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The Ripple Effect

  • Posted on December 6, 2013 at 10:00 AM

The Affordable Care Act. When the law was passed, my family was safe and secure in a state-run program that offered families a way to ease off of medical assistance by providing an opportunity to purchase subsidized insurance when they no longer qualified for fully-funded insurance. I’m not entirely sure how this program really worked, because this month is the first time I made enough to be eligible for the transition and the Affordable Care Act killed the program. Now, my choice is Obamacare or bust.

When President Obama first started pushing this legislation, I wasn’t exactly supportive. On the one hand, we really do have a problem in this country, so there was a part of me that really wanted it to work. On the other hand, this legislation doesn’t do anything to fix the problem, because, as the system stands, healthcare cannot be “affordable” for providers and insurers and the people. Somebody has to lose out on that deal. Seeing as the major supporters of the legislation included providers and insurers, I suspected that the people would be the losers, no matter what the President and his supporters claimed.

When initial estimates for Wisconsin residents were released, all the evidence pointed to the people being the big losers. Recently debated figures indicate a rate increase of 10-185% due to the legislation that makes health insurance “affordable.” Since I cannot afford health insurance independently, my only hope of providing my husband and me with adequate coverage is to hope and pray for adequate subsidies (my children are still covered through Wisconsin’s disability-related insurance program). The only way to access those subsidies is to go through the program run by the federal government.

This is all the more complicated by the very unsuccessful roll-out of the new website. When I discovered that I would be forced to use President Obama’s hallmark legislation to provide my husband and me with insurance, I was also taking a class about the crossroads of technology and public administration. Let’s just say that the disaster that is seems so much worse when you’re actually informed and leave it at that. Okay, I’ll throw this in too: After discovering how important online security really is, I really have no interest in loading up confidential financial information on a site that hasn’t passed its security tests because those tests were deemed too time-consuming under such a tight deadline.

The problem is that I don’t have any good choices. I can either go without insurance, which means my husband will go without prescription medication, or I can let the federal government take even greater control over my life. Either I pay a penalty for having no insurance or I pay more than I can afford for insurance that I cannot afford to use effectively. The only other option is to give up the freedom of self-employment in favor of a job that will provide insurance I can actually afford, if there are any employers who can still afford to provide insurance to their workers after this whole mess shakes out.

The Bureaucratic Failing

  • Posted on February 11, 2011 at 8:26 PM

Human societies have this nasty habit of needing something long before they figure out how to meet that need.  The need creates the motivation to fulfill that need, which, by necessity, means we hurt until that need is filled.  The hurt grows until it motivates us to develop the means to meet the need.  This is a natural, normal process which has led to a great deal of human progress.

Bureaucracy is one socio-technological system we’ve devised to meet certain needs, mostly related to managing the volume of work created by our massive societies.  In theory, bureaucracy is efficient.  In reality, bureaucracy often sacrifices effectiveness for efficiency by divorcing decisions from reality.

Consider health care:  Many of us believe health care is a basic human right.  From a social justice perspective, I would agree.  It is unjust to have health care and not to disperse it to the whole population.  From a more pragmatic perspective, the idea is problematic.  The freedom of speech, the freedom of ideas, the freedom of association—these are basic human rights.  Health care cannot be a basic human right any more than food or education can be a basic human right.  You see, from a pragmatic perspective, the freedom to communicate, share ideas, and choose with whom we associate requires others not to hinder us.  Whereas, the supposed rights to health care, food and education requires others to provide for us.  These are two very different concepts.  On the one hand, the freedom to communicate would best be described as a right we naturally have unless we are deprived of that right.  Whereas, health care would be best described as an entitlement we’d like to claim.

Furthermore, providing these entitlements require us to be technologically advanced enough to develop systems that can effectively provide these goods and services.  No such systems exist.  We have health care systems, but they do not provide health care goods and services to everyone.  We have food systems, but they do not provide food to everyone.  We have educational systems, but they do not provide education to everyone.

To help compensate for the lack of an effective system, we use bureaucracies to allocate limited resources.  These bureaucracies choose who gets what goods and services.  Currently, our health care system relies on a hodge-podge of bureaucracies with different goals.  There are federal bureaucracies that regulate the resources themselves—further limiting the resources that are available in attempt to ensure those resources are safe for use.  There are federal and state bureaucracies that provide limited resources.  There are private bureaucracies that provide limited resources for profit.  There are private bureaucracies that provide limited resources without the pursuit of profit.  There are federal and state bureaucracies that distribute access to the limited resources that are available.  There are private bureaucracies which distribute access to the limited resources that are available for profit.  There are private bureaucracies which distribute access to the limited resources that are available without the pursuit of profit.  In effect, these bureaucracies are often at cross-purposes and make a mess of things.

These cross-purposes make a mess of things all by themselves.  This mess is exacerbated by the fact that the nature of a bureaucracy often sacrifices effectiveness for efficiency by divorcing decisions from reality.  You see, in a bureaucratic system you have someone sitting at a desk with a piece of paper or information on a computer screen.  That person has to make a decision based on that information.  This person makes hundreds of decisions like this a day.  It’s a job.  It can be a tedious and thankless job.  That decision is influenced or dictated by decisions made by other people sitting at other desks.  None of those people are connected to the provider or the recipient.  The decision is divorced from reality.  For the decision maker, the significance of the decision resides in how it will affect the person’s job, not in how it will impact the provider or the recipient.  The real impact of the decision is unknown and unimportant to the person responsible for making it.

That is our system.  That will remain our system after Obamacare is enacted.  To solve our problems, we need new systems that can supply the entitlements we’re demanding.  Obamacare doesn’t do that.  Right now, we lack the technological sophistication to do that.  In the meantime, while we’re waiting and hurting for the progress that will make that possible, to satisfy the requirements of social justice, we need to dismantle the broken systems and replace it with systems designed to meet the needs to the best of our abilities.  Obamacare doesn’t do that.  The system itself is broken and Obamacare adds layers of bureaucracy to a system already broken by bureaucracy.  Bureaucracy is the best we can do, because we haven’t devised something better.  But Obamacare is not the best we can do.  Obamacare complicatedly adds more cross-purposes, not fewer.  Obamacare further divorces decision makers from the people their decisions affect.  And, worse still, Obamacare turns the entitlement we want—that which we want to be provided—into a legal obligation we cannot avoid.  It gives more power to the government.  It takes away the freedom of choice—the choice not to pay into a broken system—and forces people to entrust their health care into the hands of bureaucrats who are, of a necessity, divorced from their reality.