Advice on health care exchanges

Sebelius, incidentally, is the first daughter of a governor to be elected governor in American history. She has a liberal arts BA and a master’s in Public Administration. The CMS Chief Operating Officer is Michelle Snyder who holds advanced degrees in Clinical Psychology and Legal Studies and Administration. She has been a manager in the HHS budget office and had assignments with the Office of Management and Budget, Congress, the Social Security Administration, and as a management consultant in the private sector.

I’m sure liberal arts majors and management consultants have an important role to play in modern society. That role does not, apparently, include being in charge of a major IT project. Not only are they incompetent to run it, it seems that they are incompetent to appoint someone competent to run it. Personally, I’d have started with Richard Granger,, ex-head of the UK NHS Connecting for Health program that pissed £10-15 billion down the drain for no result. Yes, his track record is beyond absymal – on the other hand, a) he now knows first-hand all the mistakes you shouldn’t make and b) when you announce his appointment the expectations on your project will plunge so low that even delivering a badly-working underperforming system will impress people.

Hopper is of course correct here. She has been known to drink Nick Luke’s beer which is always a sign of intelligence and good sense.

17 thoughts on “Advice on health care exchanges”

  1. “Yes, his track record is beyond absymal – on the other hand, a) he now knows first-hand all the mistakes you shouldn’t make …”

    Ah, if only that were a sure-fire guarantee against making them all over again somewhere new…

  2. Best solution: don’t have government build it.

    Why did there have to be one exchange? Why not just specify rules about exchanges and let private sector companies build them? That’s what we do with car insurance and electric prices – anyone can build a comparison website.

  3. Getting a degree or masters in public admin must be the most high risk study choice?
    What if the monopsony employer decides it doesn’t want you? Noone else would hire you, you’d starve.

  4. Your post was about the implementation of the Affordable Care Act. I’m an American and I suspect that most Brits are somewhat upset with our near default and the government shut down but don’t really understand how it happened. I wrote a summary of the problem starting with how the Tea party was born in the white hot crucible of the over the top right wing lies about the Affordable Care Act. See it at

  5. @bif,

    as a student I pulled pints in a pub in my parents’ home town during the holidays, for pocket money. One of the other bartenders was a little older and had finished his degree, in “local government administration”. I asked why he wasn’t working as a local government administrator, and he replied in all seriousness that the way local government administered stuff had changed since he completed his course, and it was thus difficult for him to get a job administering stuff for local government.

  6. “the Tea party was born in the white hot crucible of the over the top right wing lies about the Affordable Care Act.”

    I thought they were born of racism? Or was that yesterday’s Libtard line?

  7. As a retired long-term computer professional, I can tell that trying to codify crap into a computer system will get you a bad rollout.

    As Obamacare was always intended to destroy private health insurance so the federal government could step in, none of rollout problems are of strategic importance to the Obama administration. At the top, Obama couldn’t care less. Such trivialities can be dealt with by underlings; he’s going golfing.

  8. @ Brian R Baxter
    If you didn’t spew out such a torrent of partisan abuse I might be able to read through to the bottom of just one of your posts (but I just cannot). If you want to oppose Fox News, try some other tactic than copying their worst traits.
    Obamacare will reduce the number of Americans without heathcare insurance: it will not reduce it from 100% uninsured to zero uninsured as your site implies.
    Actually some of us Brits noticed that the House of Representatives passed a Budget. The Democrat-controlled Senate and President Obama triggered the shut-down by failing to pass that budget. It is a convenient lie to say that the Republicans shut down the government: they did not.
    It is quite fair to blame the TEA party for the shut-down but it is lazy to say that the Republicans actually caused the shut-down.
    It is quite a stupid lie to say “the Tea party was born in the white hot crucible of the over the top right wing lies about the Affordable Care Act” since it pre-dated that by several years. Wikipedia states “Al Gore cited the study and said that the connections between “market fundamentalists”, the tobacco industry and the Tea Party could be traced to a 1971 memo from tobacco lawyer Lewis F. Powell, Jr.” Others claim that “that the Tea Party movement emerged from the “ashes” of Ron Paul’s 2008 presidential primary campaign” before Obama was elected “websites such as (registered in August 2008” and that the first protest had nothing to do with healthcare “On February 19, 2009,[88] in a broadcast from the floor of the Chicago Mercantile Exchange, CNBC Business News editor Rick Santelli criticized the government plan to refinance mortgages, which had just been announced the day before. He said that those plans were “promoting bad behavior”[89] by “subsidizing losers’ mortgages”. He suggested holding a tea party for traders to gather and dump the derivatives in the Chicago River”
    The Patient Protection and Affordable Health Care Act was a blatantly partisan piece of legislation – it was so partisan that some Democrats refused to support it until persuaded (aka bribed) by massive subsidies to their constituents, which fired up massive opposition. John McCain had proposed a sensible affordable care act which which have passed quickly with amendments focused on making it work better (right-wing Republications opposing their party leader would have beenb quickly and easily sidelined but Obama, choosing to rub McCain’s nose in his defeat, handed the proposal to the left-wing extremists in his party (Brownites in UK parlance) who put forward legislation that was unacceptable to moderate Democrats even when facing a party whip.
    That is all on the record.
    I find those people who assume that they are so superior that they know everything and that I cannot read thoroughly obnoxious, and despicable. Would you dare call me an illiterate idiot face-to-face? If not, why do you do so on the internet?

  9. It is a convenient lie to say that the Republicans shut down the government: they did not.

    To a point. Congress had previously passed bills mandating levels of spending on particular programs (including the ACA). The proposed House budget would have made it impossible for the government to obey the laws by which it is bound – hence, it wasn’t a serious option for the Senate to pass (the President never had the opportunity to pass or veto it – he signed the only bill he was presented).

    And the idea that the ACA, which continues to give more power to private insurers than any other developed world healthcare system (and which is almost identical to healthcare solutions proposed by federal Republicans and actually implemented by state Republicans such as Romney during the 1990s and 2000s), has anything to do with left-wing extremism is a fanatical, Tea Party nonsense.

  10. @ john b
    A bill so partisan that it is blocked by moderate Democrats and gains not a single vote from moderate Republicans meets the normal definition of “extremist” in that it was proposed by the extreme left of the Democrat caucus and had no support from the centre of the political spectrum. I don’t regard Brownites in the UK as extremist (whatever their other sins) but in the USA their equivalents are at the lefty-hand extremity of the Senate and House of representatives. To smear an advocate of state-funded healthcare with “fanatical, Tea Party” is so ludicrous that it is beyond being insulting.
    “Nearly identical” – for some value of “nearly”,but not the one in common use.

  11. Ignore whatever infighting that it arose from: the *actual outcome* of the ACA is a piece of legislation that is less socialist than Romneycare, and less socialist than the insurance legislation Bismarck passed in 1883.

  12. “Ignore whatever infighting that it arose from”
    When we’re debating whether it is a piece of partisan legislation. You must be joking.

Leave a Reply

Your email address will not be published. Required fields are marked *