If You Have Insurance You Like

I've been thinking about President Obama and the line, if you have a health plan you like, you can keep it.

I don't think he knew he was wrong.  That's because I worked for an insurance company for sixteen years, and I didn't know he was wrong.

There are a couple of pieces to this.  First, back in 2009, I took this as a statement addressed primarily to people who had health insurance through their employers.  The idea was that the old employer-based health insurance system wasn't going away.  The same for people on Medicare.  And this statement is true for these groups.

Second, the individual insurance market was and is notorious.  It didn't occur to me that people covered here would prefer their existing policies to better policies that were cheaper.

Third, the junk policies, which are relatively recent and can be found in both the individual and the employer-provided market.  Among the worst of these policies are those that provide no coverage for hospitalization.

Without putting too fine a point on it, hospital stays are the expensive part of the health system.  (I know, I know.  Drugs are expensive.  Stay with me.)  Traditionally, hospital stays were what insurance was for.

It never occurred to me that anyone would like one of these junk policies.  They're better than nothing, but to my mind they're not real insurance.  They don't keep you from being bankrupted, and they don't keep you from being kicked out to die when you run out of money.

So I made two mistakes.  First, I was distracted by the fact that most people weren't affected by the new law.  Second, I thought the people who were affected understood the coverage they had.

On this second part, I should have known better.  And so should the President.  But I'm not going to lose sleep over this one, and I hope he doesn't either.

P.S.  I wonder if the insurance companies told the administration they were sending out cancellation notices before they did it.

I Crashed the Server: Thoughts on the Healthcare.gov Debacle

Benefits are complicated.  Really complicated.  I remember at Cigna there was a competition between the payroll people and the benefits people.  Payroll was always on top of its game.  Benefits was constantly floundering.

Payroll is complicated in a large corporation. Taxes in how many states -- we'll leave out international.  And local taxes.  And the deductions that the benefits people feed over.

Payroll was cocky.  Eventually they got their reward.  They got to take over the benefits operations.  And one day I was walking out of a meeting, and a senior payroll guy said to me, "You know, benefits are really complicated."

I think a lot of this complication is unnecessary -- just what you get when you leave insurance companies to their own devices for a century or so.  But it's not going away.

Split Eligibility
Here's an example.  You have a retired couple.  The former employee has just turned 65.  The spouse is 62.  They've both been on the retiree health plan, but now the retired employee is signing up for Medicare.  The spouse is not eligible for Medicare.  What do you do?

The answer is called split eligibility.  The former employee gets Medicare as primary insurance, and the company provides a wrap policy to pick up expenses that Medicare doesn't cover.  Meanwhile, the spouse stays on the old company retiree health policy.

But wait.  It's one policy.  Computer programs are written to provide one set of benefits for one policy.  What do you do?  You write a whole new, much more complicated computer program.

Did I tell you your head was going to hurt?  Mine did, for years.

Benefits are complicated.  And, let's face it, benefits are boring.  So are benefits websites. Who, other than computer geeks, could possibly want to play around in the guts of a benefits website?  Certainly not me.  And yet I went to the meetings for 16 years, my eyes glazing over, my mind wandering to the day I would walk the Elysian Fields.

For this simple reason -- the crashing boredom involved -- management tends to leave benefits websites to the IT people.  Bad mistake.

Remembering Y2K
IT people love it when they're left alone.  Remember Y2K?  Most of the world's computers were supposed to crash when 1999 became 2000, because they could not recognize a year that began in 20 instead of 19.  Big problem.  Created of course by the IT people.  And they solved it.  They said, give us a lot of money and go away for a couple of years, and we'll fix this.  Just don't ask us to do anything else while we're off playing with ourselves, fixing a problem that we created.

And that's pretty much what happened, at least at Cigna.

I Crashed the Server
IT people just aren't good at playing nice with others.  This brings me to the day that I crashed the server.  We'd been working on a new web-based program for some benefit -- I honestly don't remember what -- and we needed to do a launch.  This involved sending an email to our 40,000 employees, asking them to click on a button and go to the website.  Maybe just have a look, maybe do something.  But definitely click the button and go to the website.

Our group -- the communications geeks -- suggested that we stagger the emails to employees over the course of the launch day -- a few thousand here, a few thousand there -- so that we wouldn't overwhelm the system by sending 40,000 people an email at once, having 40,000 people open the email at once, and having 40,000 people click the button at once.  We were a bit worried about whether the website would be able to handle that.

No problem, said our IT confreres.  I believe the word "robust" was used.  As in "robust website configuration," or something.  So we sent out about 40,000 emails at once, and about 40,000 people clicked the button more or less at once, and the server crashed.

Or, more accurately, I crashed the server.  Someone needs to be blamed for such a terrible thing.  After all, the IT people had some cleanup to do, the site wasn't available for awhile, and management was terribly embarrassed that such a thing happened on their watch, while they weren't watching.

The Joy of Lunch
Shortly thereafter, I was at a nice communications meeting at a hotel near the office.  This involved lunch in a large room at tables with tablecloths, and of course an open and forthright dialog among people whose incomes varied by a factor of 100.

At one point the divisional IT vice president stood up at his table down front and said he was very unhappy that I had crashed the server.  I waited a beat, then stood up at my table (which was more toward the back, away from the dais), and said that I proposed to keep crashing the server until we got the systems support that we needed.  For what it's worth, he left the company before I did.

Don't Trust the Consultants
So don't leave these things to the IT people.  Number one.  Number two, don't trust the consultants.  Another story.

We were launching yet another major program -- I don't remember this one either, they all blend together -- and we were at a large meeting in a very nice conference room on a floor to which I had never been admitted before.

We were there with the program's chief consultant, to make sure our communications plans were in order.  I was reliably informed that this fellow drove a Rolls-Royce.  I hadn't expected to speak at the meeting, but Mr. Rolls-Royce, as he went down his checklist, asked a question:  What percentage of employees did we expect to reach with our elaborate program of communications?

Nobody spoke for a while.  Then a helpful vice president suggested that I should answer the question.

"Oh, 80 to 90 percent," I said.  I was mindful of riding in an elevator some time previously.  We'd been encouraging employees to move their 401(k) money out of a fund that we were discontinuing.  The fund had $200 million in it, and for a variety of reasons it was better if individuals moved their money out voluntarily, rather than have us do it for them.

Two men were talking in front of me in the elevator.  One asked the other what he was going to do with his money.  The second man asked the first man what he was talking about.  The first man said, Didn't you get the letter about the fund closing?  (The letter I wrote.)  The second man said, "Oh, I never read my Cigna mail."

As we used to say, again and again, attention to benefits information is very low.  (The low attention levels and the complexity of medical benefits explain why people keep saying on surveys that they don't understand Obamacare.  They never will.)

But back to the meeting with Mr. Rolls-Royce.  He pondered my 80-90 percent answer for a moment, then said he was sure that management would require our communications to reach 100 percent of employees.  And he wrote something on his paper.  I think it was probably 100 percent.

Consultants tell management what they think it wants to hear.  What they say may or may not have a connection with reality.
 
Some Classic Mistakes
So here's what I think happened with Healthcare.gov.  Lulled by consultants who had no clue of the difficulties involved in benefits websites, management deferred to the IT professionals, who also had no clue of the difficulties involved in benefits websites.

Some other classic mistakes occurred.  Benefits sites always have a hub -- medical, dental, life insurance, 401(k) all need to talk with eligibility and payroll.  Healthcare.gov, drawing from a host of government databases and dealing with a host of insurance companies in dozens of states, had that problem on steroids.  This is simply not an easy design problem, and I suspect that it's the basic one.

Bottlenecks.  Okay, who said, Hey, let's get everybody to open an account before they can browse.  Amazon lets you look at the books before you buy them.  Somebody help me out here.  Consumer behavior:  First you browse, then you buy.

Something that I haven't heard about -- and I don't know if it's an issue, but I suspect that it is -- is the ping-pong phenomenon.  At one point at Cigna, we decided to go with an outside vendor for our employees' annual enrollment.  The vendor was in Massachusetts; we were in Philadelphia.  A slender electronic pipe connected us.  Programs that had worked just fine when all the servers were in the same room all of a sudden didn't work so well.

Apparently the programs were used to chit-chatting in a very intense back-and-forth manner.  This round-tripping, as I think it was called, all of a sudden took actual time, and the delays just got worse as the communications pipe got more and more clogged.  Eventually the problem was fixed.  I don't remember how.

Last Story
One last story.  Eventually management decided it was time to do a complete overhaul of its pay and benefits systems.  A lot of the underlying programs we were using were quite antiquated, our hub had been jerry-built over the years with inadequate funding and unrealistic expectations, and frankly I thought a top-to-bottom overhaul was a good idea.  Until I heard about the consultants.

Yet another large meeting.  I managed not to say anything, and transferred to the international division shortly thereafter.  Much later I heard from an IT friend about launch day.  Unbeknownst to the consultants, my friend had stored a backup of the old system on a little-used server (Cigna had a lot of them at that point).   D-Day came.  The consultants triumphantly flipped their switch, turning off the old system and turning on the new one.  According to my friend (this is his story, but I believe him), the new system promptly crashed, and the consultants panicked.  They had no backup plan.  The system they had turned off had been trashed in the process of turning it off.  My friend let them sweat for a few minutes and then he flipped on the backup system that he had stored away.  Nobody on the outside ever noticed that the site had gone down, and a few weeks later the consultants had debugged their system, and the relaunch went seamlessly.

Unfortunately, my friend's option wasn't available to Healthcare.gov.  It wasn't replacing anything.  It was brand-new.  But the problems Healthcare.gov has been facing are not new, and they're not subtle.

How Do I Feel?
How do I feel about that?  I worked awfully hard to help get the Affordable Care Act passed, and I'm angry that the administration made such obvious mistakes with the implementation.  I feel President Obama let me down on this one.  I'm sorry, but it's personal.

From Ben Tillman to the Tea Party

The Tea Party are an odd bunch, with their three-cornered hats and Revolutionary War flags, and their -- to me at least -- strange approach to politics.  Where do these people come from?

For a long time I assumed they were getting their political ideas, and possibly their practices, from the American Revolution.  Then one day I stumbled across a book that my daughter had read in graduate school:  Ben Tillman and the Reconstruction of White Supremacy, by Stephen Kantrowitz (University of North Carolina Press, 2000).  It's about something I've never paid much attention to -- the South after the Civil War.

This is where the Tea Party comes from.  I don't know anybody who enjoys studying American history from the end of the Civil War to the start of the Progressive movement.  But the industrial revolution in the North and the rise of Jim Crow in the South go a long way toward defining where we are today.

I've been particularly averse to Southern history in this period, mainly because I find it so depressing.  But we need to know.  How did they do it?  How did a defeated group of states get up off the floor and largely replicate their former way of life?

The short answer is, by not being Japanese.  When General MacArthur showed up to run Japan at the end of World War II, the Japanese more or less said, Well, they won the war, so I guess we need to do what this MacArthur guy says.  And they did.

Before the war, the South was basically owned and run by its planter elite.  Today we would call them the one percent.  They were a small minority sitting atop two populations, one black and enslaved, the other white and at least notionally free.

At the end of the Civil War, the "wealth and intelligence" of the South, as they were sometimes called, faced the very real prospect of becoming a displaced elite.  The Union army occupied their land, and the blacks -- no longer slaves -- moved rapidly to claim economic and political power.

The Southern elite said, We liked it better the way it was.  This was particularly true when it came to the subject of blacks in politics.  As Ben Tillman put it, whites had a "God-given right to rule where any considerable number of his people sojourn among the colored races." 

And so, like the Bourbons of old, who had learned nothing and forgotten nothing (despite many teachable moments during the French Revolution), the wealth and wisdom of the South launched a counter-revolution.

Let's have a closer look at this Southern counter-revolution -- put it under the microscope, if you will.  Let's go to South Carolina, to the little county of Edgefield.  This is Ben Tillman's home.

Tillman served as governor of South Carolina from 1890 to 1894 and then moved to the United States Senate, where he served until his death in 1918.  But before all that he was a thug.  A rich thug.  His family was one of the largest land-owners in Edgefield County.

His career in politics and terror started shortly after the end of the Civil War.  With other members of the county gentry, he rallied the white people of Edgefield to defend hearth and homeland against blacks and the federal government.  In this xenophobic world view, hatred of blacks and the federal government were intimately intertwined.  They were the two faces of the hated Other.  As long as the North pursued actual reconstruction in the South, Tillman said that white Southerners would have "no conception of the word 'nation' except that it is connected with the word 'nigger.'" 

The rhetoric of this movement -- and particularly Tillman's rhetoric -- was violent, irrational, and fact challenged.  Discourse with opponents was loud, inarticulate, and deaf.  Armed counter-revolutionaries would show up at their opponents' political meetings and demand that the meeting "divide time" between Reconstructionist speakers and anti-Reconstructionists.  They would then proceed to "holler down" the Reconstructionists and use their fists to break up the meeting.

This kind of behavior carried over to election day, when black would-be voters faced an increasingly hostile and volatile atmosphere at the polls.  And, as reactionary whites regained control of the electoral apparatus, those blacks who did succeed in voting could not trust that their ballots would be counted.

Suppression of the black vote was particularly important in South Carolina because blacks were actually the majority of the population.  (In the 1860 census, South Carolina and Mississippi were the only two states with black majorities.  They were also the first two to secede.)  If all the whites in South Carolina were to vote for one candidate, and all the blacks were to vote for another, the candidate of the blacks would win.  So shenanigans with the ballot box were not optional.

And violence was ever at the ready.  Even those, like me, who have never seen the movie Birth of a Nation have probably seen clips of D.W. Griffith's night riders in their white gowns and conical hats.  And of course their masks.  But the Ku Klux Klan was only one source of violence.  In South Carolina, groups called "rifle clubs" were particularly important.  These were armed units of mounted men who acted bare-faced and in daylight.

The violence escalated over the years, climaxing with the election of 1876, after which Reconstruction came to an end.  In July the rifle clubs earned their place in the history books with the Hamburg massacre; they engaged in a one-sided firefight with a negro militia unit (the rifle clubs had a cannon), and then massacred many of the survivors.  Tillman was there with the Sweetwater Sabre Club.

As Ben Tillman later put it, "In 1876 we shot negroes and stuffed ballot boxes."

The 1876 election in South Carolina was critical to the outcome of that year's presidential race.  As a result of the Compromise of 1877, which put Rutherford Hayes in the White House, federal troops were withdrawn from the South, and Reconstruction came to an end.

And the counter-revolution continued.  The erection of Jim Crow took a while, but with the new Constitution that South Carolina adopted in 1895, the most important pieces were in place.  The new Constitution used property qualifications and literacy tests to deny the vote to most blacks, and to many poor whites.  Tillman was chair of the constitutional convention's committee on suffrage.

After a very long run, Jim Crow finally came to a close, but the Southern way of politics -- particularly the South Carolina way of politics -- didn't die.  Instead, with a little help from Richard Nixon's Southern Strategy, it went national by joining the Republican party.

In 1948, Strom Thurmond of South Carolina helped lead the Dixiecrat breakaway from the Democratic party, which had adopted a pro-civil rights plank in its platform that year.   In 1964, Senator Thurmond became a Republican.  His father was Ben Tillman's lawyer.

Over the years, Republican ideas and Republican tactics came more and more to resemble the ideas and tactics of Ben Tillman.  And now we have the Tea Party.

I think some of you right now are thinking, Ben Tillman was a long time ago.  We've had the New Deal, the Civil Rights movement, the Great Society.  It's no longer fashionable to hate black people in public, and just about everybody looks forward to Social Security and Medicare.

How can Ben Tillman's ideas, born of racism, elitism, and xenophobia, possibly have direct influence on our public discourse today?  It's even more ridiculous to think that his tactics might prove useful in the age of Facebook and Twitter.

Well, as William Faulkner of Mississippi put it, "The past is not dead.  It's not even over."  Ask Jim DeMint.  Ask Lindsey Graham.

Maybe Lying Is Starting to Stop Working

Nearly ten years ago I had a car accident. My wife and I had just finished bringing the groceries into the house.  I got in the car to put it in the garage.  This involves driving several blocks, so I pulled up and stopped at the intersection, where there was a red light.  I was in the left lane.  In front of me, straddling two lanes, was a contractor's truck.  He was well forward of where he should have been, across the crosswalk, and poking a bit into the intersection.

We in Philadelphia are accustomed to shoddy driving, particularly by contractors.  I didn't think much of it.  Then the truck -- we still had a red light -- began to move.  Backwards.  Quite rapidly.

"I didn't want to block the box," he told me after he'd buckled a good part of the right side of my car.  Philadelphia had recently started a public information campaign about not blocking intersections.

We traded insurance information.  I called the police.  He left before the police arrived -- you can do that in Pennsylvania. I figured it was no big deal, since he'd already admitted that he was at fault.  The police report had my story.

And then, a few days later, I learned that his story had changed.  He hadn't moved.  I ran into him.  I spent a fair amount of time on the phone with my insurance company and his.  They both said it was his word against mine.  The arbitration split the costs between us, and I was out a couple of hundred unnecessary dollars. 

I've known my insurance agent for a very long time.  He tried to comfort me.  He told me that, in the insurance world, people lie with great frequency.  I actually knew that.  It had just never happened to me before.  I confess I was a bit stunned.

Lying, of course, is not confined to car accidents in Philadelphia.  Indeed,  it has become a major spectator sport.  I sometimes think that it will replace baseball as the national pastime.

Just look at National Intelligence Director James Clapper, who told Congress that the NSA wasn't doing massive data sweeps on American citizens.  Then Edward Snowden proved him wrong.  And Clapper apologized, saying he had responded to a question with the "least untruthful answer possible."

There's something about a personal declaration of moral bankruptcy. 

It's not just the Obama administration.  Apparently there's now an anti-Obamacare web video that shows Uncle Sam peering between a woman's legs at a gynecologist's office.

This from the people who brought us the state-mandated transvaginal ultrasound.  And so add hypocrisy to the charge of mendacity.

There's an old song from the Vietnam War, "The Ballad of the Green Berets."  I never liked it, because it's pretty jingoistic.  But there's a line in there -- "Men who mean just what they say."

I'm comforted by the thought that lying may be starting to stop working.  My contractor with his truck gouged me for a few hundred bucks, and got away with it.  Mr. Clapper will keep his job -- apparently lying to Congress is okay if you have the right job.  But the NSA's whole surveillance program is under serious assault, and American intervention in Syria is quite dead -- a casualty of George W. Bush's lies about Iraq.  Obamacare seems quite healthy, despite the assaults.  The budget battles continue, and the cover stories are unraveling.

Joseph Goebbels, one of the leaders of Nazi Germany, popularized the theory of the big lie:  Say something really wacky, and keep saying it, and sooner or later people will start to believe you.

I think that's over.  Or at least, I think it's beginning to be over.

Obama Plays Chess

President Obama has given Syria to Congress, and it appears most of the media has missed the story.  Possibly on purpose.  Lots of long faces -- Obama on the ropes etc.  I do have the feeling I'm being played.  Set up a cliff-hanger, then watch Houdini-Obama escape again.  Makes for good television.  Sells newspapers.  The White House is just fine with it.  John Boehner, poor sod, probably isn't so happy.

Boehner must know that Obama has just forked him -- it's a chess move.  If Congress approves bombing Syria, Obama gets to bomb Syria, and the responsibility for it -- and everything that follows -- lies not with Obama but with Congress. 

And if Congress won't let him bomb Syria, then everything that happens in Syria becomes the property of Congress.

Obama just dropped a little horsie-knight on a square that nobody -- not even his own staff -- expected him to occupy.  So Boehner can lose a bishop, or a badly positioned queen.  And Obama doesn't care which.

Congress owns Syria.  They're stuck.  I think I need some popcorn.

Syria and Queen Anne's War

I've been thinking about Syria. And the decrease in government's power to fight wars. I came of age during the Vietnam War, and I carried a draft card. When the draft was abolished, it was very meaningful for me.

Recently, I believe it was Prime Minister Cameron who told the House of Commons in London that President George W. Bush had poisoned the well of government credibility with his lies about the Iraq War.

Vietnam said no more mass infantry wars.  Iraq said -- what?  Maybe, we'll never believe you again.  I'm not sure.

There's a longer historical progression here. If you go back to the eighteenth century, the business of monarchs was war. Anybody remember what Queen Anne's War was about? I don't, but I'm sure it involved royal vanity, along with Kissingerian statecraft.  (Actually, I just looked it up.  It was about who should be king of Spain.)

The idea that governments should do things other than war -- say look after the welfare of the people -- really got its start with the American Revolution.

As I often do, I find myself feeling sorry for President Obama. He wants to do the right thing.  And here he is paying for George W.'s sins.

But maybe, long-term, we're on a good arc. Maybe government has other tasks, beyond figuring out who has the biggest missile.

Lidice and the Power of Nothing

Lidice

Lois and I and our friends Greg and Martha Cukor just spent a fabulous two weeks in St. Petersburg (the one in Russia) and in Prague, in the Czech Republic.  Greg is now known as Grishka, and I actually learned the Cyrillic alphabet (it's gone now).

From ballet at the old Mariinsky theatre to the Hermitage museum to Catherine the Great's summer palace to the old city of Novgorod to the Charles Bridge and Old Town Square in Prague, the blur of four-star experiences was becoming a bit overwhelming.  But then something happened.  On the way from Prague to the old fortress town of Terezin, we stopped at a little dot on the map called Lidice.

It used to be a farming village with a little more than 400 inhabitants.  Then it got caught up in World War II.  To make a long story short, there was a fellow named Heydrich, who was a very important Nazi.  If you want to know how important, read Laurent Binet's HHhH.

Some Czech soldiers parachuted in from England and killed Heydrich in Prague.  As a reprisal, the Germans showed up in Lidice one day, killed all the men, took away the women and children, burned the town, and then blew up anything still standing with explosives.

To paraphrase Tacitus, they made a desert and called it peace.  Or at least they tried to communicate the idea that they were very angry.  At any rate, Lidice was no more.

We got there pretty early in the morning.  It was a beautiful summer day as we walked through the colonnade to the plaza that looked down a slope to where the village had stood.  It was basically a large field of grass with a few statues, punctuated by trees, all strongly reminiscent of a Civil War battlefield in the United States.  I started to have that memorial feeling.  People died here, in this peaceful, grassy place, and it was important.

Lois wandered down for a closer look at the group statue of the children.  The rest of us went to the museum.  There wasn't much there.  But surely never has so much been done with so little.  I think the thing that did us all in was a group picture of the students and teachers at the local school, apparently taken eight days before the reprisal.

The Civil War battlefields still resonate, at least for me, communicating what happened there.  But let's face it, the Civil War is ancient history.  Lidice is within living memory, and what happened here still has raw power, despite the peaceful setting.

When we got back to the car, I said one word to our driver, Mirek:  "Tough."  He didn't have much English, but his look said he knew what I was going through.

We rode off to Terezin, which was a concentration camp where many people died.  I'm afraid I didn't give it justice.  I was still back in Lidice, on a beautiful summer morning.