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Medical Costs Bankrupt Patients; It's the Computer's Fault 637

Posted by Soulskill
from the i-blame-the-schools dept.
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."'"
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Medical Costs Bankrupt Patients; It's the Computer's Fault

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  • A cynic's view (Score:5, Insightful)

    by mariox19 (632969) on Tuesday August 13, 2013 @08:00PM (#44559723)

    The rollout is being delayed until after the 2014 congressional elections. The problem is political, not technical.

    • Re:A cynic's view (Score:5, Insightful)

      by Anonymous Coward on Tuesday August 13, 2013 @08:12PM (#44559841)

      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.

      • Re:A cynic's view (Score:5, Interesting)

        by gander666 (723553) * on Tuesday August 13, 2013 @08:18PM (#44559891) Homepage
        This.

        The mess is deep and wide, and likely still has some duct tape applied to cover up the Y2K transition. Many/most of these systems are ancient, and creaking under their own mass.
        • Re:A cynic's view (Score:5, Interesting)

          by cusco (717999) <brian...bixby@@@gmail...com> on Tuesday August 13, 2013 @08:37PM (#44560105)
          The last time I had to deal with the insurance programs they were nothing more than a web GUI hiding a dumb terminal interface. Most are still on mainframes.
          • Re:A cynic's view (Score:5, Interesting)

            by AK Marc (707885) on Tuesday August 13, 2013 @09:26PM (#44560493)
            Sadly, the reason we can't comprehend the problem is that nobody will make intelligent decisions. With "only" 300,000,000 records, and probably not more than 100 q/s (which should be restricted to UID, as privacy is important), the thing could run on any of a number of cheap and ubiquitous databases. Use off-the-shelf querying programs for reporting. Standards-based interfaces, and require other systems connect in standards-based ways. Instead, we have ancient systems built in the '70s and such on unusual languages with proprietary interfaces, and everything new needs to connect back with the old interface. When 30% of your systems are big-endian and 30% little endian, and 30% some bastardized undocumented middle endian (just making up a worst case, hopefully it's wrong), integration costs are large.

            Burning the place to the ground and starting over would be cheaper. The problem is they never figure that out until after the first hundred billion dollars are spent. And the bigger problem is when they do burn it all down and start over, the never remember to lock the politicians in first.
            • Re:A cynic's view (Score:5, Insightful)

              by jamstar7 (694492) on Tuesday August 13, 2013 @09:56PM (#44560675)
              Problem is, insurance companies as well as financial institutions HATE to spend money unless it's on executive perks. If it ain't broke yet, it don't need replaced. No matter how obsolete or kludged it is, if it still works, it'll be kept around. That's why the Y2K 'bug' had them so freaked out, they were using old COBOL software from the Stone Age that kept working, and they didn't want to spend money to upgrade.
              • Re:A cynic's view (Score:5, Informative)

                by MoneyT (548795) on Tuesday August 13, 2013 @10:22PM (#44560851) Journal

                Part of the reason for the resistance is lost institutional knowledge. These are old systems, probably poorly commented and poorly documented. They've been modified and patched a thousand times over to handle corner cases, odd hardware based bugs, new interfaces, new regulations and new laws, as well as mashing with new insurance companies, new plans, old plans, outdated data and new data and 50 states worth of independent regulations. How much money and how much time do you suppose it would take to rewrite that entire 30 year history, including refactoring all of the data such that is accessible back to the beginning, in a modern language, with modern technologies and can guarantee that it is 99.99% exactly the same functionality for all possible input combinations?

                For reference, the state of North Carolina recently overhauled their Medicaid billing system. They are months and billions of dollars behind in payments from this change over, and the project was already over due and over budget.

                • Re:A cynic's view (Score:5, Insightful)

                  by postbigbang (761081) on Tuesday August 13, 2013 @10:31PM (#44560903)

                  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?

                • Another factor in all of this is the general lack of interest in the open source community when it comes to nuts and bolts accounting software. There are several reasons for this in my estimation. First, many developers work on this kind of software in their day jobs and the prospect of spending what little hobby time remains on bean counting software just isn't very exciting. Second, the small and medium sized business market for this type of software is already well served with off the shelf retail produc
                • Re:A cynic's view (Score:4, Insightful)

                  by Rich0 (548339) on Wednesday August 14, 2013 @09:16AM (#44563783) Homepage

                  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:A cynic's view (Score:5, Insightful)

                by laird (2705) <<lairdp> <at> <gmail.com>> on Tuesday August 13, 2013 @11:05PM (#44561085) Journal

                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:A cynic's view (Score:5, Informative)

              by Anonymous Coward on Tuesday August 13, 2013 @10:09PM (#44560771)

              Just so you know, every time you write a check in the united states, the format that it needs to get converted into follows the x937 spec. Each record is in ebcidic but requires a big-endian record header except for the records with image data in them, where the image data is required to be little-endian. The medical systems running our nations hospitals make banking look sane.

              There's your 10 minutes of terror for the day.

              • funny ebcidic story (Score:3, Interesting)

                by Anonymous Coward

                back in 1995 I was working for a larGe TElco when my director called me into her office and instructed me to go down to Hartsfield (ATL airport) & pay the walk-up fare to get on the next flight to Raleigh b/c they couldn't process commissions & the SE sales reps were revolting ("you ain't kiddin' - they stink on ice" - sorry, couldn't resist). I immediately knew what problem was (well, 99+%) but felt conflicted so called (then) girlfriend (now wife) and said: "${DIRECTOR} just told me to get on ne

            • Burning the place to the ground and starting over would be cheaper.

              I see a grasshopper who prefers the fire to the pan. The (few) systems built in the seventies that are still in use today, are here for one reason only, the stability and predictability imparted by 40yrs of field testing and maintenance, it's the "if it ain't broke don't fix it" rule in action. Different interface standards are not the root problem (middleware exists to solve that maze), the root problem is the difficulty of extracting the currently embedded business rules from the existing code. Why would

              • Re:A cynic's view (Score:4, Interesting)

                by usuallylost (2468686) on Wednesday August 14, 2013 @08:49AM (#44563537)

                Because the customer's first requirement will be that the new system comes up with the "same numbers as the old system" (even if they are wrong).

                That is the truth there. At one point in college I worked at a place where they had a legacy accounting system that ran on ancient mainframe that it was becoming incredibly expensive to keep running. They were unable to get it to function properly on any other hardware. So they finally gave up and reimplemented the system on what was then the latest and greatest hardware using modern programing techniques and languages. The software in question implemented an incredibly complicated set of rules to various transactions. They spent a fortune having people go through the old code, as well as the original source documents, to map what all these rules were. Just one problem, in some cases the new system would sometimes come out a few cents to a couple of bucks off from the old system. This on transactions frequently in the multiple, or even hundreds, of millions of dollars. The end result of that was that for the entire time I worked there they had to enter everything into both systems. Last time I talked to anybody from there they were still doing that. All the while the organization has spent a fortune trying to find out why the numbers are different. That is despite the fact that as far as they can tell everything is implemented exactly right in the new system. So there is every possibility that it is the old system that is wrong. Management just can't accept that and take the leap of faith to declare the new system right and move on.

        • Re:A cynic's view (Score:4, Interesting)

          by TapeCutter (624760) on Wednesday August 14, 2013 @05:44AM (#44562659) Journal
          Having worked on these kind of systems I'm sure the code is a dogs breakfast, but changing financial rules isn't something unexpected, it's practically an everyday occurrence in a large corporation operating across multiple jurisdictions. Two years to debug and fix y2k was reasonable considering most legacy code did not envision operating beyond 1999, and the herculean task of regression testing required for some systems, even though most systems only had a few lines of code changed. Two years to add a fairly straight forward line item to an account sounds like 'top floor' politics to me.
      • Re:A cynic's view (Score:5, Insightful)

        by KernelMuncher (989766) on Tuesday August 13, 2013 @08:33PM (#44560051)
        Even with these complexities if the insurance companies really wanted to cooperate, the could add up the out of pocket costs and when it was >12,700, just stop and exempt the person. But obviously that would cost them money so they throw up the "technical difficulties" flag and say it's impossible.

        What they are really saying is "We want to delay this for as long as possible so we can keep maximizing our profits".
        • Re:A cynic's view (Score:5, Informative)

          by profplump (309017) <zach-slashjunk@kotlarek.com> on Tuesday August 13, 2013 @09:24PM (#44560471)

          You'd be amazed how difficult it actually is to track accumulated values (like out-of-pocket payments) in most insurance software. It's not just "SELECT SUM(claims.oop) WHERE claims.member = X" -- it should be, but it's not. And the process in place is so fragile that any change at all might well break the whole thing.

          There's also the problem of the system not being able to accommodate things like a legislative limit that's different from the contract limit, or a contract that changes after initial implementation -- if you don't assign a new group number to the members you can't apply new limits to them. And you can't assign a new group number without a new contract entry. And there is no new contract because the change was legislative not contractual. And you can't just update the old policy entry because it would apply retroactively to all old claims.

          It's all stuff that any one with 2 credits in database administration could fix in like 4 minutes, but it's all baked in to 40 years of COBOL, intermixed with business logic, writing fixed-width data to ASCII "tables", and no one is willing to risk changing anything unless God and his wife both sign off on it.

          • by rsilvergun (571051) on Tuesday August 13, 2013 @10:06PM (#44560749)
            just do away with insurance companies and switch to single payer. We all need health care to live and stuff. What we don't need is a middle man that adds no value between us and our doctors.

            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.
            • by MightyYar (622222)

              What do you mean switch? We already have Medicare/Medicaid, and 1/3 of the uninsured go into those programs under Obamacare.

              • lots of states will not opt those people in. Lots more will use lies and subterfuge to keep people off the roles. Arizona does everything it can to disqualify people. I've got friends with kids on the local medicaid program that have to report birthday money from granddad as 'income'...
            • Face it, health 'insurance' made since when the only thing a doctor could do was a) amputate and b) give out aspirin.

              On the contrary, health insurance only "made sense" because during World War 2 businesses were prohibited from increasing wages to attract workers (because it would increase costs of material for the war effort), so they started offering employer-sponsored health insurance instead. Once the war ended, the idea stopped making sense again (but stuck around anyway).

        • Re:A cynic's view (Score:5, Interesting)

          by i.r.id10t (595143) on Tuesday August 13, 2013 @09:30PM (#44560509)

          Which is funny, because my health policy company (whatever BCBS in Florida is called this month - FloridaBlue I think?) sends me a statement every month of what was charged, what was paid, what I paid. And at the end of the year they send a nice summary for tax filing purposes. Heck, hte pharmacy the family uses - Publix - has a "year to date" on each receipt we get for prescriptions.... so, it obviously isn't impossible, or even too hard....

      • Re: (Score:3, Insightful)

        by ganjadude (952775)
        why is no one talking about the fact that obama does not have the power to delay the law from being implemented? i mean i am not a fan of the law (its longer than the IRS code) but still, he has no authority to be delaying this from being implemented. But not having authority has never stopped him before. Our congress needs to grow some balls and call him on his shit.
        • Re:A cynic's view (Score:5, Informative)

          by meglon (1001833) on Tuesday August 13, 2013 @09:15PM (#44560399)
          Don't believe every little talking point you hear..

          http://www.leadertelegram.com/blogs/tom_giffey/article_c9f1fa54-d041-11e1-9d01-0019bb2963f4.html [leadertelegram.com]

          I was curious to know how the length of the Affordable Care Act compared with other major pieces of legislation. Take, for example, the Wisconsin state budget (officially known as Act 32) signed into law last July by Gov. Scott Walker. The PDF of the budget, as approved, is 532 pages long. I cut and pasted the text into my word processor, and learned the budget ran to 409,629 words (give or take -- the figure includes some page headers and other extraneous verbiage). How long is the Affordable Care Act? By my count, it’s 418,779 words (again, that’s approximate).

          In other words (pardon the pun), a law refashioning one of the major sectors of the U.S. economy is only slightly longer than a law setting the two-year budget for one of the 50 states.

          http://www.fourmilab.ch/uscode/26usc/ [fourmilab.ch]

          The complete Internal Revenue Code is more than 24 megabytes in length, and contains more than 3.4 million words; printed 60 lines to the page, it would fill more than 7500 letter-size pages.

          Part of The Big Lie strategy is repeating a lie over and over again till it's common enough people start to believe it. Don't fall for that type of dishonest stupidity.

        • Re: (Score:3, Interesting)

          by Anonymous Coward

          I hate to post AC, but I've modded this thread already.

          As somebody who doesn't rate Obama too badly as presidents go, I still agree with you, that Constitutionally, he does not really have the power to delay any part of it. But who would challenge his actions in this case? The opposition party is full of people who are heavily beholden to the insurance companies and various medium sized business groups that tend to have just enough employees they aren't sure if the law will hurt them or not, and are working

      • Re:A cynic's view (Score:4, Informative)

        by DragonTHC (208439) <Dragon@gamerslaC ... minus physicist> on Tuesday August 13, 2013 @09:49PM (#44560629) Homepage Journal

        I completely agree. That said, the billing systems already have this function built in. Hospitals and other health care providers want to track what they're owed and by whom.

        Stating their systems don't have this functionality is a bald faced lie. Congress should try some due diligence.

    • by msobkow (48369) on Tuesday August 13, 2013 @08:20PM (#44559913) Homepage Journal

      Oh, come on.

      Do you really think insurance executives know how to add?!?!?!?

    • Re:A cynic's view (Score:5, Insightful)

      by mc6809e (214243) on Tuesday August 13, 2013 @08:20PM (#44559915)

      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.

    • by MrBigInThePants (624986) on Tuesday August 13, 2013 @08:23PM (#44559945)

      Annnnd the fact that every time this sort of article gets posted there is this fundamental and extremely naive assumption that you are still in control of your government, it is still supposed to work for the people and that the politicians (and their masters) are not fully aware of what they are doing.

      Remove that and this faux surprise and outrage goes away and the real work can begin...fixing the ACTUAL problem...

      • by bfandreas (603438)

        Annnnd the fact that every time this sort of article gets posted there is this fundamental and extremely naive assumption that you are still in control of your government, it is still supposed to work for the people and that the politicians (and their masters) are not fully aware of what they are doing.

        Remove that and this faux surprise and outrage goes away and the real work can begin...fixing the ACTUAL problem...

        In this case I actually buy the explanation that they can't get the IT side of things done in time.

        While I have no insight into this here are my assumptions based on 15 years of dealing with this BS professionally. I expect:
        A hairball of a mess of interconnected subsytems that were developed independently. Compatibility propably wasn't high on the requirements list.
        Subsystems that got adapted for each and every policy change since the 1980ies. Even the subsystems propably aren't consistent anymore.
        Load

    • Re:A cynic's view (Score:5, Interesting)

      by dkleinsc (563838) on Tuesday August 13, 2013 @08:25PM (#44559965) Homepage

      For who's benefit, though?

      As far as I can tell, Republican partisans believe that everyone will hate Obamacare once it actually exists, which would mean that the Democrats are trying to avoid having it exist. The Democrats could have cut a deal with the insurance companies to prevent things from rolling out on schedule so they wouldn't have to deal with the negative campaign ads about their support of it.

      On the other hand, Democratic partisans believe that everyone will love Obamacare once it actually exists, which would mean that the Republicans are trying to avoid having it exist. The Republicans could have cut a deal with the insurance companies to prevent things from rolling out on schedule so they wouldn't have to deal with the negative campaign ads about their opposition to it.

      Or, alternately, gerrymandering has made it almost guaranteed that the House will be controlled by the GOP, and Obama is not up for reelection, so no matter what happens in November of next year nothing will get done. And don't think waiting 2016 will help, because the staunch Republican voters are slowly dying off making the president likely to be a Democrat, but still have a majority in enough congressional districts to keep the House Republican. So there's a good chance that absolutely nothing useful will come out of Washington D.C. for at least another decade.

      • by laird (2705)

        Actually, Republicans have been well documented (in their own writing) as knowing that if Americans ever got decent healthcare reform they'd vote for the party that gave it to them forever, dooming the Republicans to losing forever. That's why Republicans fought to hard to prevent health care reform, then negotiated like crazy to make it as complicated and ineffective as possible, and made sure that the major benefits were deferred until after the 2012 election (hoping to win the election and kill health ca

        • by Magius_AR (198796)
          You are cynical and wrong about Republicans. We do believe it's a bad idea. My insurance premiums haven't budged in 5 YEARS, and this year they're scheduled to nearly double (~90% jump). I can see when a bill doesn't do a damn thing to attempt to curtail costs while simultaneously raising expenses on all participants in the industry. It's not that hard.
  • Balance :) (Score:4, Interesting)

    by Mitreya (579078) <mitreya@LISPgmail.com minus language> on Tuesday August 13, 2013 @08:00PM (#44559729)

    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.

    So what's on the other side of this "balanced" solution?

  • by Y2K is bogus (7647) on Tuesday August 13, 2013 @08:01PM (#44559737)

    My current plan already does this and I'm certain it's a basic tenet of all medical insurance plans. After all, most people choose a plan by balancing the up front premium costs with the out of pocket costs on the backend. Der, someone is fibbing. X-/

    • Re:That's funny (Score:5, Informative)

      by Sarten-X (1102295) on Tuesday August 13, 2013 @08:23PM (#44559941) Homepage

      Having worked firsthand in the medical data field, I'm actually more inclined to believe them. It's pretty easy for a billing system to say "You haven't met your deductible" or "You've paid about enough"... but as I understand it, the legislation requires that each patientis cost be tracked on a per-patient basis - not per-policy or even per-insurer. That means the records have to be combined from every participating hospital, correlated with information from every other insurance provider, and deduplicated accurately, before they can be added.

      There are many people with multiple health insurance policies, who go to several healthcare systems, or have incorrect identification data in their records. What's being asked is not simply adding a few numbers in a bill, but rather merging trillions of records with few errors, across hundreds of formats from thousands of providers.

      I wish them luck, and I'm glad I'm not in that field any more.

      • by SQLGuru (980662)

        My policy has an out of pocket maximum for individuals and for family. If an individual reaches the max, they don't pay for the rest of the year. If the family combines to reach the family max, no one pays for the rest of the year. How is that any different than the 12.7K max per person?

  • Well damn, better go tell Microsoft to stop making Excel... *facedesk*

    How the heck does this happen?
    • Re: (Score:2, Insightful)

      by Anonymous Coward

      How the heck does this happen?

      Technical people don't understand politics.

    • by ShanghaiBill (739463) on Tuesday August 13, 2013 @08:30PM (#44560013)

      Well damn, better go tell Microsoft to stop making Excel... *facedesk*

      Go ahead and try to put health data into Excel without violating HIPPAA and going to jail. The same medical procedure can be billed at hundreds of different rates, depending on numerous criteria, many of which are covered by privacy laws, or are calculated by third party labs or testing facilities. If you really think this is easy, then you don't have a clue. There is a reason that we spend 2 trillion a year on health care, and if you compare America's longevity, infant mortality, etc. to other countries, it is pretty obvious that all that money isn't being spent on actual effective medicine. My family doctor's office has one doctor, two nurses, and four people in the billing department.

  • Who said you had to use a computer?

  • by NettiWelho (1147351) on Tuesday August 13, 2013 @08:06PM (#44559783)
    So instead of just doing the paperwork on paper(or excel) theyre going to let the patients die if they cant cough up the cash, because the insurance company doesnt want(or cant) do 6th grade math.

    Today your government is brought to you by PepsiCo and Corrections Corporations of America [wikipedia.org], Low on regulation and high on regulatory capture.
  • What a sick system (Score:5, Insightful)

    by Anonymous Coward on Tuesday August 13, 2013 @08:06PM (#44559787)

    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.

  • Q&A (Score:5, Funny)

    by girlintraining (1395911) on Tuesday August 13, 2013 @08:07PM (#44559795)

    Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?

    That depends entirely on whether the insurance company wants to remain in business or not. Next question.

    • Export to Excel
    • A Calculator
    • Pen & Paper
  • by Anonymous Coward on Tuesday August 13, 2013 @08:17PM (#44559883)

    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.

    • by Gavrielkay (1819320) on Tuesday August 13, 2013 @08:29PM (#44560007)
      5) This is an improvement over the decisions about life or death being about share prices and executive bonuses. I don't want it to even remotely cross the mind of anyone with a say in my health care that they might possibly make more money if they leave me sick.

      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.
    • Paver Stones on the Road to Single-Payer ... Which is what Obama has wanted since day one.

      How I wish that were true.

  • Just curious (Score:5, Interesting)

    by Trailer Trash (60756) on Tuesday August 13, 2013 @08:23PM (#44559943) Homepage

    By what legal authority did Obama delay this implementation?

  • by the eric conspiracy (20178) on Tuesday August 13, 2013 @08:27PM (#44559989)

    So what is the opposition party alternative? Repeal.

    That will limit the out of pocket costs when? Never.

    Plus it will eliminate the various positive effects that the ACA is already having.

    Basically the people that are screwing up here are the beneficiaries of the higher out of pocket costs, our Medical Insurance Overlords.

  • I'd make one very simple addition to all insurance building systems:

    while(true) {
    DontBeBastards();
    RememberYoureDealingWithHumanBeings();
    }
  • by Anonymous Coward on Tuesday August 13, 2013 @08:29PM (#44560003)

    Easy answer on this one from someone who has worked in the insurance industry for a few years... the systems suck.

    I am not defining 'suck' from the standpoint of performing because they do what they need to... however they become so bloated with complexities that even minor changes seem daunting. No person or team in my organization knows how the systems work from end-to-end and even the vendors need to use reverse engineering to resolve issues because of the complexities.

    Not unusual for an insurance company to build a new system to support new plans because integration of the benefit rules into an existing system is not worth the pain. In the end the company ends up with several systems and IT silos built up around them.

    The system at my current work will not be able to handle tracking co-payments over any period of time. The jobs that run overnight to price claims and track this sort of thing are already running at capacity.

    On top of all this the executive management in this industry tend to be incredibly conservative and avoid risks like the plague.

  • by thegarbz (1787294) on Tuesday August 13, 2013 @08:34PM (#44560055)

    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.

  • by madmarcel (610409) on Tuesday August 13, 2013 @08:35PM (#44560075)
    An old programmer once told me that insurance companies run on OpenEdge (aka Progress), and old versions at that.

    Gigabytes of proprietary spaghetti code <<shudder>>

    I'm not putting my hand up to fix that.
  • by Amigan (25469) on Tuesday August 13, 2013 @08:35PM (#44560081) Homepage
    From what I heard today, the problem is as follows:
    1. 1) patient goes to pharmacy to get prescription filled
    2. 2) pharmacy contacts authorizer to find out what the cost of the prescription is under patient's plan
    3. 3) patient buys drugs for price returned by authorizer
    4. 4) authorizer sends bill on to insurance company

    Step 2 is an immediate response, step 4 is handled in batch processing nightly. So far so good. Except that the Affordable Care Act makes it *illegal* to make a patient pay more than the annual limit. The authorizer and/or the pharmacy can be charged for forcing the patient to pay above the annual limit. This means that the authorizer must be aware of limit of each patient and be able to respond in real-time so that neither they nor the pharmacy will be sued. The insurance company doesn't have that information available real-time, nor do they make it available to the authorizer.

    It is a computer issue, but as simple as everyone thinks. Putting individual insurance files on-line so that the out of pocket expenses can be tracked real-time isn't trivial. Now, maybe the Insurance companies were hoping the law wouldn't be implemented so they didn't do the hard work necessary to get set up, or maybe the rules were only written as to how to handle the annual limit must be handled.

    Just remember, the last time companies put together a real-time on-line credit/debit system, the government decided that they charged too much to support the infrastructure, and started regulating it. That was the Durbin amendment to Dodd-Frank, which put a fixed limit on per swipe fees - regardless of what the infrastructure and support costs actually are.

    jerry

  • by AdamHaun (43173) on Tuesday August 13, 2013 @08:36PM (#44560089) Journal

    Tell me, Slashdot, how difficult would it be to rewrite an insurance billing system to aggregate a policyholder's out-of-pocket costs?

    It's somewhat more difficult when you waste three years assuming the Republicans are going to win big in 2012 and repeal the whole ACA. You gamble, you lose.

    Snark aside, the real answer seems to be in the article:

    The health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.

    So insurance companies outsourced different parts of their work to different companies that don't talk to each other. It's not "the computer's fault", it's an administrative problem within the insurance company itself. That text was right above the paragraph quoted in the summary, but curiously the submitter felt the need to ask a rhetorical question instead of including the most important piece of explanation in the entire article.

    (Also, have you ever heard a story about a giant years-old financial/billing system that was clean, well-implemented, and easy to maintain and modify? I sure haven't. Not sure why we'd expect anything to be a trivial change in one of those...)

  • by Greyfox (87712) on Tuesday August 13, 2013 @09:23PM (#44560463) Homepage Journal
    Have the patient collect his receipts and tell the insurance company "Ok I've been billed 12 grand! Now stop!" Boom! Problem solved! You're welcome!

    What? Too simple for you? I guaran-fucking-tee you that if you put this mechanism in place, the insurance companies would suddenly discover that they can, in fact, figure out how much you've been billed over the time period in question. "Oooh! THAT billing info! We just need to look in this computer for THAT!"

  • HR 676, Medicare for All [healthcare-now.org] would be simpler and cheaper.
  • by istartedi (132515) on Tuesday August 13, 2013 @09:59PM (#44560695) Journal

    My computer isn't set up to pay the bills. It isn't set up to pay the penalties for not paying the bills either. I was too busy programming an interface to my asset protection plan. It's beautiful. You should see it. Rounded corners and everything, and the interest on my overseas accounts is lined up in formatted columns and everything. It doesn't do medical billing outlays though. So sorry. I'm sure you'll understand.

  • by no-body (127863) on Tuesday August 13, 2013 @10:07PM (#44560763)
    would not be in the pocket of big money, the story would go in that manner:

    What? Not ready by 01/01/2014 - it's going to cost you a million a day per case penalty and all the systems would be able to add up the numbers at deadline just fine.

    This is laughable

    An yes, the whole Obamascare show is political: http://www.dailykos.com/story/2013/08/11/1230529/-The-real-reason-for-the-GOP-s-all-out-war-on-Obamacare?detail=email [dailykos.com]
  • Just Sad (Score:4, Informative)

    by Murdoch5 (1563847) on Tuesday August 13, 2013 @10:28PM (#44560887)
    This is another example of how private health care doesn't work! Coming from Canada and having a few rare / serious medical conditions I just can't understand how anyone can support private healthcare.

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