It's not that bad, yet

A couple of weeks ago, we encouraged readers to hold on to their hats when it came to the new health exchanges that will be the route through which many people will be obtaining health insurance from now on. Given the complexities of the new law - the Affordable Care Act, which others may know as Obamacare - and the enormity of the change, to say nothing of the technical challenges involved in setting up individual exchanges in 50 states, some glitches were inevitable. And that's before you consider that many states were unhappy enough about the underlying philosophy behind the Act that they opted to let the federal government set up their own exchanges for them (Vermont, of course, built its own), and were not exactly overly cooperative about helping the feds construct their state exchanges.

All the ingredients were in place for a recipe that produced the result we have seen since October 1: Online exchanges that are at best clunky and slow, at worst, unusable. Everyone has by know heard all the horror stories about long waits to log in, or to create an account, and that's not even before the typical consumer gets to shop around and select a plan that works for their budget and personal situation. Furthermore, in Vermont at least, that would-be consumer won't be able to actually pay for it until Nov. 1 or maybe even later, because the software needed to run that part of the "back end" isn't functioning yet.

And given that this was President Obama's signature domestic legislative accomplishment in his first term as president, it's somewhat shocking to hear that he was not as in the loop, as his spin-doctors have implied, as he might have been, given the central role these exchanges were designed to play in the roll out.

Then there's the sheer cost; in Vermont, some $170 million, maybe more, has been spent to build the health exchange to get it up and running. Even in Montpelier or Washington-speak, that's a lot of money.

You can point fingers in all sorts of places, and that would be fair. The government kept changing rules, right up to the last minute, so the software engineers were constantly scrambling to write the correct code to reflect those changes. Some states, as noted above, intentionally dragged their feet, because they hated the underlying philosophy of the new law, seeing it as more government intrusion into people's lives that deprived them of choices. Others have highlighted the cost of the insurance that so far has been offered - although you need to do the math and factor in the subsidies to really make that determination to see if it's really going to be more expensive than what you might already be paying. Others wondered whether it was fair to compel younger folks to take out such insurance, when the likelihood of them ever needing it or getting a return on their investment was marginal. Maybe if the lawmakers had simply tried to replicate the Massachusetts model pushed under then-Gov. Mitt Romney, it might have produced better result.

These exchanges do herald in a profoundly new way many Americans who may not currently be obtaining their health insurance coverage through an employer or another organization will be protected against an inability to pay for an unforeseen or catastrophic illness. Those who have issues with the mere existence of the exchanges and the changes it involves need to say what they would advocate in its stead. We can think of one - tweaking it more to allow for more competition. Vermont, for example has two major health insurance carriers offering four levels of plans. Two is better than one, but three carriers would be better and, we would think, result in lower prices or better terms. Wherever possible, we would like to see as much competition and free-market thinking pervade these exchanges, because that is the surest way to keep the pressure on hospitals, health providers and insurance carriers to move in the direction of reducing costs and waste that seem to still permeate the health care industry.

Too many needless tests, too many frivolous lawsuits, too little transparency around how hospitals charge what they do and why the federal government reimburses what they reimburse - it's still a crazy patchwork "system" that needs an overhaul.

Whether it needs to evolve further into a single payer program is another question. Costs count. Whether it will be a financial wash is yet to be determined. Gov. Shumlin has made it clear his real goal is to move to that as quickly as possible after 2017. We will have a few years of experience with the exchanges by then. At that point, the current technical hiccups will probably be an ancient memory, not that those aren't serious problems right now and it is inexcusable that the vendors signed up at large taxpayer expense seem to have flubbed their task so abysmally. But here too, we see why more competition, rather than less, might have helped. Becoming a federal contractor is not an easy task. Small start-up firms really need not apply. The rules and regulations they need to follow in most cases are extensive and often beyond the reach of many smaller businesses. And those larger companies who have invested the resources to qualify aren't always excited to see more players crowding their turf. The further danger in this badly botched exercise is that more people are reinforced in believing that anything the government does is bound to end in failure or disappointment, or that too few young people, upon whom the success of the Affordable Care Act is predicated, won't sign up for it.

If these problems persist, then there definitely should be extensions of the enrollment period and a cessation of any penalties that may be associated with that. There is still a long way to go, even once the immediate log in and registration issues are resolved, which involve all the "back end" connections between the insurance carriers and the public. That part may make this opening go-round seem mild by comparison.

If the problems bedeviling some of the state exchanges are still on the front pages by this time next month, that invites a re-think, but for now we'll suggest that folks give it a chance, and if some one has a better idea on how to protect people from the poor house if they unexpectedly have a medical problem, they should speak up.

Meanwhile, a dose of personal responsibility, like eating sensibly and getting enough exercise, wouldn't be a bad idea either. Good health starts at home, not with a health exchange.


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