Our U.S. Secretary of Health, Kathleen Sebelius, apparently does not live in the world that you and I inhabit. In her world, healthcare.gov - the federal platform for enrolling Americans in Obamacare insurance - is "simple and user-friendly."
She apparently lives in a universe where magical thinking works, or maybe with Alice In Wonderland (Lewis Carroll, 1951) where, "Everything would be nonsense. Nothing would be what it is because everything would be what it isn't. And contrary-wise; what it is it wouldn't be, and what it wouldn't be, it would. You see?"
In our world, the real world, the roll out for online purchase of mandated health insurance is a nightmare, a "riddle, wrapped in a mystery, inside an enigma," (Winston Churchill, 1939).
As I am (a) the consumer advocate on the Board of Directors for our State (NM) Health Exchange; (b) a physician as well as a systems theorist; and (c) have a reputation for speaking simply rather than in political-speak, I got three separate calls for telephone interviews from reporters in three different States.
Interestingly, each reporter had first attempted to use the federal platform -- healthcare.gov -- before speaking with me. Their experiences were similar to what millions of Americans went through. The system was "absolutely incomprehensible and effectively opaque" said one. In essence, the feds' governing principle was, "Average American: don't bother yourself trying to understand our impossibly complex scheme. TRUST ME! I am doing what is best for you. Just sign on the dotted line and give me your money."
Two of the reporters, both quite savvy with computer programs and online searches, timed out trying to understand what was available or even possible, and how much it would cost them. They stayed On Hold "forever, it seemed." No one ever spoke with a knowledgeable, helpful human being. They got phone trees, menus, more menus, and cul-de-sacs. Each person waxed eloquent about how user-unfriendly the site was.
Each reporter asked me what I thought about this, and what was happening in New Mexico, which is the only true hybrid Exchange in the nation? Governor Susana Martinez, quite wisely in this author's opinion, chose to set things up so that the New Mexico Health Insurance Exchange (NM HIX) would take care of SHOP-only (Small business Health insurance Options Plan) for the first year of operation. During 2014, we are deferring the individual market to the Washington-created Exchange called healthcare.gov. The NM HIX -- at bewellnm.gov -- would take over the State's individual market in 2015, while continuing our SHOP.
New Mexico businesses had no serious glitches signing up. Average wait time on the phone was less than 120 seconds. Every caller spoke with a human being, and 524 businesses purchased insurance easily, in one case saving more than $1,000/month over what it had previously spent.
Elsewhere, the exchange in Maryland was just as confusing and dissatisfying as the federal platform on which it was precisely modeled. People in Alabama found their choices on their State Exchange -- precisely modeled on Obamacare just like Maryland -- limited in the extreme.
I expressed to each reporter my fear that if the federal exchange failed, we -- the NM HIX -- would be blamed even though we were not responsible or in control. My worry was unnecessary. New Mexicans gave us kudos for their facile, satisfying sign-up experience for small business and laid the blame for the failure of the individual market where it belonged -- in the Beltway.
The approval rating for Congress is currently 10 percent with 87 percent (!) of Americans disapproving of their performance. If you need to ask why, the Sebelius press conference of this week is a good demonstration. Of course, you can just recall our president promising you could "keep your doctor if you like him," without admitting that Obamacare will likely force your physician to quit practicing medicine (as I did).
Our elected officials tell us one thing. Our experience tells us the opposite.
My new book, The Cancer In Healthcare, emphasizes the aphorism, "Look, Don't Just Listen." This means you must never take on faith what anyone says or writes, even or especially if they have a big title. "Look" means verify for yourself: consider the evidence, then you decide. As millions of Americans listen to Secretary Sebelius and then try to confirm her veracity by purchasing insurance through healthcare.gov, they experience a disconnect. What they are hearing is not what they are experiencing. Therefore, what they are hearing is not true, no matter how high-minded the official statements sound from the White House and its Secretary of Health.
Unless, of course, Sebelius is talking about some alternate universe.
Deane Waldman, MD MBA, is the author of just-released The Cancer In Healthcare, described as the first step in healing Healthcare. Dr. Deane is a retired pediatric cardiologist, a systems theorist, and serves on the Board of Directors of the recently created (May 2013) New Mexico Health Insurance Exchange.