The Quill is Mightier than the Keyboard

Grab you quill and get enrolled.

Grab you quill and get enrolled.


You may have been feeling adrift, but every time I sat to write a blog it appeared to be another development in the land of I-Got-Mine-Now-Get-Yourself-Elected-to-Get-Yours.

Our program with the Navigator had very few people.  Bummer.  However, the ones that were there had FAB questions.  Our navigator, whom I give the Nom de Plume, Navigator, was FAB.  He explained how the system was supposed to work, what he had been told and problems he had seen,  what we should do between now and December AND he explained what he didn’t know.

What he knew – The system had 3 times the amount of folks trying to enroll which assisted the online crash.

He explained that when you go on to the site it is as if you are standing in line.  Unfortunately, you can’t see the line ahead of you is composed of a few million people.  Might as well bring a sleeping bag and lunch. . . and cocktails.

He had been working to get people on the system from his end and had a lot of trouble.  He had seen folks make an account and then have the account disappear.  He was a very patient, nice guy.  One audience member had been on the phone with Navigator many times and neither one snarled.  In fact, listening to the audience member made the process clearer.

Audience member had an interesting problem.  He could retire and get Medicare, but because of his income fluctuation, it may make more sense to get a plan on the Exchange and cover family members.  He had been to the Kaiser Family Foundation calculator to get a guess-tamate on his costs.  But, because he hadn’t seen exactly what the actual insurance plans and deductibles, he couldn’t make a real decision.

There are different categories of plans – Bronze, Silver, Gold and Platinum.   Bronze has the cheapest premium with the lowest coverage and highest deductible.  These shift to increased premiums and lower deductibles as you move up the metal ladder.  Previously it was thought government subsidies would only be used on Silver plans.  We found out that they could be used on Bronze and Gold also.  Not sure about Platinum.

Another audience member went to the Blue Cross/Blue Shield website, got a FAB brochure in the mail.  Her cost would be $900/month.  Ouch!  However, she and Navigator got onto, and saw the same plan [BC/BS] for around $400/month.  She was stunned that different insurance brokers would charge you a different price for the same plan.  Welcome to our FAV broker gambling game – How Much Can I Get You to Pay?  [cue audience applause]

What we should do between now and DecemberUse a paper

As confining as being glued to your computer all day enrolling

As confining as being glued to your computer all day enrolling

application.  Yes, tie up your corset and don your bonnet, we’re off to the 19th century information age to be sure that you will get into the 21st century system.  The Let’s-Get-Every-Programmer-in-the-US-to-add-their-2 Cents-With-No-Company-Responsible-to-Ensure-the-System-Works wonks in Washington waxed poetic that the online program would ease enrollment.  But, if you had trimmed your feather pen and filled out a paper application on October 1, you would have already been part of the paperwork.  Those of us sitting at our FAV electronic online implement in our jammies trying to open an account at 4am every morning for weeks were out of luck.

What Navigator doesn’t know – What happens after your application arrives.  You post your application to London . . . Kentucky.  Then, someone is supposed to get back to you.  However, Navigator had no idea who that would be.  No one in the agency where he works for has been knighted for that task.  His best advice, call the numbers on the application in a few weeks and start figuring it out.  My advice: Make a copy of the application.  Send it return receipt.  Get a piece of paper that states it was received.

I have been thinking a lot about whether Kathleen Sebelius, head of the Department of Health and Human Services should be ousted.  I’m thinking no.  In all confrontations there is the pro side, con side and the third side.  The third side is where you pull out the emotions and look at the whole picture.

Had the Republicans let the Affordable Care Act go on its merry little way or even let it drop after the Supreme Court stated it being constitutional, there may have been enough time to actually put the website together.  But, the on/off-let’s-destroy-this-thing continuing attacks, including the shutdown, left programmers wondering what they should do.  The biggest problem in my eyes – no one company was in charge of seeing the entire project through and testing all systems.

Most new internet programs are done by a small group.  They add someone as needed to keep the project streamlined.  This thing had many companies working on it with no one at the helm.  So, we are left with an amorphous group of Bart Simpsons saying, I didn’t do it. [Luv Bart]

Which leads to Marilyn Tavenner, the Administrator of the Centers for Medicare and Medicaid Services.  She was the head honcho who rolled out this debacle.  She Screen Shot 2013-10-30 at 2.40.56 PMstarted life as a nurse.  I LUV nurses.  Then, Marilyn goes into administration and earns a Masters in Health Administration.  Great, she knows how to make sure there are enough gauze pads and medical personnel to apply them.  She’s a successful administrator – in hospitals.  Nowhere do I see she understands IT, instituted an electronic medical record system or is the go-to gal if your monitor dies.  She gets 162K in retirement pay in addition to what you and I add for her boat payment.

UPDATE – Media reports have had tech gurus talking about how they basically launch websites for the consumer.  They dole it out in batches.  The first thing is to enable folks to see your product, get them interested.  This is called window shopping. Have the consumer see how it fits with them.  Then, you get to the specifics.  An example is online loan applications.

You put in what you are looking for, some basic numbers about you and the house then you get some quotes.  When you have zeroed in on the loan that looks the best, you put in specifics and make sure of the deal.

Marilyn decided 10 days before the launch to yank out the window shopping and make you go straight for plunking in all the specific numbers and having it all checked with the IRS.   This cross-checking caused most of the bottle-neck and crashing.  Who told her to do this?  As far as I can see it was her decision alone.  Thanks, Marilyn.

Why didn’t we use the services of the Office of the National Coordinator for Health Information Technology (ONC).  Below is their mission statement

ONC is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.

Ever heard of them?  Not me.  This is headed by Dr. Jacob Reider.  He is a medical doctor who has worked with a number of IT firms.  Think Jacob may know some IT people familiar with the challenges of creating a national online health program?  Maybe even combine work to reduce redundancy?  Could Dr. J coordinate all the info of the Health Exchanges with a national medical database?

Sorry for the horse.

Sorry for the horse.

I think I’ll call Marilyn to schedule a carriage ride around the National Mall replete tea, crumpets, tar, feathers and uninsured citizens tired of being told to check back later.


Any thoughts, Darling?

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