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Life Health > Health Insurance > Health Insurance

On the Third Hand: Inbox

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The Centers for Medicare & Medicaid Services (CMS) says CMS Administrator Marilyn Tavenner messed up her e-mail archiving by being sloppy when she was trying to keep her Microsoft Outlook inbox under the agency’s size limit.

CMS is part of the U.S. Department of Health and Human Services (HHS). Tavenner has been in charge of HHS efforts to implement many parts of the Patient Protection and Affordable care Act (PPACA), including the public exchange system and the enrollment system.

CMS told Rep. Darrell Issa, R-Calif., chairman of the House Oversight & Government Reform Committee, that it might not be able to give him all of the e-mail he wanted because of the inbox cleanup glitch.

See also: HHS: We accidentally deleted some e-mails

On the one hand: Issa has certainly pestered CMS over, and I have fought many brutal battles with Outlook inbox size limits. Inbox size limits are one of the great menaces of our age.

On the other hand: CMS has been so weirdly defensive and secretive about PPACA implementation for so long that it doesn’t seem as if we can believe that it’s made any good faith efforts to keep and provide PPACA implementation information, including the Tavenner e-mails.

Personally, I have no problem with the goals of PPACA or the idea of the government helping to start a public exchange program, if that’s what people want. And, at this point, it’s for me hard to imagine what could be all that interesting in the Secret Archives of the PPACA exchange program information technology development effort.

CMS seems to have responded to Republican efforts to strangle PPACA, by entering the ACA Trauma Zone.

When we enter the ACA Trauma Zone, we call PPACA “the Affordable Care Act.” All criticisms of PPACA and the PPACA public health insurance exchange system are signs of degenerate Republican efforts to be nasty. All IT guy efforts to talk about the technical challenges involved with implementing PPACA seem to be soft and far away, like the murmuring of seagulls on a beach. Because, when we are one with PPACA, and PPACA is one with us, won’t the computers just … work? 

Better to focus on important matters, such as cultural competency in Navajo. Right? 

Well, back in the real world, we know that some of the people who worked on and related systems probably filmed everything and saved the footage for the documentaries they’ll do when they go back to grad school. The documentaries will show the usual combination of blowhards, nice people who needed more direction than they were getting, and competent people who were trying to get some attention, and/or trying to work out disagreements with the blowhards and the other competent people.

In other words, the was probably like most other big projects: Terrible if you look too close.

What makes the project a little different is just how tight CMS has been with information.

The managers of the state-based Nevada exchange post everything you could possibly want to know about their exchange on the Web, and more. There must be conflicts between Democrats and Republicans in Nevada, too, but Nevada posts every board meeting document online, and video of every board meeting online. Somewhere on their website, they must have an archive of every lunch menu they ever used at the board meetings.

CMS took the opposite approach. Just finding out which people were in charge of major PPACA implementation divisions has been a challenge.

The idea that Tavenner “lost” e-mail isn’t surprising. What would be surprising is if she provided all of the information Issa requested.

On the third hand, maybe the whole idea is to distract us with annoying little squabbles over, to distract us from thinking about the space aliens in that underground facility in Nevada, or wherever. In which case: Well played!


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