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Life Health > Health Insurance > Health Insurance

On the Third Hand: Trap

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I think Republicans in Congress (and Democrats, independents and footnote party members who hate the Patient Protection and Affordable Care Act (PPACA)) are putting themselves in their own version of the trap that trapped President Obama.

Obama, who is usually pretty wily about adding disclaimers to what he’s saying, trapped himself by promising over and over again that, “If you like your coverage, you can keep it.”

Especially once the U.S. Department of Health and Human Services (HHS) developed the reglations explaining what it thought the promise meant, Obama should either have knocked heads at HHS or proactively explained the real-world constraints on that promise.

He used a message that probably worked great in focus-group sessions but didn’t accommodate changes in understanding and conditions in the real world.

I think PPACA health insurance exchange program critics are walking into the same trap by hyperventilating over problems, especially technical problems, at and state-based exchange enrollment systems.

On the one hand, the problems at the enrollment sites, and the problems with exchange manager communications, may be a sign of deeper managment problems.

But on the other hand, lots of organizations have problems with getting big information technology projects to work exactly as planned exactly on time. Plenty also have security concerns. HHS should probably send a thank-you note to whoever it is that’s been hacking payment card information at the big department stores lately.

Today, in response to attacks on data security, people who are sympathetic to PPACA can say, “But, yeah, if Target and LinkedIn and all those other sites are vulnerable to crooks, how can you expect to be perfect? We can’t go live in vaults to avoid robbers, and we can’t shut down the Internet because of identity thieves.”

And if, in six months, the enrollment systems and other administrative systems work reasonably well, by new big-government systems standards, then PPACA defenders can point to obsession with exchange program data security as a bunch of hot air.

And, meanwhile, on the third hand: the plans seem to be full of expensive, politically oriented benefits that drive coverage prices into the stratosphere.

Concerns about Web problems that could well be temporary may be distracting everyone away from PPACA exchange plan design problems that might last as long as congressional gridlock lasts, or as long as exchanges let the voices of interest groups drown out the voices of people who would rather pay $100 per month for coverage with a $2 million annual cap and some holes in it than $500 for richer coverage with no annual cap.

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