ve barely ever bought their own individual health insurance in their lives, let alone sold or underwritten any or spent much time at GoHealth or But it’s also as complicated as it is partly because it’s a lot harder to deal with concerns about fairness and adverse selection in a health insurance exchange than in an airplane ticket exchange, or an online bookstore.

The exchange program is an experiment.

One of the most important aspects of doing an experiment is that you have to have a good, honest lab notebook. You have to record what’s going on as well as you can, without thinking about whether the numbers agree with what you expected, and report the numbers and any complications and suspected or detected sources of error as well as you can.

Results that get you wherever it is you want to go are nice, but dead-ends are just as important. 

When the Obama administration tries to turn PPACA implementation into a top-secret project, then it makes the House Oversight and Government Reform Committee staff members look like heroes when they can find out what the PPACA implementers’ letterhead stationery looks like. One suspects that, any day now, we’ll see reporters getting good play with revelations about which type of K-cup coffee is selling the best in the development team break room.

But, in addition to turning the smallest detail about the development process into Pulitzer Prize bait, the excessive secrecy reduces the odds that anyone will learn anything more sophisticated from the process than, “Don’t do that!”

Of course, PPACA costs a lot of money, and it would be nice if it provides everyone fine, affordable insurance while creating jobs and bringing joy to the faces of small children.

On the other hand, it might collapse in a giant puff of binary cloud smoke and leave an infinitely dense black hole of vendor lawsuits and countersuits rotating furiously where the Data Hub used to be.

On the third hand, whether the exchange system works or not, it would be great if we could all be open, honest and reasonably open-minded about what’s happening with implementation, to help give the designers of future public and private exchanges ideas about what to do and what not to do. 

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