The grim truth is that I have no special access to anything or anyone and am shy, to boot.
I have no way of knowing what really goes on at the Center for Consumer Information and Insurance Oversight, the Centers for Medicare & Medicaid Services or the U.S. Department of Health and Human Services.
I feel a little bit like a high-class insider just for knowing what CCIIO is, and that some people pronounce the acronym “Sih-Sigh-O.”
So, on the one hand, I have no idea what it’s really like to work for Gary Cohen, the CCIIO director who is leaving his post voluntarily March 31, as his boss announced in an email to CMS employees.
I don’t know what that boss, Marilyn Tavenner, or Kathleen Sebelius, is really like in private, either.
But, on the other hand, just going by how they acted during congressional hearings: I think their testimonies support the idea that free markets are a great promoter of honesty.
Maybe, in the real, private world, Cohen, Tavenner and Sebelius are all extremely nice, honest, effective people.
During the hearings, it seemed as if they embodied the concept that closeness to the customer — to the nervous, grouchy human being who causes Demand to hesitantly hand money to Supply — breeds openness.
Sebelius has always seemed to be speaking with the implicit message, You know I can’t go off my talking points with you. What’s your problem?
Tavenner seemed to recite the talking points as if she really believed them herself.
Cohen seemed to do as much as he could to push the boundaries of the talking point and share as much of the truth as HHS and CMS would allow. He was positive about the performance of the Patient Protection and Affordable Care Act exchange system in September — but at least he tried to warn Congress and others that the exchange program might start more slowly than expected.
To me, it seems as if both the brokers and the various in-person assisters trying to help actual consumers use actual exchanges also embody that principle.
Wonks at the conservative think tanks tend to say intelligent, abstract things about the exchanges and how the exchanges will eat our children.
Wonks at the liberal think tanks tend to say intelligent, warm, anecdotal things about how the exchanges have helped every moderate-income grandmother who has ever knitted a sweater could get the affordable health coverage she needed to treat the chronic carpal tunnel she has from knitting all of those fine sweaters.
The insurance company executives mostly just keep their mouths shut.
Brokers may be skeptical about the nonprofit types of exchange helpers, but the mere act of helping seems to push at least some of the nonprofit helpers toward the broker level of openness.
In Nevada, for example, the state-based exchange there has started posting letters both from brokers and nonprofit helpers about concrete problems they are seeing with the coverage application process and the operations of the plans.
The Web-based brokers also are starting to report some data about what’s really happening with health coverage sales.
On the third hand, maybe shutting brokers and other insurance sales people and enrollment helpers down is good for us. Maybe all of that honesty will just force us to think about problems no one with clout is actually going to try to solve…