(Secretary of Health and Human Services Kathleen Sebelius. Photo AP).
There is the troika of alleged scandals in progress in town. It is quite remarkable, since the media has been trance-like for so long on the wonderful stuff that has been going on, the roaring economy and falling unemployment and all that stuff.
Wait…oh never mind. Those were problems back when we got the Patient Protection and Affordable Care Act.
I still don’t get that, but I read at the time that the signature progressive agenda items was examined by the politicos in the West Wing, and that looked like it was achievable, barely, and so we got a law that neither protects patients nor is particularly affordable.
Don’t get me wrong. I am vaguely supportive of a single-payer health system, but I view any such scheme with a jaundiced eye. It will, inevitably, lead to rationing of care, just as it does in Britain and Canada, two perfectly fine societies. And yes, there are panels of experts- not all of them medical people- who determine who is likely to benefit more from the allocation of those resources and apportion them accordingly.
I have been a single payer subscriber of military medicine for 37 years, and it has always been there, even if not particularly convenient to access, and always a pain in the butt to deal with. If something like that is the answer to a system that seemed to work for most people, and provided for the rest with the safety-net of the Emergency Rooms that cannot, by law, turn anyone away…well, I didn’t think that was the crisis that needed to be fixed.
No, no, I am not going to go into a rant about Madam Pelosi or the collective lunacy that gave us “you have to pass it to find out what’s in it.” There are so many impossible things to believe these days that I will just chalk that one up to some kind of collective madness that sweeps over groups of people in stressful situations.
It happens at Big Pink. There have been periodic mass delusions here. One famous one was that the balconies were all weakening and we would be plunged to our deaths in the parking lot, or drown in the pool if we managed to leap from the falling concrete and re-bar.
Engineers were called in to consult on the matter, and it was nonsense.
A couple years ago the routine replacement of the uptake pipes for the hot water system was begun. It was intended to be a measured response, doing sectors of the building to manage costs. At the annual meeting one of the ladies of a certain age revealed that she had gathered up her furniture into a mound in the center of her living room so she could have a place to stay dry against the coming flood when the old pipes burst.
We all got quite hysterical about the hypothetical, and of course the Board decided to replace all the pipes at once, because no one wanted anyone to drown up on the seventh floor.
Several prominent people have observed that there are some minor problems involved with the implementation of the new health system. We have to lunge into the belly of the vast law to see what is coming.
I used to work- briefly- as an acting Deputy Assistant Secretary in the bureaucracy there. I manage to survive my service unindicted, and learned a lot. But the poor Department has a lot on its plate at the moment, and there are a series of scandals involving beleaguered Secretary Kathleen Sebelius that no one is really looking at- yet, anyway- as she struggles to implement the stand-up of the new system that will oversee 20% of the largest economy on the planet.
Kathleen has given the states until mid-December to make their health insurance exchange decisions, in or out, and state regulators are hoping to navigate the rapids with a minimum of turbulence. They are not likely to get their wish. Among some of the obvious issues- like, young healthy people who don’t have any particular need for health care at the moment- there are a host of less visible ones.
How is this one? Will states that are jointly running their health exchanges link their information technology systems to the newly established Federally Managed Data Services Hub?
HHS is busily setting up the Hub. I won’t go into whether this is best agency to be doing that, it being the law, after all. And with that, it appears that the states will have to connect to the Hub, regardless of whether their exchange is state-based, a partnership or federally-facilitated.
That made me curious. We just went through a discussion of IT and liberty on the gun thing, so my ears perked up on what is coming. By October of this year, the Hub is expected to be “a streamlined application and eligibility system for people buying health plans through state exchanges and for people applying for public health plans like Medicaid and CHIP.”
This is fantastic. The Hub will be able to verify all sorts of cool things: Social Security Number identity, citizenship, income information, tax credit eligibility and public minimum essential coverage eligibility.
This is, as you might imagine, the largest personal information database ever attempted. I am very excited about this. HHS has never really been a compliance organization, and since there has got to be a hammer in here someplace to ensure that people go along with something they might normally eschew, the rose for that has been pinned on the IRS.
You know we can rely on their impartiality and fairness.
According to what the IT geeks are planning, the Hub will be able to do a sort of “instant background check” to enable verification of the complex subsidy formula against all personal information of the citizen.
All insurers, self-insured businesses and government health programs will have to submit reports to the IRS about the individuals they cover, which the IRS will cross-check against tax returns, just as they do with those goddamn 1099s people send me each year.
Like I said, I am delighted at the unholy alliance of the tax dudes and the health care mafia and complete access to my health information and bank accounts. I mean really, as the President said at commencement at Ohio State, “You’ll hear voices that incessantly warn of government as nothing more than some separate, sinister entity that’s the root of all our problems, even as they do their best to gum up the works; or that tyranny always lurks just around the corner. You should reject these voices.”
I will grant the President his view that Government can be the answer, even we may not be sure what the question was. I think perhaps he might have been more circumspect in his remarks if they had been given after the IRS Inspector General’s report came out.
“We have never been a people who place all our faith in government to solve our problems, nor do we want it to. But we don’t think the government is the source of all our problems, either,” the president said.
Nope. Not all of them. Oh, there have been several senior IRS officials who have got the boot over the scandal, including the acting director who wasn’t there when the abuses were going on. Sarah Hall Ingram, commissioner of the office responsible for tax-exempt organizations, 2009-2012, has quietly moved on, too.
You will be comforted to know that she is now the director of the IRS’s Affordable Care Act office.
It almost makes me feel like Chris Matthews, you know? With that warm tingle up the leg?
(Sarah Hall Ingram. Image capture CSPAN.)
Copyright 2013 Vic Socotra
www.vicsocotra.com