Medical Costs Bankrupt Patients; It's the Computer's Fault 637
nbauman writes "Don't get cancer until 2015. The Obama health reform is supposed to limit out-of-pocket costs to $12,700. But the Obama Administration has delayed its implementation until 2015. The insurance companies told them that their computers weren't able to add up all their customers' out-of-pocket costs to see whether they had reached the limit. For some common diseases, such as cancer or heart failure, treatment can cost over $100,000, and patients will be responsible for the balance. Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs? 'A senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: "We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person's out-of-pocket costs. They asked for more time to comply."'"
A cynic's view (Score:5, Insightful)
The rollout is being delayed until after the 2014 congressional elections. The problem is political, not technical.
What a sick system (Score:5, Insightful)
It's just another example of bought and paid for politicians sucking the dick of corporations. The famous words "of the people, by the people, for the people" are such a sick joke if you look at the USA government. Coming from a country that covers 100% of such common procedures, I just can't imagine how people can live like that. And Americans still think they have the most superior country in the world. America! Fuck Yeah! Please stop spreading your ideas of freedom to the world and try spreading those ideas at home instead.
Re:Computers can't add? (Score:2, Insightful)
How the heck does this happen?
Technical people don't understand politics.
Re:A cynic's view (Score:5, Insightful)
A cynic would also know that billing system software is some of the most byzantine crapware on the face of the planet. It's hacking on this kind of software--plus payroll, HR, accounting, etc--that sustains both Oracle and IBM, plus thousands of smaller consulting firms.
So, the administration's excuse is both plausible and fortuitous. In other words, I doubt the insurance companies had to twist the administration's arm to postpone the mandate and cap.
Paver Stones on the Road to Single-Payer (Score:3, Insightful)
Which is what Obama has wanted since day one.
1) Pass a bunch of rules with an unreasonable compliance schedule that no insurance company on Earth could hope to meet
2) Blame insurance companies when the new "free healthcare for all" law fails miserably
3) Use it as an excuse to ram single-payer down everyones' throats
4) Government now has the power to decide who lives and dies, based on political ideology, which is what leftist despots like Obama want.
Re:A cynic's view (Score:5, Insightful)
A cap on out of pocket expenses means the insurance company has to pay more.
Where will they get that money? They'll get it from higher premiums.
Forcing people to pay higher premiums just before the election would look bad, hence the delay.
Re:What a sick system (Score:0, Insightful)
I know what you mean. The system in the USA preys on its weakest members instead of helping them. Honestly I can't see how thinking Americans can sing their own national anthem without wanting to puke.
Re:Paver Stones on the Road to Single-Payer (Score:5, Insightful)
6) Having someone in the family get a very nasty, expensive disease no longer ends in bankruptcy. Which means the rest of us continue to pay for it, but the afflicted family isn't ruined. As we live longer and eat more crap, this begins to affect almost everyone.
7) We quit talking about health care as though it should be less important than police or roads or a standing army - things we already care enough about to devote tax dollars to.
Re:A cynic's view (Score:5, Insightful)
What they are really saying is "We want to delay this for as long as possible so we can keep maximizing our profits".
Compliance time linked to the punishment (Score:5, Insightful)
Businesses exist to maximise profits, all profits, even those derived from delaying compliance activities. It becomes a simple cost benefit case. Is it cheaper to pay some politician's wage and go moan about how hard it is for your one programmer to re-write the software within a timeframe, or is it cheaper to simply hire the right number of people to do the job properly and quickly.
The answer is nearly universally the former. Major companies (not just healthcare) will rather moan about how hard done they are by the government than actually step up to comply with the new regulations. If a large fine is linked with non-compliance they'd have the software modified by the end of the month.
I've seen similar cases in industry too. Companies will replace truly horrendous parts of their plant like-for-like because installing what they want is tied with meeting the new standards of the day rather than the easier standards of when the equipment was originally designed, and thus we have a plant basically half replaced as new with no gear that meets any modern emission standards.
There's simply no motivation to go down the more expensive route.
Re:A cynic's view (Score:3, Insightful)
Re:Just curious (Score:2, Insightful)
By what legal authority did Obama delay this implementation?
None.
But then again, what legal authority did he (or HHS Secretary) have for:
None are legal because the law itself doesn't give anyone the power to change it willy-nilly, as each changes the law without the necessary legislation to modify the existing law.
jerry
Re:Competition, not regulation (Score:5, Insightful)
The USA health care system has some of the worst possible perverse economic disincentives. At literally no point is there a clear economic incentive for you to be healthy and taken care of.
1) Consumers have no interest in keeping costs down. They pay the same deductible no matter what happens. Unfortunately, this is only up to a point (see #4 below) but that's not going to enter casual consideration.
2) Hospitals have no interest in keeping costs down. They blatantly inflate their costs knowing that the insurance companies will only pay a fraction anyway. They also have no incentive to keep supplies costs down since they are paid "cost +" by insurance companies. They'll tend to buy whatever sponge or soap dispenser is in "the catalog".
3) Providers of supplies to hospitals have no interest in keeping their costs down. Hospitals get paid on a "cost +" basis by the insurance companies so charging $35 for that "medical grade" sponge that cost them $0.35 wholesale has 99% profit margins as its incentive.
4) Insurance companies have some incentive to keep costs down, which they generally do by axing their most expensive customers with any of the myriad of technicalities written into their eye-gouging 10 page contracts full of inverted double negatives and exceptions. A good example is somebody with a job who gets cancer. Sure, he/she may have excellent health insurance, but what about when he/she loses his/her job because they didn't show for four months while undergoing chemo therapy? Even so, the myriad of regulations in place (and a legal department that ensures that one plan can't be compared to another) provides an opaque enough service offering that customers are unable to distinguish which plan is actually "cheaper".
5) Doctors had to just about kill their mother to get through medical school, and are saddled with enough debt to make anybody contract stress-related symptoms. Since they get paid for the work they actually perform, they have every incentive to declare a medical emergency and take you under the knife, regardless of whether or not it's necessary or even beneficial. I'm not saying every doctor will give you heart surgery when you come in with a rash, but I'm not alleging something that doesn't happen [nytimes.com]. Citation 2 [usatoday.com].
The majority of bankruptcies in the United States are for medical reasons [cnbc.com], and the majority of *those* are by people who had health insurance at the time they got sick. Anybody who says this ridiculous would-be-laughable-if-it-wasn't-true system is lying or misinformed.
Re:Dear merica, (Score:2, Insightful)
Typical 'merican outrage over a perceived yet fictional generalization. Face it middle America, you will never be rich so stop blindly supporting policies you think will some day benefit you. You are only hurting yourself. The lazy American sucking off the tit of society that you are so scared of is either you today or you in the near future. You are unsophisticated, undereducated, and unprepared for the future and that is just the way they want you and imaging, chances are, you live your life through part of the 60's. You had the great privileged to experience some of America's fat years, as long as you were white and somewhat educated. Those days are not coming back and your children will have an ever increasingly hard time.
Re:A cynic's view (Score:5, Insightful)
Oooo, ooo. Pick me teacher. I can solve this one (Score:5, Insightful)
Face it, health 'insurance' made since when the only thing a doctor could do was a) amputate and b) give out aspirin. It didn't matter that they only did a few big things that were mostly comfort before you died. Now we want to _use_ insurance. Insurance can't be profitable if we're all going to use it. The entire _point_ of insurance is that most of us aren't going to use it.
It's like hurricane insurance in Florida. Good luck buying it.
Re:Paver Stones on the Road to Single-Payer (Score:5, Insightful)
It's not such a great idea to remove personal accountability.
You get cancer, it's your responsibility. Can't pay the bills? Then don't get cancer.
You get crippled by a drunk driver who speeds off and is never caught? It's your responsibility. Can't pay the bills? Then don't get hit by a drunk driver.
Leg blown off in a terrorist attack? It's your responsibility. Can't pay the bills? Then don't go to spots that terrorists want to blow up.
Oh, that happened to you? So sorry, here's a bailout because you had personal accountability. Enjoy your long life!
I love the "personal accountability" line. It's simply a nice way of saying "not my problem - fuck you".
Re:A cynic's view (Score:5, Insightful)
Most projects are overdue and over budget because of two reasons: mission creep, and poor systems analysis in the first place. When have you heard of one that was on-time and under-budget? People would look at it with furrowed eyebrows, like-- what's wrong with it? When's it going to break? Are we throwing good money after bad?
Who's to blame? We are. We as coders and analysts let people get their way, rather than making them pay for 20-20 hindsight. We do poor QA, and things break and require fixing. We make things complex and hard to sustain workloads, while other teams sit on their thumbs and play online.
But this mission is about your health and mine. The date will continue to sag until someone says (probably a Federal judge): this date or $100,000/day. Until then, each date is squishy, and the code is squishy, and everyone will wring their hands about what to do. No one wants to report a bad couple of quarters while they burned serious money on systems upgrades. But eventually, everyone has to do it. Will it make cloud brokerage better? Someone designs a killer app and OEMs it to insurance companies so they can comply?
Nah, no one's that smart.
Hey Benioff-- ya listening?
That's the beuaty of it (Score:5, Insightful)
But far be it from me to let a little thing like facts and the failures of the US healthcare system get in thy way of irrational fear mongering perpetuated by a multi-billion dollar insurance industry. Viva la death panels (well, the private ones anyway)
Re:A cynic's view (Score:5, Insightful)
Not cynical enough. In large, old companies there's software running key parts of the company that they don't have source code any more, or that they can't recompile because even with source they don't have the ancient compilers, etc., or if they have source and tools, nobody remembers the code and it's undocumented, etc. - all of which means that there's tons of code that's "frozen in time" and all they can do is write layers on top of it.
They'd love to blow the code up and rewrite it. The problem is the work required to reverse engineer whatever the code does. Keep in mind that they're heavily regulated, and whatever they're running now is approved. So if they blow it up and rewrite, they have to spend years figuring out what it all does well enough to recode it, then do so, then validate it as supporting every line of business under every ancient contract they've ever signed, then re-certify it with whoever approves their SOX/HIPPA/etc., stuff. And they have to do all of that while continuing to run the business, so both systems have to run in parallel, creating huge piles of extra work for everyone in the business, doing double entry, reconciling differences, etc. At infinite cost and business risk that nobody will sign off on.
So instead, they keep running ancient software, and writing layers on top of layers. It's horrible, but it's that way for a reason.
Re:Oooo, ooo. Pick me teacher. I can solve this on (Score:5, Insightful)
Yeah, ever so much better to let a vastly overpaid CEO make that decision.
Re:No so much (Score:5, Insightful)
BTW, what was this basic "human right" again? I can't seem to place it from what you're saying. You've just been yacking about "socialized health care".
Question: Do you believe that someone without insurance, or who otherwise has no ability to pay, who is suffering from an acute medical emergency, should be turned away from a hospital emergency room and left to die on the sidewalk?
If the answer is "Yes," then you're some kind of barbarian, and we're done here.
If the answer is "No," then I've got some even worse news for you: we already have "socialized medicine." The patient will, in fact, be treated, and you and I will, in fact, pick up the tab. It just costs us several times more than it would in any other civilized nation on Earth, because unlike those nations, we insist on kidding ourselves.
Re:That's the beuaty of it (Score:5, Insightful)
Re:A cynic's view (Score:4, Insightful)
Let me address your thoughts:
Coders working on teams have a responsibility to themselves and their teams to interact with others in such a way that the job gets done. There are lots of management problems, PHBs, and others that can get in the way, but ultimately, code is crafted by coders. If you can't do a resonable job, get out and keep your integrity. Yeah, you have to eat. I'd rather eat sparsely and sleep at night than the reverse.
If you don't interact successfully with analysts, the same problem occurs. If you're a coder with reasonable skills, and you understand your code's place within infrastructure, than you have the nexus to tell analysts where they're wrong or need improvement. Lacking that, it's also irresponsible to, having warned, to render the expectation that results will work.
And you might be wrong. But without voicing this legitimately, projects become blackholes, code doesn't fit the efforts of others, QA gets testing roadblocks, and the timeline creeps ever more.
There are big differences between solo efforts and team efforts. Team efforts require a lot of flexibility, but importantly, keeping an eye on the goal. Do that, and the end result is more easily calculated and executed by all, rather the mercurial results often achieved-- if they are, at all.
I'll concede that management expectations can be ludicrous. But if you tell the truth, you'll also achieve it.
Re:A cynic's view (Score:4, Insightful)
50 states worth of independent regulations
Honestly, I'm a big fan of federalism, but it really does create MAJOR problems for automation. I'm working on a software application that deals with international shipments and you have the exact same problem but on a national scale.
At any time some small African nation can issue a regulation, perhaps by sticking it in the classified section of the national newspaper or putting it on display in the national library or something, and make it effective in a week. The regulation can specify anything that you can communicate in the local written language. Now your fancy automated system will be out of compliance unless the logic is changed and deployed to production within a week.
Sure, there are better ways of solving the problem and worse ways of solving it, but no matter how you slice it there are a bazillion inconsistent rules that you need to follow. State sales tax is a great example of this. If it were just a matter of having a DB of 9-digit zip code vs tax rate it would just be a huge pile of work. However, in addition to the rate varying by location, the kinds of items it applies to also varies. So that means a zip code table for every item in your catalog, and then some means to update all those tables every time some local town council changes their mind on whether an umbrella is an article of clothing or a household good, and what exactly is and isn't an umbrella.
Re:Single payer means single choice (Score:3, Insightful)
When there is only one payer, they control absolutely what things they will choose to pay for.
And you honestly don't think this happens today? Seriously?
Make no mistake: There are death panels in existence right now, this very moment. They work for the private insurance companies, doing their damned best to figure out how to kick people off of insurance rolls and rescind coverage for whatever reason will legally scrape by. Or even illegally, if they think that it would be cheaper to fight the battle until you die than to pay out your claim. The big difference is that today, you frequently don't find out what's not covered until after you're sick and need the coverage.
You don't trust government, I get it, I really do. And to some extent, neither do I. But you know what I trust even less than government? For-profit companies with a perverse incentive to deny you coverage you're paying for using whatever underhanded tactic they can and an historical willingness to do so, especially when the people being denied coverage don't have time or the money for a protracted legal battle and are at a physical or mental disadvantage that directly impacts their ability to fight such battles.
So yeah, I'd take a single-payer system over the crappy system we have today any time. Ultimately, that is the solution to our health care system, not private insurance, not employer-paid insurance, not even Obamacare, although it's a hell of a lot better than what we had. Maybe one of these days if you have the gut-wrenching experience of watching your mother fighting her insurance company for payment of cancer treatments while suffering from the "downtime" effects of chemotherapy, you'll prefer the general incompetence of government over the outright malice of for-profit insurance companies. Personally, I'm nice enough to rather you use common sense to arrive at the conclusion that having for-profit insurance companies responsible for funding your health care is and always has been a dumb idea.
Re:A cynic's view (Score:2, Insightful)
No you are wrong.
The problem is that their old crappy systems are old and crappy because it helps them to not pay claims.
Seriously. THEY WANT OLD SHITTY SOFTWARE.
Experienced first hand. Insurer failed to pay claims at hospital in it's network "Sorry, your doctor is not in network."
Yes she was, hell, they payed earlier claims. I got that sorted out and they 'fixed it' then it was 'sorry, new doctors are only loaded on the weekends, call back next week.' called next week 'sorry, they must have missed the cutoff for the load, call back next week'
Rinse and repeat until it gets resolved after 2 months (no kidding), then next time it all happened again. I was told that they updated the system and some doctors did not import and then they pulled the same 'weekend load' crap over and over again.
It is all a game to get old/stupid/rich/clueless people to pay out of pocket for things that should be covered and to hang on to money from the motivated as long as possible to improve their cash position and earn interest on the money they are not paying out properly.
They are thieves, fraudsters and murders.
Every other country does it better for half the price, so obviously our system is broken. No further stats or discussion needed.