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Health exchange faces challenges


Three reporters, including this one, attended the inaugural New Mexico health insurance exchange board meeting this month. We were looking for fireworks. There weren’t any.

To be candid, there was some thought that board members J. Deane Waldman, a pediatric cardiologist at the University of New Mexico, and Human Services Secretary Sidonie Squier might launch some sort of a tempest by saying things at the meeting that they’ve said elsewhere. They didn’t, and the meeting proceeded with tedious decorum.

Waldman has written that the Affordable Care Act, known as Obamacare, establishes death panels. This is that ridiculous claim, most famously advanced by Sarah Palin, that says government-sponsored efforts to determine what medical procedures actually work and that, therefore, ought to be paid for will lead to government-sponsored withholding of health care that, in turn, will kill patients the government somehow deems unworthy to save.

Since government and private insurers already ration health care by establishing payment rates for all medical procedures based on no particular understanding of what works or is cost-effective; since about half of all tests performed by physicians are either unnecessary or inconclusive; since 30 percent of every health care dollar is lost to waste; since there are only about 20 diseases for which there has been developed well-understood, evidence-based, nationally accepted standards of care; since all the other diseases are treated in any number of ways, some successfully, some not; since it might be nice if someone could let providers know which approaches to those diseases really do work; since health care is now consuming about 17 percent of the nation’s economic output with no end in sight; and since every insurance company and every health system of any size, from UNM Health Sciences Center to the Cleveland Clinic, is trying to get medical providers to stop doing things that don’t work so they can shift spending to things that do work, the death panel charge remains what it always was: nonsense.

Squier has made it clear in many nonpublic meetings with many staff members, people from other agencies, businesspeople, medical people and political people that she loathes Obamacare, which she has characterized as socialism.

I always get a kick out of that. The major achievement of the Affordable Care Act is to force millions of people to purchase insurance from private companies, which then will pay hundreds of thousands of private businesses, including drugstores, hospitals and doctors, for the care they deliver. How increasing the market opportunities of for-profit businesses is socialism is beyond me.

There is much wrong with Obamacare, but it contains no death panels and is not socialism.

In any case, the words “death panel” and “socialism” were not heard at the board meeting.

The board was authorized in the last legislative session to oversee development of a state health insurance exchange. The governor appointed Waldman to the board. The Human Services secretary is a board member by statute.

The exchange is supposed to be something like an Amazon or Expedia for health insurance. Consumers are supposed to be able to go to a website starting in October, find an insurance policy that works for them, and with the click of a mouse button buy the product. The system is supposed to determine in real time whether the consumer is qualified for Medicaid or other public support.

I was a product manager in the computer industry for years, and believe me when I say this is one dreadfully complicated bit of software that almost certainly will not be ready for prime time by October.

The progress toward building an exchange has been oddly sporadic. Dan Derksen was loaned to HSD by UNM to secure federal money and develop plans for an exchange only to be forced out when he was ready to start implementation. Legislation to establish the exchange was vetoed in one session, signed in another. The effort was interrupted when HSD decided to hire former Utah Gov. Mike Leavitt’s firm to guide creation of the exchange. A request for proposals to install exchange information systems was issued in February 2012. The contract still hasn’t been awarded. The governor, Legislature and attorney general wrangled for months over a governance structure for the exchange that only this month started work.

The governor’s people have insisted that while they may not like Obamacare, they will make it work in New Mexico. Appearances to the contrary, they say there has been no deliberate effort to sabotage the exchange. One is left to infer, therefore, that with five months to go and no exchange in sight we are witnessing either incompetence or a miracle in the making.

UpFront is a daily front-page news and opinion column. Comment directly to Winthrop Quigley at 823-3896 or wquigley@abqjournal.com. Go to www.abqjournal.com/letters/new to submit a letter to the editor.


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