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Harold Pollack: Again, this is Curbside Consult. This ... I'm Harold Pollack, talking to Joanne
Kenen.
I do want to mention, by the way, one ... one story which I think is getting way too little
coverage, which is the real human tragedy going on right now among 5 million people
who would be receiving Medicaid, except that they are in a state whose Republican governor
has chosen not to embrace the expansion. And I think that, from my point of view, this
is the most tragic, single dimension, and it's one that has gotten too little attention,
compared to the ...
Joanne Kenen: We've covered it a ton. And I've seen others covering it. I don't know
that every paper around the country has it, but I think there's been a fair amount of
coverage. We've actually had two of our six reporters spend most of their time covering
the states, and we have written many, many, many, many, many stories about both the politics
and ... We actually had a reporter go to some clinics. We're very Washington focused, and
we actually did have somebody go on a plane and talk to poor people.
And the administration's really been hitting that this week. The president went to Texas
the other day, he's going to Florida and Louisiana. In Florida, Rick Scott, is a very, very conservative
governor who's very anti-ACA. He has, in fact, tried and he's really tried ... not just put
out one press release. And he did try to get it through his legislature, and he probably
will continue. In Louisiana, Bobby Jindal's not about to change his mind. In Texas, Rick
Perry's not about to change his mind. We do see a number of other states who could still
go. The Pennsylvania situation is in flux. Tennessee is in flux. Virginia is in flux.
Obviously McAuliffe wants to do it. He can't wave a magic wand. There's a legislative commission.
It's complicated, but you know, it's ...
Harold Pollack: John Kasich almost waved a magic wand.
Joanne Kenen: John Kasich ... and Jan Brewer. Jan Brewer, she's a very conservative Arizonan.
She basically came out ... she had a huge fight with fellow Republicans, and now some
of them were talking about suing her. She got it through, and she got it through on
basically morality and fairness grounds. John Kasich has been saying ... he was the house
budget chairman before Paul Ryan. He's another conservative guy. And he's been making a really
interesting ... what he talks about is a moral case about taking care of poor ... which isn't.
But, you know, it's not like Rick Perry's talking about it. It's been very, very interesting
to watch...
Harold Pollack: That is the part that makes me the most optimistic. Although I fear the
performance failures in the early stages of the website have made it harder to make the
case around the country. If right now this were rolling out really well, then there would
be more pressure across the country to say, "Hey, you know, whatever our former disputes
were, we got to make sure that poor people can get health care." Even though Medicaid
is actually going much better than healthcare dot gov, the overall story is not one that
is increasing the pressure for this critical issue. You've got to do a good job when you
implement government. If your claim is government can help people, you got to prove it.
Joanne Kenen: I mean, if you're a Republican who hated the Affordable Care Act, there are
legitimate governmental congressional oversight questions that both sides are asking. And
they're asking it with, you know, with a different clause after, you know. The Republican says:
"I want to know why hundreds of millions of dollars and this website doesn't work, and
I hate the law." Democrats, are just saying somewhat more softly, "We need to know, too,
about why we spent hundreds of millions of dollars and this website isn't working, and
I love the law."
This is not a made-up political slogan. I mean, this is a very expensive, three-and-a-half
year, hundreds of millions of dollars ... very time you look you get a different number.
We don't really know who was paid what, what the performance bonuses are, who doesn't get
paid until they fix it. I don't know any of that yet, and maybe we won't ever be able
to answer all these questions correctly.
But, yeah, if you think that if your government spends a couple hundred million dollars and
spends a few years and has an army of contractors that they should be able to get a website
that works. The president has an awful lot riding on this whole program, and then to
have it not be able to go forward because a website doesn't work.
Harold Pollack: I bet many liberals around the country find Al Gore's "reinventing government"
initiative a little bit less boring than they thought two months ago. This is ... anybody
who's covered the Pentagon could tell you, certainly hundreds of millions would be a
drop in the bucket if you looked at the F35 program or the F22 program or pretty much
set of letters and numbers that you put together government procurement. We have to find ways
to improve the performance of government in some of these key tasks.
It's a very humbling insight, because those of us who ... There's a number of ways you
can take it. Mike Konczal wrote a great piece where he said, "Is this failure a critique
of liberalism?" He basically says, "Look, if you had a more lefty, more comprehensive
social insurance program, it'd actually be simpler to explain, and much simpler to implement.
I actually think some of the conservative and some of the left critiques are quite consistent
with each other. We have a political process that produces a very kludgy way to do stuff
... that does not execute at the level that it needs to execute at. We see this being
played out.
I must say that the website will work. I'm convinced, personally, that it will work.
Joanne Kenen: We can't be 100% sure it's going to work in time to get people signed up by
January 1st. I just don't think we know that. Is it working better than it was working before?
Yes. Is it working well enough to handle the volume they're talking about? Right now they
say they can get 17,000 applications an hour. Well, that's not the volume that we saw in
the first few days, and that's just that initial step.
They haven't told us the metrics on the other stages of the process, so you know, it's November
8th. There are only four weeks in a month ... I don't know . . . I've talked to people
... I mean it’s all guesswork on the outside ... I've talked to people that said, "yeah,
yeah. We'll be able to get it up." The whole problem is a two-month problem ... I've talked
to people that have said this is a six-month problem.
I am not in the room where these coding geniuses are trying to fix it and I wouldn't understand
it if I was. So I don't know that we know ... and I don't that they know, right?
I don't know that anybody ... it's such a complicated system ... that anybody at this
point know ... they've been working on this logging enrollment stage. They said yesterday
that some new problems had come up. As they get deeper into this complicated system, I
don't know what other cyber brick walls they hit . . . I don't think that anybody ... that even the
geniuses necessarily are completely sure that there's not other bugs in there, waiting to
bite them when they get to that part of the system ... We know that they said their punch
list has hundreds of items and I have no idea of what that means as a non-technical person
in that room.
Harold Pollack: I would say that one of the heartening aspects to a somewhat sobering
way to close out this conversation is what's now happening is all about performance. Do
things work? Are people helped? What is the real experience of people? The debate about
health reform has gone from this 50,000 foot ideological thing to the real stuff. I don't
think it's going to be a 100% success or failure. I tend to think it will be closer to success
than to failure ultimately, but it's the real work. There will be some bugs.
People will emerge with some bug bites on them, but you know, the health system before
ACA was one in which fifty million people were uninsured ... and in which in many profound
ways, the system was failing. As an incremental improvement, hopefully three months from now
we will sit down over drinks and say, "Wow. That was really a tough patch" and we can
begin to see the improvements in people's lives. That's the appropriate test, I think
because.
It's not about partisanship and ideology, although those things are inevitable and important.
It's really about "Can we execute something so that we have a better health system?" I
think this is actually a better place to have that fight than it's been over the past several
years, because it's real.
I want to thank you for joining me. I'll let you go about your day. I really enjoyed this
conversation, and I hope we can have it again.
Joanne Kenen: I would love to. It's been great, and there will be plenty to talk about, and
all I can think of is, wow, it would be really nice to have time three months from now just
to sit down and have a drink.
Harold Pollack: Yeah. As a reporter you guys must all be burning fumes at this point.
Joanne Kenen: Uh yeah. You don't even want to know what I ate for dinner tonight, but
we can leave it on that note.
Harold Pollack: Okay, we will leave it on that note ... on the Lean Cuisine note for
2013.