Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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Obamacare: Examination and Response
An appraisal of the Affordable Care Act and-- with some guesswork-- its tricky politics. Then, a way to capture major new revenue, even paying down existing Medicare debt, without raising premiums or harming quality care. Then, an offering of reforms even more basic, but more incremental. Finally, the briefest of statements about the basic premise.

CHAPTER THREE: Sudden Fiasco ,
Of Electronic Insurance

The next thing to happen was Obamacare's computer systems didn't work. And they didn't work, in a big way. It had happened before, notably when Medicare was implemented, forty-five years earlier. But by 2013 everybody in California seemed to be running computers with ease, while the U.S. Government couldn't even get started.

It isn't enough to have a good plan, a President has to have the skill to get big projects executed, even though he cannot be expected to manage them himself, day to day. They may fail, but if they do, he has to protect the nation from the failure, and still project the image that he knows what he is doing. Since almost the same disaster befell Lyndon Johnson when he started Medicare and Medicaid in 1965, it seems fair to criticize Barack Obama for failure to learn the lessons. We therefore begin with a brief anecdote from 1965, followed by general endorsement of the idea underlying the computer bumble of 2013. Our criticism centers on his trying to do too much too soon, which has a lot to do with failure to delegate, failure to verify what has been delegated, and failure to master the government style of procurement.

This problem has not been fixed, even after a frantic scramble for months. If chaos continues too long, it will probably tarnish the public image of a good idea so badly, the public will no longer tolerate trying anything which even sounds like it.

1288 Money Bags

2603 Electronic Insurance Exchanges

2604 Redesigning Electronic Insurance Exchanges

2615 Creative Destruction for Health Insurance Companies

2626 Streamline Health Insurance?

2629 Electronic Medical Record

Originally published: Tuesday, December 31, 2013; most-recently modified: Thursday, July 17, 2014