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Republicans who are trying to exploit the difficulties with Obamacare's rollout for political gain are, as usual, getting it all wrong. Those problems with "healthcare.gov" don't prove what conservatives think they prove. They're an indictment of the Right's visions of privatization, and of the self-described "political center's" ambitions for Medicare, Medicaid and Social Security.



Lead Republican budget negotiator Paul Ryan says so himself: They want to dismantle Medicare as it exists today and replace it with "Medicare exchanges." Hey, what could go wrong?

That's why I only partially agree with Bill Scher when he says that "liberal journalists shouldn't pile on" to criticisms of the health care exchange websites. Mike Konczal comes much closer to my own viewpoint when he says that the website's problems are an indictment of neoliberalism, that "third way" Democratic Party attempt to reconcile the interests of the public with those of deep-pocket corporate and individual donors.

That approach gives conservative Democrats some common ground with the Republicans. But the neoliberal agenda forces its adherents to package social initiatives in Rube Goldberg-like contraptions, in an attempt to reconcile the ideology of the free market and the interests of powerful corporations with those of the public.

How's that working out for you?

Social insurance, Rube Goldberg-style.

The Affordable Care Act was born, as many people know, in the bowels of the conservative Heritage Foundation think tank as an alternative to the health reforms being proposed by Bill and Hillary Clinton in 1993 and 1994. The Clinton initiative was overly complex because it, too, tried to reconcile the needs of private corporations with the need to provide broader health care coverage.

In that sense, therefore, the ACA can be seen as a streamlined version of the Clinton proposal. But even a streamlined version of a program like this is extraordinarily complicated.

What makes the process so complex? First, a variety of individual insurers must be connected with the government exchanges. Second, their bids must all be assembled and presented to the public in uniform and readable form. As one who designed health systems for insurance companies in a previous life, I can tell you: this process is more complicated than it sounds.

But what makes it especially complicated is the fact that, in a certain sense, healthier individuals are expected to subsidize the cost of caring for sicker individuals, which means the success of the entire program rests on the ability to make enrollment as attractive as possible to them.

Quotes that sell.

That's why it's become so hard for people to get quotes on the exchanges. The "quick glimpse" of pricing that most people would like to get, without having to submit a lot of information, would only show the amount insurance companies will be receiving for their care.

The systems designers wisely understood that this would drive a lot of people away. The system couldn't be designed simply to offer raw insurance quotes. The quotes had to be as low as possible in order to seal the deal. (This process also hides the subsidies which insurance carriers receive from taxpayers, although that may not have been the intent.)

For this reason, designers only wanted them see the rates they themselves will pay -- rates which will often be lower than the "raw" rate, especially for the younger and healthier individuals the program needs to attract.

That complicated set of requirements led directly to the problems we're seeing today.

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