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On the Third Hand: Scripts

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To me, what’s most hilarious about the new public health insurance exchanges’ lack of respect for how much it costs to get people into health insurance plans is that it shows that the exchange runners’ aren’t too big on risk management.

The exchanges wanted to pay agents about $50 per qualified health plan (QHP) enrollee. Agents suggested that $200 to $300 might be a realistic minimum. 

In the real world, the most efficient, gungho, volunteer-run operations seem to be spending at least $80 per QHP enrollee head, typical enrollers are spending a few hundred per head, and some enrollers are averaging thousands of dollars in grant money per head.

Of course, the exchange managers tell healthy young consumers that they need QHP insurance because something could go terribly wrong.

The young invincibles could go snowboarding down a black diamond trail and, somehow, mysteriously, find that the ground is in the way and causes a leg to break.

But the exchange managers seemed to base their open enrollment plans, and enrollment budgets, on the idea that they could just read from a script about how wonderful the Patient Protection and Affordable Care Act (PPACA), the PPACA marketplace system, and the QHPs, are, and enrollment websites would populate consumers into the plans licketty split, because the little people inside the Internet pipes would see how great and noble the marketplaces and QHPs were and force the computers to behave themselves.

An operational guide for the PPACA exchanges run by the U.S. Department of Health and Human Services included just one paragraph about what would happen if the magical Internet fairies didn’t lead exchange systems to work properly.

On the one hand: The truth is that I’m a wild optimist who believes that every new day will be better than every day I’ve ever had before, that every new restaurant will serve better food than the last one, and that every article I write will flow smoothly out of my fingers into the computer.

But, on the other hand: Realistic optimists have to recognize that things actually do go wrong a lot of the time, and that the only way to live a sensible optimistic life is to honor and obey Murphy and His Law; to know that anything that something can go wrong will go wrong; and to assume that everything will take twice as long, cost twice as much and involve twice as many hassles as expected.

The whole reason to have health insurance is to be prepared (just in case) the mountain isn’t quite as smooth as you’d expected.

The whole reason for consumers to get help from live humans with enrolling in and using health insurance is because, let’s face it, a lot of time the enrollment and claim submission processes don’t stick to the Happy-Happy-Joy-Joy script. Sometimes, everything’s a mess. Maybe your live human has met the insurer’s live humans and has some mysterious back-channel way to fix things.

The reason for the  exchanges, to make an effort to be polite to creative, bull-headed, commission-earning, nonchain-of-command-worshipping, bureaucracy-piercing live human agents and brokers is because, as much as they loathe those obnoxious, script-ignoring, independent live humans, and loathe paying (or having QHP issuers pay) those obnoxious live humans, when the scripted processes break down, the exchanges need those obnoxious live humans to figure some alternative to the scripted processes.

In PPACA World, the exchanges need agents and brokers to insure themselves against the possibility that something could go wrong in PPACA World.

On the third hand, the bright side is that maybe producers who could have made a little money earning QHP sales commissions, if the exchanges had been nice, can now make a lot of money by promoting themselves as “PPACA exchange business interruption emergency backup services” vendors.

Now, (some) exchange managers may have come to the conclusions that mountains (and exchange IT system problems) can pop up in the craziest places. 

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