Inside the Nightmare Launch of HealthCare.Gov - "Unknown to a nation following the fiasco, McDonough's assignment from the President had boiled down to something more dire than how to fix the site. As the chief of staff remembers his mission, it was 'Can it be patched and improved to work, or does it need to be scrapped to start over? He wanted to know if this thing is salvageable.' Yes, on Oct. 17, the President was thinking of scrapping the whole thing and starting over." (previously) [more inside]
I signed up for an account on Healthcare.gov last week. It wasn’t the smoothest process, but I was able to create an account. Some parts are slow; sometimes you have to reload a page to make progress. But it’s starting to work. It will be fixed, because it has to be. And now that the launch and inevitable crash has finally happened, in a way the worst is over. Real-world traffic is providing programmers all the debugging data that they could ever want, and “all bugs are shallow with the president watching,” as Paul Ford writes in Bloomberg Businessweek, paraphrasing the open-source-software advocate Eric Raymond’s assertion that “with enough eyeballs, all bugs are shallow.” -- Rusty Foster in The New Yorker
Happy Political Clusterf*ck Day (U.S.)! In one corner: the first federal government shutdown since 1996, born of the House GOP/Tea Party faction's crusade to delay, defund, and destroy Obamacare (and the Democratic Senate and President's resolve to not do that). "Continuing resolutions" have ping-ponged between the two houses, fighting over language to cancel healthcare reform (plus a few other items, such as the implementation of Mitt Romney's entire economic agenda). National parks are closed, contractors are hamstrung, and 800,000 federal workers furloughed until Speaker Boehner drops the "Hastert Rule" and passes a bill the other branches can agree to. In the other corner, heedless of the chaos (though not without glitches of its own): the official rollout of the Affordable Care Act and its state insurance exchanges. The portal at Healthcare.gov is your one-stop shop for browsing, comparing, and purchasing standardized, regulated insurance coverage with premium rebates, guaranteed coverage, and expanded Medicaid for the poor (in some states). A crazy day, overall -- but peanuts compared to what might happen if the debt ceiling is breached in 16 days. [more inside]
A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare. The man is impressed. "This beats Obamacare I hope," he mutters to one of the workers. “Do I burst his bubble?” wonders Reina Diaz-Dempsey, overseeing the operation. She doesn't. If he signs up, it's a win-win, whether he knows he's been ensnared by Obamacare or not.
In less than an hour, the Supreme Court will hand down its final judgment in what has become one of the most crucial legal battles of our time: the constitutionality of President Obama's landmark health care reform law. The product of a strict party line vote following a
year century of debate, disinformation, and tense legislative wrangling, the Affordable Care Act would (among other popular reforms) require all Americans to buy insurance coverage by 2014, broadening the risk pool for the benefit of those with pre-existing conditions.
The fate of this "individual mandate," bitterly opposed by Republicans despite its similarity to past plans touted by conservatives (including presidential contender Mitt Romney) is the central question facing the justices today. If the conservative majority takes the dramatic step of striking down the mandate, the law will be toothless, and in danger of wholesale reversal, rendering millions uninsured, dealing a crippling blow to the president's re-election hopes, and possibly endangering the federal regulatory state.
But despite the pessimism of bettors, some believe the Court will demur, wary of damaging its already-fragile reputation with another partisan 5-4 decision. But those who know don't talk, and those who talk don't know. Watch the SCOTUSblog liveblog for updates, Q&A, and analysis as the truth finally comes out shortly after 10 a.m. EST.
With the constitutionality of the Affordable Care Act being argued in lower courts, it's probably also worth looking at Vermont's adoption of single-payer health care: "On May 26, Gov. Peter Shumlin of Vermont is expected to sign legislation that will create universal coverage in the state—eventually. Vermont will use subsidies from the Affordable Care Act to help create a Canada-style system. And its system, or so the theory goes, will become so popular and cheap that the rest of America will want to copy it." [more inside]
Dirty Medicine — How medical supply behemoths stick it to the little guy, making America’s health care system more dangerous and expensive. [more inside]
What US Health Care Needs Medical doctor and writer Atul Gawande gave the commencement address recently at Stanford's School of Medicine. In it he lays out very precisely and in a nonpartisan way what is wrong with the institution of medical care in the US — why it is both so expensive and so ineffective at delivering quality care uniformly across the board. (via)
Atul Gawande offers a way for health care to be improved through experimentation and pilot programs, much as agriculture was in 20th century
What kind of health insurance would you have as a federal government employee? The Office of Personnel Management would like to help you decide among the gazillion plan choices you have. Perhaps you are a Congress member? Then head on down to the Attending Physician of the United States, "It's one of the, quote, benefits of being in Congress," Kagen said. "They have physicians and nurses that will see you on the spot, on the beck and call." (link to single page print version). [more inside]
Healthcare reform has agitated right-wing extremists and moneyed interests in the United States for some time — during the presidencies of FDR and Truman as well as Clinton and Obama, most recently — but where do the objections originate from, and particularly those which are known to be based on complete untruths? Some of these lies start with or are repeated by well-known right-wing media personalities, but there are other people who get the ball rolling, who are perhaps less well-known. Elizabeth "Betsy" McCaughey originated one of the current myths more commonly known as "death panels", but despite her attempts to market herself as a folksy voice fighting for the well-being of senior citizens, she has been an effective advocate for the interests of private health insurance companies since the early 1990s. [more inside]
How American Health Care Killed My Father After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem. (via mr) [more inside]
Search for an Rx - We asked Johns Hopkins administrators, physicians, and researchers about the health of a system Americans rely on to keep them healthy. Afterall, an ounce of prevention... [more inside]
Political Fratricide: The GOP is reportedly [+] proposing $15 billion of cuts — or is it $25? — in veterans' benefits between now and 2007, and groups like the Veterans Against the Iraq War are hopping mad. Hell, I imagine the pro-war wing is pretty peeved, too. It's part of a plan with delusions of grandeur to deliver massive tax cuts AND kill the deficit ... you know, the one that did not exist before W was elected, as I understand it ... in six years. The original tip is from Stand Down. The actual status of the cuts is nebulous at this point, however, with the SF Chron reporting that they will likely fail in the Senate as the tax cut is halved and others reporting that the die is not yet cast. The House budget resolution, for metafilter accountants who like these things, is here.
You're the king of a small african nation. You have an annual health budget of $15 million. Two-thirds of the people in your nation are HIV positive, and two-thirds are living below the poverty line. What do you do? Why, you buy a $31 million private jet, of course!