Politics & Media
Sep 01, 2010, 10:59AM

Why the Affordable Care Act is Only the Beginning

Once more into the bureaucratic breach.

Vigilant readers may remember the couple of paragraphs I put together during my camp session at the Maryland Vehicle Administration:

Waiting for your number to come up—you’re never more a number in the system than when you’re at the DMV—you can’t help but notice the same despair etched across the faces of countless others. The frustration pools under their eyes, weight is shifted from one foot to the other. Everyone is on edge. The malaise quickly swallows the occasional bursts of laughter.

Granted, the whole experience was made worthwhile by the placement of three different taqueria trucks outside the MVA, but my point is that I might be unsettlingly sensitive to the doldrums effect of massive state bureaucracies.

The other day I found myself split by car trouble and health insurance drama—the latter made massively more difficult by the former. I’m set up with the Maryland Health Insurance Plan, a program that gives people like me—people who can’t get health insurance the normal way because of preexisting conditions and 9999 other reasons—some prime-cut Blue Cross Blue Shield coverage. It’s not cheap but it’s the real deal and, without question, worth it.

BCBS is no backwater institution, and they run a relatively tight ship—relative is pulling quite a hidden weight here, since MHIP is run through the state and that’s what I have to deal with. All logistical trouble shooting—change of address, billing, premiums, payment—must go through the state office. Nothing is outwardly digitized: not my address, account number, payment history. Everything is done through snail mail. The process of getting the damn coverage in the first place took months and months. Sure, all those figures are probably in a computer somewhere, but no one can find it.

So, when a banking snafu pushed me to the brink of the billing race period—I owed them a chunk of money, and if they didn’t get it they were going to shut off the water. I’d have to reapply all over again. Every last step.

You can imagine my panic. I borrowed my friend Zach’s car and headed out to Owings Mills, a depressing oasis of milquetoast urban sprawl, where HQ is located. All I had to do was hand deliver a check. Couldn’t be done online or over the phone or even over-nighted through the mail. In hand, that day, or no more coverage.

After spending an inordinate amount of time just trying to get to the place, I walk into a small lobby with a single desk and a hallway leading off to half a dozen cubicles. It was completely full of people. I walked slowly to the desk; the woman told me to sign in. I said all I was doing was dropping of a check. Sign in, please, sir, we’ll be with you shortly.

Over an hour lapsed before I handed my check to the woman behind the desk. Quite a fundamental, basic action, handing a check to someone and that person telling the machine that I had in fact handed them a check.

The Affordable Care Act allocates $20 billion for health information technology, which will, “Make our health care system more efficient and reduce paperwork for patients and doctors. Expand access to affordable care. Build a healthier future for our nation.” Yeah.

While the patient-doctor dynamic requires some serious retooling—and thankfully the ACA gets the ball rolling—individual states are full of backwatered systems (which makes me think of this Collin David post) that are serious roadblocks to reform.

The ACA is the first of many, many steps needed to bring some sanity to the archipelago of health care systems and programs. When one can’t simply drop off a check to pay off a premium without taking off nearly an entire day of work, the problem is much, much larger than tort reform and individual mandates. It’s about paper, files, computers and the millions of interactions that take place every day.


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