My biggest objection to the Affordable Care Act (Obamacare) is not the sleazy way it was railroaded through Congress, or the crazy Supreme Court decision that allowed it to pass as a tax when President Obama had repeatedly said that the purchase mandate was not a tax. From the beginning I have believed that the whole thing was unworkable and that implementation would be a logistical nightmare.
It’s not just the snafus and computer glitches that have plagued the recent opening of the health care exchanges. I cannot imagine that the government will be able to enroll more than 30 million people in these exchanges even when more than half of them will receive premium subsidies.
As someone who worked in the insurance business for over 35 years, I know how difficult it was to get people to pay for something that they disliked even when they acknowledge that they needed it. Very few people like to pay for any kind of insurance. It’s like taking bad tasting medicine. Although a basic amount of auto insurance is mandatory in most states, here is Connecticut we still have to add uninsured motorist coverage to our policies. Driving without insurance is against the law but many still take the chance.
To overcome such reluctance insurance companies strongly encourage automatic pay plans where payments are automatically deducted from checking accounts. Anything is better than waiting for customers to mail in payments. The government learned this many years ago when it required employers to withhold taxes and Social Security payments from paychecks.
However, it’s not just a question of payment. I suspect that a large portion of the eligible population will not, for various reasons, even bother to sign up. They will either not want to, not know how, or just be turned off by the red tape. This group will even include those who do not have to pay. After all, in the past it was very easy to just go to the local hospital emergency room when you were sick. You could never be turned away.
It’s true that those who fail to sign up will have to pay a penalty but how is that mandate to be enforced? Will it be a payroll deduction or a deduction from a Social Security disability check? Will the government reduce someone’s unemployment check?
Thinking about these administrative problems brought to mind my first and only experience as a government employee. In our first of marriage my wife and I decided that I would go back to graduate school to complete my course work for a PhD in history. She was a nurse and would be the breadwinner. I was able to complete my course work in a year. By that time she was pregnant and I had to get a job. Fortunately, I had taken and passed the US Civil Service exam and just at the right moment I received a notice offering me a position as management analysis intern with the Federal Aviation Agency at New York’s Idlewild airport. President Kennedy had been assassinated the year before but the airport’s name had not as yet been changed to JFK.
I interviewed and was hired. I was a lowly GS 5. The FAA was a large organization with a huge responsibility but the management analysis office at the airport was a small operation. There was the chief who had his own private office and then three senior analysts of varying grades. Our desks were all in a row and I was assigned one right by the door. We were a diverse crew and resembled one of those World War Ii movies where the crew of the plane or ship was made up of different ethnic groups. The three analysts were all educated and middle class—one was Italian, one Jewish and the other Black. Of course, there were few female analysts then but there were two young expert secretaries, who in those days were still called secretaries.
I was a management intern totally lacking in knowledge or experience of either aviation or management. Back in the 1960s management analysis was a somewhat new thing and the government was just beginning to follow private industry in adopting it. At the time management analysis was looked down upon by people who were actually doing the real work. The whole field was also held up to ridicule by comic authors and filmmakers who liked to make a mockery of the so-called time and motion studies done to improve workplace efficiency. Anyone who remembers Lucille Ball (I Love Lucy) at the assembly line in the chocolate factory will know what I mean.
In the beginning I remember that I spent most of my time reading aviation magazines. There was no formal orientation program. Eventually, I must have been given some low level assignments and responsibilities but only remember one. In 1964/5 President Lyndon Johnson launched a much heralded government efficiency program. He took the lead by personally shutting off light bulbs in the White House. More seriously, he insisted that all government agencies cut back on paperwork. Since this was impossible, he took the drastic step of forbidding the purchase of any new filing cabinets. This would force all departments to reevaluate what they really needed to file, and also clean out unnecessary files. For example, the FAA was required to file papers detailing every take off and landing at even the smallest airports. It would not surprise me it these documents from the dawn of aviation history might still be in some repository.
Anyway FAA management analysis offices all over the country had to implement these new filing regulations. We sent out manuals, directives, and detailed instructions to all field offices and mandated that they comply. Now field offices were the places where the vitally important work of the FAA was done. I recall one trip to a massive flight control center where Air Traffic Controllers (mostly ex-military pilots) were intently watching the blips on the primitive radar screens that often seemed perilously close to one another. It was a fatiguing and nerve-wracking job and I wouldn’t have done it for a million dollars. The safety of thousands of air travelers was in their hands.
But in our office we were concerned about files and filing cabinets. One day one of the field offices called up and virtually begged us to go out to his office and help him figure out how he should implement all these new directives. We couldn’t be bothered. It was his job. Just read the manual. The last thing we would want to do was to visit a field office or actually try to implement one of our own directives.
My experience with the FAA has stayed with me for over 50 years, and makes me sympathize today with all those doctors who, while holding the fates of thousands of patients in their hands, must deal with the administrative nightmare that is Obamacare.
At the end of my first year I got an offer to teach at a small college in Connecticut. When I told the bureau chief that I would be leaving, he expressed regret and told me that he was considering a promotion for me for a job well done.