The Profundity of Pelosi

Nancy Pelosi explains her choice of words.

Former Speaker of the House and current House Minority Leader Nancy Pelosi has produced two of the most memorable quotes of the Obamacare era: 2010's "we have to pass the bill so that you can find out what is in it" and 2013's "embrace the suck."

The latter quotation came into widespread use by the military during the second Iraq war. "Embrace the suck" means that the situation is bad, but deal with it. The phrase is vulgar, funny, and...wise. An honest appraisal of and full engagement with one's condition is the first step toward climbing out of a hole. Wishing that things were different is often an exercise in futility.

While her supporters have argued that these quotes were taken out of context, Mrs. Pelosi has never apologized or offered a retraction. Her sayings may make her an object of mockery by opponents, but they are not silly. After her party lost the House in 2010, Democrats nevertheless re-elected her as leader. Republicans would be wise not to underestimate her. © 2013 Stephen Yuen

Losing Letterman

British PM Cameron, Danish PM Thorning-Schmidt,
with President and Mrs. Obama (Getty Images)

Five years after George Bush left office, David Letterman finally took a break from bashing the ex-President and commented on Barack Obama at the Nelson Mandela memorial:

Did you see that picture where the President was using an iPhone to take a selfie? And it was him and a guy from Great Britain and the woman in charge of Norway, or whatever Denmark? And I thought it was interesting---he knows how to operate the camera to take a picture but they can't figure out to operate the Obamacare website

1) As humor goes, it wasn't much funny, but David Letterman has to start somewhere.

2) If he's lost Letterman, he's in deep....trouble.

Medical Bypass

A family member was referred to a San Mateo ear-nose-throat doctor and was treated promptly and effectively. What was unusual about this story is that the doctor didn't accept insurance or even credit cards. Payment is via cash or check only.

By avoiding the elaborate medical payments bureaucracy Dr. Kelly charges a fraction of what other doctors bill (a good portion of which the insurance companies disallow anyway). He's literally old school, that is, he's eligible for full retirement under Social Security and his nurse-administrator uses a typewriter.

Opponents of the Patient Protection and Affordable Care Act should not fall into the trap of defending the pre-2009 system that has multiple middlemen coming between the doctor and patient. Obamacare may or may not be repealed, but we will not go back to the old system either.

Dr. Kelly's clean, simple, and very old-fashioned method of handling payments won't work in most cases today, but what about tomorrow? Changes in everything, not just health care, are happening more often and more quickly. The one surprise is that people are still surprised when the unexpected happens.

BTW, Dr. Kelly's Yelp rating is five stars. © 2013 Stephen Yuen

Losing the Narrative

Over the last half century the non-STEM academy has embraced postmodernism, which has as one of its premises the lack of an objective "truth", that is, everyone has his or her own equally valid experiences, truths, and stories to tell. This philosophy, plus our embedded preference to listen to stories over other styles of communicating, is one reason why we are inundated with people telling their tales throughout the day. Narratives are fine for entertainment, but they're often a lousy way to set public policy. Nevertheless, that's the world we live in and the way decisions get made.

Over the past 20 years the debate over health care has raged, primarily driven by (true) stories about the rapacious behavior of insurance companies, and to a lesser extent drug companies and heartless hospitals. In 2009 the Democratic Party, which controlled the legislative and executive branches of government, birthed the Patient Protection and Affordable Care Act, aka "Obamacare," under which the Federal Government took control of the health care sector of the economy. No, the government does not technically "own" the health care sector, but through a combination of massive regulation, spending, and taxation the government controls it.

Now the horror stories are going the other way. They are so compelling that the Administration and its Obamacare supporters are finding it impossible to control the narrative. One example: stage-4 cancer patient Edie Sundby's story of insurance cancellation because of Obamacare regulations:

Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.

But in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market.

The narrative is lost, and in the postmodern world probably the battle is, too. © 2013 Stephen Yuen

"Politically where are we right now, at this moment?"

Peggy Noonan, WSJ editorial page:

It’s as if it’s 1964 and the administration has just passed landmark civil rights legislation and the bill goes into effect, and....It doesn’t help minority groups – it makes their lives harder and less free! And it does real, present and intimate damage to the majority.

It’s as if it’s 1937 and they launched Social Security, only rich coupon-clippers on Park Avenue immediately started getting small monthly checks, and 67-year-old dust bowlers in tarpaper shacks started getting monthly bills.

In other words, "ObamaCare is a practical, policy and political disaster, a parlay of poisonous P’s."

We can also play the "P" game. Critics of ObamaCare opposed it on the grounds of

principle: government takeover of a major sector of the economy,

privacy: as in loss of, especially since the IRS would administer it,

practicality: the government is not able to run something this big without turning it into the post office or DMV,

price: cost estimates were low-balled by hundreds of $billions.

All the criticisms made sense, but the one that resonated the strongest was the practical: I just didn't see how they were going to make it work. From July, 2009:

the current [healthcare] system is deeply flawed, yet, based on the government's recent performance in the comparatively simpler task of reviving the economy, have no confidence that the cure will be better than the disease.

© 2013 Stephen Yuen

It's Free at Last

Four years after the last one (the gastroenterologist recommended a three-year interval),  I scheduled a colonoscopy for December. Since we're staying with our current insurance carrier, there's little point in waiting until next year in the hopes of getting a better deal.

Obamacare does promise to save some money on colonoscopies, versus private plans:

In 2014, insurance providers will be forced to (1) cover a screening colonoscopy at 100% and (2) classify the colonoscopy as screening even if polyps are found.

As the article points out, however, many aspects of colonoscopy reimbursements are unclear, like the liquids I'm not supposed to drink 24 hours before. This year I know what I'll be paying, and I know what services I'm getting, so I may as well get it over with.

Preparation for the procedure involves drinking a prescription medicine that "cleans your colon by causing you to have diarrhea" (the drug company didn't run the instructions past marketing, obviously). Hey, another untouted benefit of Obamacare: the diarrhea is free. © 2013 Stephen Yuen

Just Science Fiction

One of the unanswered mysteries in 2001: A Space Odyssey: Why did the HAL 9000 supercomputer malfunction and murder nearly the entire crew on the trip to Jupiter?

In the sequel 2010: Odyssey Two it was explained that

HAL's crisis was caused by a programming contradiction: he was constructed for "the accurate processing of information without distortion or concealment", yet his orders.....required him to keep the discovery of the Monolith TMA-1 a secret for reasons of national security.

HAL's architecture was based on openness and transparency, but government higher-ups ordered HAL to conceal important information from the crew. HAL went through the computer equivalent of a psychotic break.

Forbes [bold added]:

In the case of Obamacare, the web site was made needlessly complex just in order to avoid this sort of transparency [as programmed into Medicare Part D]. There was probably fear in the White House that if consumers browsed plans and saw the list cost (without first knowing how much the government would subsidize their plan) many people would not return.

At the end of 2001 sole survivor David Bowman performs a "lobotomy" on HAL to save the ship. Bowman finishes the mission by operating everything manually. Human beings having such resourcefulness, however, is probably just science fiction. © 2013 Stephen Yuen

There's Always Next Year

Blue Shield Silver is the closest to what we have now,
and the net cost through Covered California will be half
of what we will pay next year.

The open enrollment period on my retiree health plan expires today, October 25th, when I have to decide whether to re-up for 2014 or take my chances on the California Obamacare exchange, Covered California. If we do choose Obamacare, however, we can't go back to our old retiree plan...ever.

On the one hand I can pay over $1,000 per month--my share of the cost, with my former employer kicking in a smaller amount--or pay a lot less through Covered California, provided I am willing to do or believe the following:

1) Manage our household income to be below four times the poverty rate (in our case that means capping it at slightly less than $79,000). This will enable us to a) limit the premiums to 9.5% (or less) of our income and b) receive a tax subsidy.

2) The extensive personal data that we will be entering into Covered California is secure.

3) The benefits and costs from the insurance company that we select are as described on the website.

The decision isn't close. We will stay on the insurance plan that we know, though we will pay thousands of dollars more. It's a matter of risk, but most of all it's a matter of trust---the fact that we trust health insurance companies more than the government to deliver on promises is a terrible indictment of our current system.

And there's always next year to change our mind. I'll be happy to be proven wrong. © 2013 Stephen Yuen

Glitches, Icebergs, and Other Metaphors

On October 1st President Obama compared Obamacare's rocky start to problems that Apple encounters---and fixes--whenever it rolls out a new product [bold added]:

[On] every new product roll-out, there are going to be some glitches in the sign-up process along the way that we will fix....And we're going to be speeding things up in the next few hours to handle all of this demand that exceeds anything that we had expected. Consider that just a couple of weeks ago, Apple rolled out a new mobile operating system, and within days, they found a glitch, so they fixed it.

When Apple has a "glitch," even one as bad as last year's Apple Maps or the antenna problem in 2010, it fixes the problem or offers a substitute within a matter of weeks. The market eventually (re)embraces Apple's products as second to none in quality and aesthetics.

An Apple glitch is like the mole on Cindy Crawford's cheek: hardly
noticeable in light of other favorable attributes. (China Daily photo)

Commentators have been less forgiving in their metaphors. Peggy Noonan:

(WSJ Graphic)

The ObamaCare rollout is a disaster for the White House, not a problem or a challenge or an embarrassment, not a gaffe or a bad few weeks. [snip]

Asked whether Kathleen Sebelius should be fired, [former Obama chief of staff Bill Daley] said: "To me that's kind of like firing Captain Smith on the Titanic after it hit the iceberg." The Titanic. Some will see his comments as disloyal. Actually they were candid and realistic. Although in fairness, the Titanic at least had three good days, and Edward Smith chose to go down with the ship.

Then there's the Hindenburg:

Lisa Benson cartoon

Your humble observer is quite confident that healthcare.gov will be "fixed" by the end of November. A website can be set up in less than an hour, and a feature like user registration can be added in less than a day.

More complex features, like enrollment with an insurance carrier, verifying taxpayer income and subsidies, and securing and encrypting data could take a lot longer than 45 days. However, because there is no published spec sheet the Administration will declare the project complete on November 30. The features that you or I are expecting, dear reader, will be in version 2.0, date to be determined. © 2013 Stephen Yuen

Three Weeks Later

From President Obama's October 1st remarks on the government shutdown and the Obamacare rollout:

starting today, you and your friends and your family and your co-workers can get covered too. Just visit healthcare.gov, and there, you can compare insurance plans side-by-side the same way you'd shop for a plane ticket on Kayak or a TV on Amazon. You enter some basic information, you'll be presented with a list of quality, affordable plans that are available in your area with clear descriptions of what each plan covers and what it will cost.

You'll find more choices, more competition and in many cases, lower prices. Most uninsured Americans will find that they can get covered for $100 or less. And you don't have to take my word for it, go on the website, healthcare.gov, check it out for yourself and then show it to your family and your friends and help them get covered just like mayors and churches and community groups and companies are already fanning out to do across the country.

And there's a hotline where you can apply over the phone and get help with the application. Or just get questions that you have answered by real people in 150 different languages. So let me give you that number. The number is 1-800-318-2596 -- 1-800-318-2596. Check out healthcare.gov, call that number, show your family and friends how to use it and we can get America covered once and for all so that the struggles that these folks have gone through and millions around the country have gone through for years finally get addressed.

Normally I would underline the phrases that events made ironic, but just imagine the whole passage as underlined.

O, the Humanity (Reprise)

I cut a lot of slack to politicians when they make predictions. I may think that they're dead wrong when they claim, for example, that lower government spending or higher taxes are the way to solve the debt problem. But they probably aren't "lying", i.e. knowingly spouting something untrue; they may be indulging in wishful thinking---heck, they may even believe with all their heart in what they're saying.

But when politicians say something utterly false--and they know it--concerning past events, the normal reaction is to get angry (perhaps because people don't like the answer to "what kind of fool do you take me for?"). However, the explanations can be so laughable that their ridiculousness disarms us.

Every six months or so the Obama Administration is good for such a howler that I can't be angry at them.

September, 2012 - the attack on the American consulate in Libya, as well as uprisings across the Middle East, was due to an obscure YouTube video. President Obama, on 9/12/12:

"What we do know is that the natural protests that arose because of the outrage over the video were used as an excuse by extremists to see if they can also directly harm U.S. interests."

May, 2013 - the IRS targeting of tea party organizations was the work of low-level agents in Cincinnati:

the IRS has identified two "rogue" employees in the agency's Cincinnati office as being principally responsible for the "overly aggressive" handling of requests by conservative groups for tax-exempt status

October, 2013 - the first reason (the President did list others later in his 10/21/13 press conference) that the Obamacare website doesn't work:

"the number of people who have visited the site has been overwhelming, which has aggravated some of these underlying problems."

An amateur video, Cincinnati IRS agents going rogue, and healthcare.gov being so popular the website froze. Laughter being the best medicine, the President is correct about one thing: because of Obamacare many of us are feeling better already. © 2013 Stephen Yuen

Lisa Benson cartoon

The Endless Loop

Two weeks should have been enough time to correct startup glitches, so I decided to check out the Covered California website, reputedly one of the most reliable of the Obamacare exchanges.

Coveredca.com: an attractive home page...on to "getting covered"

Getting covered: let's try the "Shop and Compare Tool" links.

Oh-oh, we're back here again.

You are in a maze of twisty little passages, all alike.

Kidding aside, some links do work and it is possible to get to the Shop and Compare Tool.

Whew! and to think that almost three years ago I was a worry-wart.

A Plausible, Good Deal

Peggy Noonan on the "strange shutdown":

Republicans, who hate big government, are fighting to keep it open, and Democrats, who love big government, are fighting to keep it closed.

The Republicans want to fund everything but Obamacare, which is a sacred cow to Democrats; hence the impasse.

In the short run everyone in Washington is looking bad, and the Republicans are looking worse. If this goes on much longer, however, the majority of Americans may find that they're getting along just fine if Washington is closed. Big government advocates are running a huge risk: benefits and taxes both stopping looks more and more like a plausible, good deal.

Not a Flash Mob

Regular readers of this humble journal may have been expecting a few comments about the Patient Protection and Affordable Care Act, aka "Obamacare," whose insurance exchanges are going live today.

For sheer waste and inefficiency, however, it's hard to beat the jury selection process. Today over 100 people had to listen with rapt attention to people like you and me drone on about their life experiences. Would it be too much to ask to schedule group 15-minute interviews with prospective jurors? The sessions could be videotaped for later analysis by prosecution and defense. That way each of us would only sacrifice half a day instead of a week.

Why do we sheepishly put up with this? Because we have to. The judge issues bench warrants for no-shows, and bail amounts to tens of thousands of dollars.

Except for military service where the opposite occurred, more and more "voluntary" acts of civic responsibility have become mandatory. In California we keep electing people who put these laws into place, so I guess we must like it. © 2013 Stephen Yuen

We Don't Appreciate Them

Former Secretary of Education and conservative commentator Bill Bennett is the latest to rail against Congress' exempting itself from Obamacare:

Imagine the horror when these elected officials, who make $174,000 a year, realized that not only must they and their staffers be subject to inferior-quality health exchanges like the millions of ordinary Americans, but they might also have to shell out thousands of dollars for increased premiums if they exceed the subsidy income cutoff. [snip]

Heaven forbid Congress suffer the same fate as private companies like UPS, which recently had to cut health-care benefits entirely for employees' spouses; or labor unions, like the 40,000 International Longshore and Warehouse Union workers who recently left the AFL-CIO citing as one factor ObamaCare's tax on their "Cadillac" health-care plans.

It's also a shame that Congress and its staffers must pay income taxes, serve on juries, and abide the traffic laws. Let's hope that they're working on exempting themselves from those, too. The poor dears work so hard for us, and we don't appreciate them enough. © 2013 Stephen Yuen

In Praise of Divided Government

It's a cliché that the party who holds the White House deplores divided government, while the party out of power likes it very much. The principal objection to divided government is that quick, bold, necessary actions are stymied. To this humble observer that's a feature, not a bug.

When the Democrats had control of Congress and the White House from 2008 to 2010, they passed Obamacare without a single Republican vote. When the Republicans were similarly situated in 2003 to 2006 and part of 2001, they passed the so-called Bush tax cuts, arguably a major source of today's deficit problems. (It should be noted that Democrats were roughly split on the Patriot Act and Iraq War resolutions, so it's a reasonable supposition that even if congressional Democrats had slim control, George W. Bush would have gotten his legislation through, thanks to solid Republican support.)

Now we are seeing another advantage of divided government: congressional hearings on possible Administration malfeasance. Yes, investigations into the current raft of scandals are interfering with Executive Branch operations, and yes, there is grandstanding and partisan obstructionism going on, but there are also important issues at stake concerning the free flow of information prior to a Presidential election (the time when the people have the most say in their government) and the abuse of the enormous powers of the Internal Revenue Service, the agency that has information on everyone and where everyone is presumed guilty, not innocent.

I'd like to see something get done this year on immigration reform and tax simplification, but if inaction is the price we pay for divided government, so be it. © 2013 Stephen Yuen
[Update - 5/31: Ann Althouse on the 2014 elections: "Regardless of how directly Obama is implicated and how much any given voter wants to blame Obama, the scandals make a strong argument for opposite-party control of Congress."]

Worry About Tomorrow Tomorrow

Due to the requirements imposed on small businesses, Obamacare has been criticized as an impediment to job creation [update: large employers may be able to comply with Obamacare rules by using "bare bones" health plans that cover little hospitalization, if any.] However, the measure's job effects aren't totally negative [bold added]:

To implement President Obama's Affordable Care Act, San Mateo County will hire 25 people to help process the expected flood of new applications for new benefits....San Mateo County's Health Services Agency has been advised to brace for about 894 new applications per month above the 2,276 it currently receives for health benefits.

Further good news: half the annual labor cost of $3.6 million (that's an average of $144,000 per employee!) will be paid for by the Federal Government. The uncertain news: the jobs aren't expected to be permanent.

However, such an objection is unlikely to dissuade County managers from hiring. For decades California governments have believed in spending and hiring and worrying about tomorrow when tomorrow comes, and their recent actions (e.g., installing high-speed rail where most of the people don't live) show that little has changed.

The Sensibility of House Republicans

No, really, House Republicans may be acting sensibly:

House Republicans say they will not overreach on probing the Obama administration, having learned lessons from investigating the Monica Lewinsky scandal during the Clinton administration. [snip]

Impeachment is not something that has been bandied about around the House GOP leadership table, according to GOP leadership aides and a House Republican member who spoke on background.

Unless there is solid proof of high crimes and misdemeanors (using the people's definition, not lawyers' understanding) by the President, House Republicans should quash all mention of the I-word. Mr. Obama is still popular and could become an object of sympathy if there were a rush to start impeachment proceedings.

It's difficult to imagine that he would ever be as unpopular as his predecessor, but Mr. Obama may well descend to that level after three and a half more years of scandal and ineffectiveness, not to mention being the butt of late-night humor.

Thursday's Jay Leno:

This week will mark the 37th time House Republicans have tried to repeal Obamacare. If Republicans really want to do away with Obamacare they should endorse it as a "conservative non-profit" and let the IRS take it down!

A lot of critics are now comparing President Obama to President Nixon. The good news for Obama: at least he's no longer being compared to President Carter!

Six Months Later

A few days after President Obama's re-election your humble observer opined:

Now that the election's over we are likely, finally, to learn the truth about:

Benghazi

Obamacare's costs

End-of-year defense layoffs

FEMA's before-and-after performance on Hurricane Sandy

Unemployment statistics

Whether General Motors is really healthy

What the President meant when he said he would be "flexible" on missile defense

Six months later only Benghazi and Obamacare are still deemed to be important topics, but two are enough to serve the President's opponents; prolonged national conversations on either are unlikely to be helpful to the Administration's goals. A scandal that has seemingly come out of nowhere--also unhelpful, to say the least--is the IRS' targeting of "Tea Party" and "patriot" groups (actions suspected by conservatives over a year ago but ignored by the mainstream media).

Unfortunately for the President, none of the current set of problems can credibly be laid at the feet of obstinate Republicans or the Bush Administration. Welcome to your second term, Mr. President.

Misinterpreted Headline

There are "teaser" headlines that draw in readers, who often find that the content was overhyped. Then there is the misinterpreted headline, like the above.

I was hoping to read about the businesses that were being started to help medical providers and the public deal with Obamacare's complexity. The WSJ headline piqued my interest as a healthcare consumer, potential investor, or perhaps even as a potential consultant.

Instead, it was a rather pedestrian piece about how people hang on to their jobs because of healthcare benefits---which is old news---but now may venture out because Obamacare promises coverage at a reasonable price.

The pressure some Americans feel to cling to a corporate job chiefly for the health insurance could, conceivably, ease in coming years. Under provisions of the health-care law, new-business owners will be able to get coverage through public marketplaces, or "exchanges," beginning in October, for policies that will take effect starting in January.

Given that even Obamacare's authors have declared a train wreck coming, prudent employees and would-be entrepreneurs will adopt a wait-and-see attitude until implementation gets off the ground. Any startup explosion from workers chained to employer-provided health care will have to wait until 2014. © 2013 Stephen Yuen