The Obamacare Stumble

I am Hal’s complete lack of surprise:

By the end of this week, states must decide whether they will build a health-insurance exchange or leave the task to the federal government. The question is, with as many as 17 states expected to leave it to the feds, can the Obama administration handle the workload.

“These are systems that typically take two or three years to build,” says Kevin Walsh, managing director of insurance exchange services at Xerox. “The last time I looked at the calendar, that’s not what we’re working with.”

These marketplaces often get described as a Travelocity or Expedia for health benefits. While that might be the case for the consumer experience, experts say the underlying technology is hugely more complex, a maze of interconnecting computer systems meant to deliver health insurance to 30 million Americans.

“The reality is, states and the federal government are building something new,” says Pat Howard, who runs state health issues for consulting firm Deloitte. “There’s a rough blueprint in terms of federal regulations, but there’s still a number of decisions that need to happen to operationalize this.”

Read the whole thing, including a lovely chart on the complexity underpinning these exchanges. It’s going to take years and cost immense amounts of money to get these exchanges going. And then we’ll see if it works. I expect the entire thing to fall over at least a few dozen times.

As I said, I’m not surprised at all. It’s difficult enough to build complex insurance markets from the bottom up. Building them from the top down, to borrow a phrase from P.J. O’Rourke, is like building the Great Pyramid from the top down. Right now, Obama is holding up a big pointy piece and the states are scrambling around for two million blocks of stone.

Update: Here’s the graphic of how the exchange system will work. No one could set up something like this on a timescale of months.

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  1. Iconoclast

    I expect the entire thing to fall over at least a few dozen times.

    Oh, it abosutely will. We’re talking about ridiculously large and complex information systems and the interfaces between them. And each time it does crater, it’ll be Bush’s fault.

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  2. Seattle Outcast

    Cripes – I really hope my employer remains devoted to its current ass-kicking benefits plan with great health insurance. I just fucking dread getting handed over to this total cluster fuck of a plan – you’ll die of a routine infection before these morons get things running even slightly.

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  3. Hal_10000 *

    I’m gonna post the infographic just so people can see how complex this is. Complex markets exist: we use them for everything. A diagram of how my ipad is built would be huge. But these things takes YEARS to build and are ultimately judged by market forces.

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  4. Thrill

    InsipiD is right. It’s a Long March to Single Payer. That’s why it was passed in the messy, “read it to find out what’s in it” manner it was. The removal of the severability clause was probably intentional to add to the chaos and it may well be that Chief Justice Roberts just didn’t want to take the bait.

    I hate to sound conspiratorial (no, I don’t really), but Obamacare isn’t what conservatives OR liberals wanted at all.

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  5. AlexInCT

    And it’s all just a ruse to build an unworkable situation that has to be “rescued” by instituting single payer.


    Healthcare reform of any kind from the left has purposefully been about driving up cost, making it harder to get, and standing up disastrous and unworkable solutions, under the pretens of making things better and care more accessible to all, so they eventually have to “rescue” an imploding system with a government owned & run single payer system. The allure of controlling the trillions of dollars the healthcare industry funnels through it, and more importantly, of controlling the serfs by controlling their access to care, is just too much for the collectivist powerbrokers.

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  6. Hal_10000 *

    And it’s all just a ruse to build an unworkable situation that has to be “rescued” by instituting single payer.

    I think I said that long ago when this was passed. I also talked about it here. The big warning bell will be if the “public option” is dragged back out.

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