Repeal and Replace Obamacare? Not Hardly From a Technological Standpoint As It Needs a Model-Nobody Wants to Swap Out Old Glitc
Posted Jan 29 2014 2:22am
Ok so had everyone had enough of Healthcare.Gov and glitches? You want some new glitches to add on? I’m talking flat out reality here with the technology side..have you watched how long it has taken to model and build the ACA with the website being a huge part of it? Did you notice it was not ready for prime time on October 1st? We live in some very complex IT infrastructure times today and thus it’s hard to change and do a repeal and replacement. You can take sections and work on models and revise as it goes along but you can’t rip the carpet out from underneath it as it stands today.
Back when the ACA was crafted, IT infrastructure just a short few years back was much simpler than what we have today. I like to go back to “silos” for development purposes (grin)..but of course we are not going back; however updates and revisions were a lot easier then, why? We were not all connected via the web like we are today. So what you would have here is shoving Healthcare.Gov in reverse and adding on some addition disruption for all, not to mention the time required to hire enough engineers to re-write what ever the GOP modeled..but did they model? With as many financial areas as the healthcare system we built has today, you have to simulate it and create fake data hospital that does billing for example a few fake patients, a few fake doctors, etc. These are all data simulation characters whereby you can “test the computer code” before it goes out. It’s just like making a drug today where a lot of the research is done and simulated on computers before a web lab is ever set up.
I read through this and I didn’t seen any model mentioned. Granted back when Obamacare was crafted we had not so good luck too of the DeParle and Sebelius team …as soon as the math got tough, DeParle left. So their project was taking the verbiage of the law and setting up the technologies, contractors, etc. to do all the work and granted some was delegated and we have heard over and over about how that didn’t work too well with non technologists and their strange perceptions messing it up. You can’t really do that any more without someone having some data mechanics thinking along the line and I think we have it now with a former Microsoft executive and actually Sebelius should be working for him in my opinion as algorithm fairies are part of the issue and her perceptions. I had that with doctors all the time so I know it well and had to explain it is not as you perceive it, you think you do but you don’t really. This is the world we live in, the continuous rise and fall of the machines, insurers built most of the complexities as it would allow greater profits for them.
So there’s some budgets and ideas here in the list below but that’s it, where’s the rest of it? I am just being flat out blunt and telling you what kind work is involved, what kind of time it would take and again, more glitches to ride. Paul Ryan was the luckiest guy around that nobody liked his Medicare voucher program..how do you think folks on Medicare would like a roll out similar to Healthcare.Gov…we know that answer well and thus he’s lucky it died as there was no simulation model there either, just budgets and spreadsheets from what I read and saw. I’m reading these provisions below and going through my head just skimming over I see a few budget and financial models and code that would require some time. Software builds on itself too and we don’t tip and migrate servers much anymore either like we used to.
So there you have it, an idea of what it would be like in the real world to technically tear the whole thing down and hope for a rebuild, could not be done what so ever by any sane contractor or integrator without a model for sure.
So for God’s sake let’s look at things in the real world with time, money, etc. and stop with the insanity of running in with a bunch of spreadsheets of budgets and take into consideration that this needs to be modeled today and there’s a huge complex IT infrastructure attached to all of this.
The algorithm fairies don’t exist and the short order computer code kitchen burned down and there was no fire sale.
I can’t understand why Congress will not restore a tool that is need more now that it has ever been to help them with restoring the non partisan Office of Technology Assessment…and Senator Cruz is the current poster boy, was McCain before.
For goodness sakes get some resources that can help you model or create…what do think everyone else does? The link below will tell you all about it my frustrated rant on how this could really help and we would all benefit!
I was hoping this issue of folks not being able to tell the difference between virtual software worlds models and the real world would get addressed at Davos but that didn’t happen there either and we heard from a VC on Bloomberg this week, Perkins, he can’t tell either where the virtual worlds and real world unite or separate…BD
1) Eliminates the requirement that all citizens have health insurance. And eliminates the basic requirements that the ACA required of any policy. So, that part is back to where we were before.
2) Eliminates all the additional taxes and fees involved in the law which means that the subsequent tax subsidies that help pay for insurance are gone.
3) No requirement to cover people with pre-existing conditions...although people who have had at least 18 months of continuous coverage are eligible for future coverage.
4) While the proposal states that it keeps the ACA "no limits" on lifetime coverage, there is a loophole that allows insurers to begin to impose those limits again.
5) There will be some tax credits for the poor to help pay for coverage. These credits can be adjusted for age (as they are now), but NOT on geography. Which means that geographic areas with higher premiums will NOT get higher tax credits. The credits will be uniform.
6) These tax credits would be available to lower incomes that are 3 times the poverty rate. (The ACA allows credits up to 4 times the poverty rate).
7) Older people would pay more under the GOP plan. Currently, the ACA limits premiums for older people to be limited to a maximum of 3 times what a younger person would pay. The GOP plan raises that ratio to 5 times the rate.
8) Although Medicare coverage would not be changed, the GOP plan revamps the Medicaid program. Limits on funding. Limits on populations. And eliminates the "expanded" Medicaid, which is currently an option for the states.
9) The GOP plan says they are leaving employer based programs alone. However, the limited tax credits, still available, are financed (remember taxes and fees have been eliminated) by taxing 35 per cent of the employer benefit....treating it as additional income to the employee.