I've been thinking about that for the last six weeks as I've confronted, with waning trust morphing into enraged frustration, the remarkably complicated corridors of The Patient Protection and Affordable Care Act (popularly known as "Obamacare"). The problems in the roll-out of this ersatz reform are generally known and, depending on who's talking, have led to irritated calls for fixes or have been cited as proof that anything the government does that is socially responsible is a communist-inspired train wreck.
After nearly 20 years of Internet work, I know that all major web-based projects launch with problems, some of them crippling, and I know they can all be fixed. There is nothing extraordinary about Obamacare's website problems except the shrill reaction they've provoked. This is to be expected. The "looks good, sounds good, but can't do anything right" tag that underlies the controversy is one of racism's trustiest refrains and this is a President who has been battered by those kinds of comments.
The websites have run into problems because they are a kind of "Amazon" for health care and they weren't ready to do that. Soon they will be ready and the technological problems will disappear but the most important social problem -- a health-care system that has nothing to do with caring for people's health -- will remain.
My own experience, a frightening and painful process, demonstrates this truth. I am 64 years old, a member of the demographic group that most needs Obamacare, and I am not being allowed into the program. Let me tell you the story, starting with a bit of background.
I live in New York and our state is a full participant in the ACA: we have a marketplace, our own website system (called "New York State of Health"), a help system... everything the President wants us to have. While I'm still functional, energetic, and in otherwise decent health, I have a few conditions that require medication that I take, in large quantities, every day. I take the pills, I'm fine. I don't, I get sick. Their cost, without insurance, is prohibitive. I need insurance and my current insurance will expire at the end of December. Since Obamacare will take on most of my insurance company's customers, it is now not cost-effective for my insurer to continue offering non-ACA insurance. So, because of Obamacare, they're canceling my policy at the year's end. I'm currently on Social Security (my only source of income) but I can't get Medicare until March 2014, when I turn 65.
So I need Obamacare coverage for three months and, about six weeks ago, I went to my local library in Brooklyn to meet with a "navigator" from the State's ACA help system staff to get that coverage.
Navigators guide you through those Obamacare corridors -- basically helping you fill out all the on-line forms. My navigator, a competent and pleasant fellow, did the on-line forms with me. After a half hour of form-filling, he pushed the submit button and the website shook its head. "You are not eligible to purchase insurance from the marketplace", it said. That's Obamacare-speak for "you can't get Obamacare".
My navigator frowned and got on the phone with the State people from the department that manages the program and they explained that their site was temporarily malfunctioning. "Wait until tomorrow", he told me, "It will be fixed by then and you'll be able to go to the marketplace and select your policy."
I was relieved. But when I checked the site the next day, the message was the same and so I called the State number myself. I spoke to a pleasant woman -- everyone's pleasant in this story -- who explained to me that my income level was low enough to qualify me for Medicaid, the low-income medical insurance program. I told her I didn't want that; I wanted Obamacare. She instructed me to uncheck a box on one of the pages of the site and wait a day.
I was more anxious but still believing so I did as she said. No change when I checked the next day.
I called again, this time speaking to a fellow (equally intelligent and pleasant). Oops!, he said, there's another box on another page on the form that was checked and they were evaluating me for Medicaid as a result. Uncheck that one, he explained, and wait another day. Now I was anxious to the point of paranoia but I followed his instructions.
The next day... no change! I started to panic. I can imagine living with all kinds of problems but not getting my meds isn't one of them.
So I called a third time and was told that, like it or not, I qualify for Medicaid; Obamacare marketplace isn't an option. I have to wait for my Medicaid to kick in, which it will before my current insurance expires. I hung up with my already blazing paranoia still blazing: if I unchecked the boxes, thereby indicating I didn't want Medicaid, would it still kick in? Would a government whose greatest creativity is applied to not taking care of people who need care give health coverage to a guy who unchecked his boxes?