The White House celebrated enrollment results at the new public health insurance exchange system recently with a press conference and a “fact sheet.”
Not some dry, standardized, respectable-looking report that may or may not have given complete, honest numbers but one that at least humored me by pretending to give me complete, honest numbers. A fact sheet with the kinds of bullet points a bright elementary school pupil might put in a one-page PowerPoint presentation if asked to do so for a class assignment.
The White House said “8 million people have signed up for private insurance in the health insurance marketplace,” or exchange system, but didn’t even really clarify whether it meant those people have just chosen coverage or actually paid for it, or whether those people got covered by, say, yesterday, or some other date.
So, not only was the White House spinning the data, the spin was the data. There was nothing inside the spin but a bunch of question marks.
Honestly: I want the Patient Protection and Affordable Care Act (PPACA) exchange program and the qualified health plan (QHP) system to work because I can easily imagine needing it someday, and the basic concept doesn’t seem to even be particularly partisan.
Private health insurers might have created a risk-allocation system to help themselves sell coverage on a guaranteed-issue, community-rated basis years ago, if they had the legal authority to do such a thing.
So, seriously: On the one hand, I have nothing at all against the exchange concept or the QHP concept.
On the other hand: Then you start thinking about the specifics.
Many health insurance exchanges have died over the years because managers had problems with the specifics, and antiselection led to death spirals.
My wild guess is that the managers with better results will be the ones who know what they’re doing.
To me, data are one sign that managers of something know what they’re doing.
If an organization can produce a clear, steady, consistent stream of information about itself, in bad times as well as good times, that’s a sign it understands what information is interesting, knows how to collect and report the information, and has the managerial confidence to post the ugly numbers as well as the pretty numbers.
Even if, later, I learn that the managers cooked the numbers, well, at least they knew what the numbers should look like. That’s something.
Some state-based exchanges post information about themselves to the point that even I think maybe they’re over-sharing a little. I think that, in the long run, those are the exchanges that are going to muddle through the turmoil and come out on top.
The U.S. Department of Health and Human Services (HHS) has not been putting out enough information about the parts of the exchange system it runs or supervises to show that it knows what nice reports would look like even if it could simply ask a genie to make the exchanges work well and cause beautiful reports to appear in the printer tray.
On the third hand: HHS officials might say they have to use this strategy because the Republicans in Congress are very mean.
On the fourth hand: OK, maybe that’s true, but I think exchange enrollment is the very, very easiest part of all of this. There’s nothing inherently partisan or controversial about getting a website to work.
When the QHP issuers, the patients and the providers are fighting over whether a plan has enough cardiologists in the right places, that’s a hard part.
When the insurers are fighting over the money in the PPACA “3 R’s” risk-management program, that’s a really, really, hard part.
If HHS and the Obama administration have to hide behind bullet point fact sheets today, what are they going to hide behind about 18 months from now when they have to explain who’s getting risk corridors money and who’s not getting it? Pictures of kittens playing with yarn?