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ObamaCare clusterfuck opens at midnight on the day of the government shutdown and lambert finds a bug

[And if you have your own experiences to share, and especially screen dumps, please add them in comments or contact me. Either Federal Exchanges, or state exchanges. I'm especially interested in Covered California! Thank you! --lambert]

Nice timing. from Maine had a registration #FAIL at step 3. Here's the screen dump:

Read below the fold...

ObamaCare Clusterfuck: Kayfabe continues, as Republicans fall in line with Democrats against single payer

I mean, come on. You don't think all those Republican votes to abolish ObamaCare meant anything, did you? Red meat for the base, purely. Even if the Democrats lose the Senate in 2014[1], Obama's got the White House 'til 2016, and the veto pen. If the Republicans were serious, they'd have held hearings about the ObamaCare website debacle, and asked -- as we asked -- "What did Obama know, and when did he know it?" And so what hearings are they holding now? That's right: Hearings that show problems in a single payer system. Isn't this all just a little transparent? Read below the fold...

ObamaCare Clusterfuck: If you want to control a Flexian infestation, don't leave food out in the open

From an earlier discussion of Flexians at work and play:

[Janine R.] Wedel's two key concepts [in Shadow Elite] are "flex nets" and "flexians" (I like "flexian" because it sounds like a breed of alien reptiles that I, for one, welcome, except not). I think the strength of the book will come in the examples of actual flex nets, but since I'm not all the way through it, I'll just quote the introduction on the concepts. Page 15 and following.

Beyond old boys

Like interest groups and lobbies, flex nets serve a long-established function in the modern state--negotiating between official and private. But while flex nets incorporate aspects of these and other such groupings, they also differ from them in crucial ways--and those ways are precisely what make flex net less visible and more accountable.

Four key features define both flexians as individuals and those influencers who work together as a flex net. Flexians functioning on their own exhibit the modus operandi embodied in all four features discussed below, as does a flex net as a whole. Because members of a flex net benefit from the actions of the collective, pooling resources and dividing labor, not all members of the flex net must exhibit these features individually.

Before getting to the four features (below), a pause to note that Flex Nets/Flexians arguably subsume/supersede notions like corruption, "money in politics," "the revolving door," and so forth. (Nancy DiParle is, I think, the candidate for Flexianhood we might be most familiar with: Wellstone VP -> Baucus CoS -> White House -> Big Pharma, leaving a trail of ruin and destruction, if you're a citizen or a patient, that is. We'd need to know more about her network, though).

And the four features:

[#1] Member of a flex net... form an exclusive informal network that serves as an intricate spine -- the corresponding (first) feature of flex nets. Flex nets draw their membership from a limited circle of player who interact with each other in multiple roles over time, both inside and outside government, to achieve mutual goals. While their roles and environments change, the group provides continuity. .... Members of what I call the Neocon core, an informal group of a dozen or so members and a successful flex net, have worked with each other in various incarnations for some thirty years to realize their golas for American foreign policy via the assertion of military power...

When such influencers work together in a flex net, they [#2] exhibit shared conviction and action -- the corresponding second feature of flex nets. ... Members of a flex net act as a continuous, self-propelling unit to achieve objectives that are grounded in their common worldview, and to brand that view to the public.

The corollary to flexians' juggling roles and representations is that [#3] members of a flex next form a resource pool -- the corresponding third feature of a flex net. The influence of a flex net derives in part from its members' effort to amass and coordinate both material and interpersonal resources. ... The Neocon core, for instance, is an example of how a ready-made network of players with its own private agendas can straddle a state-private seesaw...

Collectively, [#4] members of a flex net help create a hybrid habitat --- their corresponding fourth feature. A flex net's strength lies in it coordinated ability to reorganize governing processes and bureaucracies to suit the group's purposes.... As flex nets infuse governing with their supple, personalized, private-official networks, they transmogrify their environment, whether temporarily or more lastingly. While these groups might call to mind old notions such as conflict of interest, they illustrate why such labels no longer suffice. As a Washington observer sympathetic to the neo-conservatives aims told me, "There is no conflict of interest, because they define the interest." ....

(The key to spotting a Flexian, it seems, is to watch for the way they blur public and private and create a hybrid habitat; that what makes their Flex Nets different from the kind of personal network one sees on LinkedIn. It feels to me like spotting a Flex Net is a research project; I welcome suggestions from readers on how to do it, because I don't see how, right away.)

The excellent Health Care Renewal shows Flexians in transition , listing Robert Gibbs (Obama's former press secretary -> "consultant"), Daniel Fabricant (FDA -> dietary supplement shill), Brendan Buck (House Speaker John Boehner’s spokesman -> AHIP), and Rachel Sherman (FDA -> drug consulant). Note that, as good Flexians, these people will all return to "public service" at some future date, even if we can never be quite sure which public they serve. HCR summarizes: Read below the fold...

ObamaCare Clustefuck: Be sure to record any conversations you have with your insurance company


In their complaint filed in California state court on Wednesday, San Francisco residents John Harrington and Alex Talon accused Blue Shield of misrepresenting that their plans, sold on California's health exchange, would cover the full provider network advertised on the company's website.

They sued on behalf of a class of people who had purchased so-called "preferred provider organization" plans from the insurer only to realize that the doctor and hospital networks for their plans were limited.

Harrington bought a so-called silver plan on California's online exchange while Talon bought a platinum plan through the insurer's website. They said they made their choices based on Blue Shield's alleged representations that their doctors would be covered.

After receiving medical treatment numerous times between January and March, Harrington and Talon later discovered that their providers were not covered, forcing them to pay the charges out-of-pocket, the complaint said.

So, it's not just the narrow networks, it's that the insurers conceal how narrow the networks really are.

And: Read below the fold...

ObamaCare Clusterfuck: Medicare doesn't need a "CEO" because it's a simple, rugged, and effective single payer system, not an insanely complex Rube Goldberg device

Get a load of this from Reuters:

Exclusive: Obama allies revive push for Obamacare CEO

Aside from the obvious "jobs for the boiz" aspect:

A group of healthcare experts close to the White House is urging the Obama administration to appoint a new chief executive officer to oversee Obamacare's online health insurance exchanges and safeguard the next open enrollment period that begins in six months.

The recommendation, in a report due to be released by the Washington-based Center for American Progress think tank, calls for a major shakeup within the U.S. Department of Health and Human Services, which presided over last year's disastrous rollout of the federal market portal,

The idea would be to take the exchanges out of the current bureaucracy and put them in the hands of a CEO with private-sector experience who could run them as true e-commerce sites. The CEO would answer only to President Barack Obama and his intended new health secretary, Sylvia Mathews Burwell.[1]

So, the so-called "progressive" Center for American Progress is fully on board with the neo-gliberal idea that "government should be run like a business,"[2] eh? Market state, here we come! Read below the fold...

ObamaCare Clusterfuck: Sylvia Burwell, Obama's HHS nominee, pleases Republicans by ruling out single payer


U.S. Health Secretary-nominee Sylvia Mathews Burwell sought to allay a major Republican worry about Obamacare on Thursday, telling lawmakers that President Barack Obama's reforms would not lead to a government-run single-payer healthcare system on her watch.

Her assurance against an approach reviled by Republicans and industry leaders came during a two-hour Senate confirmation hearing at which Burwell received an important endorsement from Republican Senator Richard Burr of North Carolina. Burr sits on the Senate Finance Committee, which will decide whether to send her nomination to the floor for a final vote. ...

Republican Senator Pat Roberts of Kansas asked Burwell if such a move was her "endgame," citing top Democrats, including Senate Majority Leader Harry Reid, as having endorsed the idea.

Burwell reminded Roberts that the centerpiece of Obamacare is a private market-based insurance system of state-based health insurance exchanges.

Rememember all the career "progressives" telling us "We love single payer, but ______." Well, here we are. Republicans and Democrats are agreed that insurance parasites are necessary for health of their host! Read below the fold...

ObamaCare Clusterfuck: "Medical homelessness" in California

KPIX (CBS local) in San Francisco:

While open enrollment for coverage under the Affordable Care Act is closed, many of the newly insured are finding they can’t find doctors, landing them into a state described as “medical homelessness.”

Rotacare, a free clinic for the uninsured in Mountain View, is dealing with the problem firsthand.

Mirella Nguyen works at the clinic said staffers dutifully helped uninsured clients sign up for Obamacare[1] so they would no longer need the free clinic.

But months later, the clinic’s former patients are coming back to the clinic begging for help. “They’re coming back to us now and saying I can’t find a doctor, “said Nguyen.

Thinn Ong was thrilled to qualify for a subsidy on the health care exchange. She is paying $200 a month in premiums. But the single mother of two is asking, what for?

“Yeah, I sign it. I got it. But where’s my doctor? Who’s my doctor? I don’t know,” said a frustrated Ong.

Nguyen said the newly insured patients checked the physicians’ lists they were provided and were told they weren’t accepting new patients or they did not participate in the plan.

Now, to be fair, "many" is not a number. But since when have we gotten good numbers on ObamCare from the administration? And since California is a Democratic state, top to bottom, we're not likely to get any good numbers from Covered California, either. Read below the fold...

ObamaCare Clusterfuck: You won't be able to buy insurance year-round any more

Missed this from early April:

Many people who didn’t sign up during the government’s open enrollment period that ended Monday will soon find it difficult or impossible to get insured this year, even if they go directly to a private company and money is no object. For some it’s already too late.

With limited exceptions, insurers are refusing to sell to individuals after the enrollment period for and the state marketplaces. They will lock out the young and healthy as well as the sick or injured. Those who want to switch plans also are affected. The next wide-open chance to enroll comes in November for coverage in 2015.

It’s a little-noted consequence of President Barack Obama’s health care overhaul, which requires nearly all Americans to be insured or pay a fine and requires insurers to accept people with health problems.

Why? Adverse selection: Read below the fold...

ObamaCare Clusterfuck: People can't find coverage that include their doctors or their drugs on the Exchange. Could that account for their unhappiness?

First, the user experience:

[T]he hunt for a health plan that would cover a particular drug or a favorite doctor proved particularly frustrating for many consumers navigating the new insurance exchanges under the federal government's health care overhaul, according to a report released Monday.

In nearly half the 85 health plans analyzed, it was difficult or impossible for people to determine what drugs were covered, according to the report by market research firm Avalere Health, the first systematic analysis of consumer experience on the exchanges.

The report analyzed health plans in five states that relied on the federal website, as well as state-run exchange plans in Washington, D.C., and a dozen states.

A directory of doctors was somewhat easier to find, but there were still some cases in which it was a very demanding search, the report found.

What's more, the websites typically ranked plans by premium price, which could have misled patients who needed a specific costly medication if it wasn't covered by the cheapest plan, Avalere spokeswoman Caroline Pearson said.

"It was very difficult for consumers to get a more nuanced view of what their plans covered," Pearson said. In some cases, a consumer would have to click six times to find drug coverage information. Even worse, no links to lists of covered drugs existed for some health plans.

That forced consumers to search insurance company websites, and, even if they found the covered drug lists, it could be tough to determine which lists went with the exchange plans they were comparing, Pearson said [and that's before we get to generics vs. brands].

"Many chronic conditions rely on medications for management and to keep people out of the hospital," Pearson said. "If your drug is not covered, then you're responsible for the full cost or you have to switch to a different drug. The impact on the patient could be several thousands of dollars a year." ...

"None of the sites has done a good job helping consumers compare out-of-pocket costs," [Robert Krughoff, president of Consumers' Checkbook] said. "That results in consumers wasting thousands of dollars a year."

And now the user reaction: Read below the fold...

ObamaCare clusterfuck: Engineers, then and now

Here's the story of how one engineer made sure the United States chose the right engineering strategy for the Apollo moon landing project:

[John C. Houbolt's] efforts in the early 1960s are largely credited with convincing NASA to focus on the launch of a module carrying a crew from lunar orbit, rather than a rocket from earth or a space craft while orbiting the planet.

Houbolt argued that a lunar orbit rendezvous, or lor, would not only be less mechanically and financially onerous than building a huge rocket to take man to the moon or launching a craft while orbiting the earth, but lor was the only option to meet President John F. Kennedy’s challenge before the end of the decade.

NASA describes “the bold step of skipping proper channels” that Houbolt took by pushing the issue in a private letter in 1961 to an incoming administrator.

“Do we want to go to the moon or not?” Houbolt asks. “... why is a much less grandiose scheme involving rendezvous ostracized or put on the defensive? I fully realize that contacting you in this manner is somewhat unorthodox, but the issues at stake are crucial enough to us all that an unusual course is warranted.”

So, fast forward to ObamaCare. Read below the fold...

ObamaCare Clusterfuck: If you've got leukemia and good coverage, wait, and your policy will hit the lowest common denominator

An interesting paper from Millman, Inc (a provider of actuarial services):

2014 Individual Exchange Policies in Four States: An Early Look for Patients with Blood Cancer
The ACA rules do permit variation among exchange plans, and these variations can be significant for services important to people with blood cancer.

This variation among plans is high in the initial 2014 exchange launch, but the authors believe it may diminish in future years as competing insurers converge toward lower-cost and more restrictive features.

So if you like your plan, you won't be able to keep it. Read below the fold...

ObamaCare Clusterfuck: About the 8 million

(Wonkblog has improved since Ezra Klein went elsewhere, interestingly.) WaPo:

Last summer, the administration had hoped that 40 percent of exchange enrollees would be between 18 and 34, based on the Congressional Budget Office's estimates that 7 million people in all would enroll in 2014. Instead, the administration got 28 percent, which the White House and supporters very eagerly pointed out Thursday was nearly identical to youth enrollment in the first year of the Massachusetts health-care law that Obamacare was based on. ...*

The 2014 enrollment stories aren't over, however. We're still waiting to find out at least the following: How many purchased coverage off the exchanges, how many paid their premiums, what kind of coverage they purchased, how many joined Medicaid because of the expansion and more.

Yep. Read below the fold...

ObamaCare: ObamaCare's mental health coverage

One of ObamaCare's features not often touted is that mental health coverage is one of the essential benefits. Unfortunately, mental health coverage has all of ObamaCare's other coverage problem, except moreso. About the benefits:

Long-awaited improvements in insurance coverage for mental conditions and addictions are expected to become more widely available this year as a result of two major steps that the Obama administration has taken.

The president’s signature Affordable Care Act includes mental health care and substance abuse treatment among its 10 “essential” benefits, which means plans sold on the public health care exchanges must include coverage.

In addition, rules to fully carry out an older law — the Mental Health Parity and Addiction Equity Act of 2008 — were issued in November, after a long delay. The parity law says that when health insurance plans provide coverage for mental ailments, it must be comparable to coverage for physical ailments. For instance, plans cannot set higher deductibles or charge higher co-payments for mental health visits than for medical visits, and cannot set more restrictive limits on the number of visits allowed.

So far, so good. So, knowing what we know about ObamaCare, what would be the first question to ask? Read below the fold...

ObamaCare Clusterfuck: Democrat hack Joan Walsh makes Ezra Klein look like a paragon of integrity

It wasn't easy! Yeah, I subscribe to Salon's news feed, so every once in awhile I hold my nose and click through to Joan Walsh, "progressive":

Ezra Klein trolled the right by declaring that it means “Obamacare has won,” which is pretty funny given that he helped lead the national freak-out over’s troubles back in October.

Read below the fold...


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