Obamacare and the Cold Equations

| December 12, 2013


There is a famous 1954 short story by Tom Godwin called “The Cold Equations”.[1] In it, a young girl stows away on a rocket ship bringing plague vaccine to a colony world deep in space; her goal is to pay a surprise visit to her brother, who is on that world. Unbeknownst to her, the ship — which travels at sub-light speeds only and was dropped off by a faster-than-light ship that has long since departed — has a very tight fuel budget. The girl’s presence on the ship means it cannot reach its destination and keep the colonists from being wiped out unless the ship’s mass — already planned for to the last ounce — is reduced back to acceptable limits. Various options are considered, including the pilot sacrificing himself, but none will work except one: jettisoning the young girl through the airlock. As the pilot notes:

Existence required order, and there was order; the laws of nature, irrevocable and immutable. Men could learn to use them, but men could not change them. The circumference of a circle was always pi times the diameter, and no science of man would ever make it otherwise. The combination of chemical A with chemical B under condition C invariably produced reaction D. The law of gravitation was a rigid equation, and it made no distinction between the fall of a leaf and the ponderous circling of a binary star system. The nuclear conversion process powered the cruisers that carried men to the stars; the same process in the form of a nova would destroy a world with equal efficiency. The laws were, and the universe moved in obedience to them. Along the frontier were arrayed all the forces of nature, and sometimes they destroyed those who were fighting their way outward from Earth. The men of the frontier had long ago learned the bitter futility of cursing the forces that would destroy them, for the forces were blind and deaf; the futility of looking to the heavens for mercy, for the stars of the galaxy swung in their long, long sweep of two hundred million years, as inexorably controlled as they by the laws that knew neither hatred nor compassion. The men of the frontier knew — but how was a girl from Earth to fully understand? h amount of fuel will not power an EDS with a mass of m plus x safely to its destination. To him and her brother and parents she was a sweet-faced girl in her teens; to the laws of nature she was x, the unwanted factor in a cold equation.

Math is hard, as is software, as is — in the end — social change. The attempt at healthcare reform by the Obama Administration and the Democrat-controlled Congress back in 2009-2010 ignore all three of those realities and tangled math (including economics), software, and social change into one massive Gordian knot. I have to believe they deliberately chose an all-in-one “big bang” approach — as opposed to an incremental, experimental, “start out stupid and work up from there” approach — because they believed the latter would end up being rejected. I think they believed that if they instead made the changeover universal, coordinated, and mandated by law, they could push ahead regardless of the opposition. And they did just that, and they did push ahead regardless of the opposition, and they are now facing the inexorable technological, economic, and social consequences.

The repeated efforts by the Obama Administration and its defenders to characterize the unfolding multi-faceted disaster that Obamacare is as a few “glitches” or ‘bumps” truly leaves one wondering: are they really that stupid, or do they simply think or hope we are?  In the midst of their happy-talk about “surging” enrollment, they can’t, or won’t, identify how many of the “applications” have actually been completed, paid for, and recognized by the target insurance company as active, legally binding health coverage policies. As Jim Geraghty (of National Review) writes this morning:

We’ve been warning that Obamacare would be a train wreck for a long time. Now the boxcars full of dynamite reach the impact point.

Pardon the ALL CAPS, but this seems like a fairly huge point: ALMOST NO ONE HAS PAID FOR THEIR INSURANCE YET!

The U.S. Department of Health and Human Services announced this morning that nearly 365,000 Americans had signed up for private health insurance under Obamacare. The vast majority came from 14 states running their own insurance exchanges, while 137,000 came by way of HealthCare.gov, the much-faulted federal website that handles enrollment for the remaining states.

But amid the rush to enroll as many people as possible by the Dec. 23 deadline, there’s a huge caveat that isn’t getting much public attention: In order for coverage to take effect on Jan. 1, enrollees must pay their first month’s premium on time. (The deadline varies somewhat by state and by insurer.)

That’s slow going, according to consultants and some insurers, raising the prospect that actual enrollment will be far lower than the figures HHS is releasing.

“There is also a lot of worrying going on over people making payments,” industry consultant Robert Laszewski wrote in an email. “One client reports only 15% have paid so far. It is still too early to know for sure what this means but we should expect some enrollment slippage come the payment due date.”

Another consultant Kip Piper, agreed. “So far I’m hearing from health plans that around 5% and 10% of consumers who have made it through the data transfer gauntlet have paid first month’s premium and therefore truly enrolled,” he wrote me.

I believe what we are witnessing will turn out to be the single largest and most catastrophic government policy failure in US history, as well as the most public IT failure in world history. There have been larger (in years and dollar amounts) IT failures, but they have usually always involved systems that never went into production, or if they did, that impacted a relatively limited number of people. Let’s summarize:

  • Healthcare.gov as well as many of the state exchanges still do not live up to the necessary quality aspects of a successfully functioning IT system: reliability, performance, functionality, compatibility, lifespan, deployment, support and cost.
  • The vast majority of enrollments to date have been in Medicaid; a much tinier fraction have been people actually signing up for insurance plans.
  • Meanwhile, vastly more people have lost insurance coverage due to Obamacare than have gained it.
  • The enrollment figures to date are far below those needed for the system to be financially viable, and there are indications that those who are pushing through to sign up are those more likely to be a financial drain on the system, rather than a boost.
  • There is no payment system in place for those who do sign up; instead, they are supposed to contact the insurance company directly, which may or may not have their information.
  • The deadline for buying insurance is just days away.

I believe that over the next several weeks, the ‘cold equations’ of Obamacare as it actually exists and is currently implemented — as opposed to the magic thinking version on the Left — are going to lead to more and more unavoidable disasters — train wrecks, in the metaphor that Jim Geraghty has been using since before Healthcare.gov went live. Vastly more Americans will have both their bank accounts and their personal health damaged than those that will benefit under Obamacare.

This did not need to happen. There have been multiple points all the way back to 2009 when a different course could have been pursued, one founded in reality-based reasoning about math, software, and social change. Instead, we are witnessing the mother of all train wrecks. To paraphrase a famous passage from the Reagan Administration’s scathing report on the US educational system issued 30 years ago (A Nation at Risk, 1983):

If an unfriendly foreign power attempted to impose on America the disastrous health care system that is unfolding today, we might well view it as an act of war.

I fear the worse is yet to come.  ..bruce w..

[1] There is some dispute as to whether the concept is original with Godwin; no matter, the story works and works very well. You can read a PDF version here.

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Category: 2014 Election, Creeping socialism, Healthcare Reform, Idiot bureaucrats, Idiot Congresspersons, Information Technology, Main, Obama Administration, Obamacare

About the Author ()

Webster is Principal and Founder at Bruce F. Webster & Associates, as well as an Adjunct Professor of Computer Science at Brigham Young University. He works with organizations to help them with troubled or failed information technology (IT) projects. He has also worked in several dozen legal cases as a consultant and as a testifying expert, both in the United States and Japan. He can be reached at bwebster@bfwa.com, or you can follow him on Twitter as @bfwebster.

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