The state ought to be able to get somebody to pull together the necessary documents and deploy a slightly tweaked out-of-the-box search engine for under $100,000.

Ha, ha, ha! You're way over your depth on this one.

I think there's massive confusion about what the 'exchange' actually is. Some folks seem to think it's just a website to allow for easy shopping. My understanding is that it's far more in-depth.

I was approached years ago by a health care lobbyist who wanted to know how to create an interstate database of health care laws/regulations that tapped into actuarial and business data of insurers and outputted personalized insurance options (basically, what the state is trying to do with the exchange). Five minutes into the conversation and it was clear that without real solid standards about 'coding' services, electronic record storage, legislative 'monitors' in each state, and a massive amount of work, it was all but impossible.

Our health care system is a total mess from top to bottom. Everything about it, from how patients are tracked to how things are paid for and how providers are compensated is so far gone that it's not worth keeping.

Five minutes into the conversation and it was clear that without real solid standards about 'coding' services, electronic record storage, legislative 'monitors' in each state, and a massive amount of work, it was all but impossible.

Justin can fix all that for $100k! Gonna run it off his laptop (will have to since the hardware alone for an exchange could be well above that amount).

Here's the other whopper...

Government does poorly vs. the free market. The very idea of a government-controlled exchange is antithetical to our nation's historical free-market principles,

While it's not written in stone, the plan that was winding through the RI Senate called for creating "quasi-public corporation that provides 'an essential governmental function' but is not part of the state government" that would use no state funding.
www.projo.com/news/stategovernment/content/HEALTH_REFORM_LEGISLATION_01-28-11_5LM6TJE_v14.19c7494.html

What Stenhouse seems to be arguing is that any regulation of a market constitutes the boogeyman of "government control." Consider that by that definition, the New York Stock Exchange is government controled and therefore "antithetical to our nation's historical free-market principles." It's a ridiculous position, but one appealing to the sentiments of the fringe-right (assuming they don't think too hard about it).

The current health care system combines the worst inefficiencies and abuses of socialism with the greed and unaccountability of corporatism left completely unchecked by market forces. It's a monstrosity that only government could create and only politically connected corporations could abuse and exploit to its limits.

I have no problem scrapping it. I just wish we could return to a free market system instead. All we're doing with Obamacare is wallpapering over the mold.

Does Russ stand to make some profit here?
He's going nuts like a roach that just got sprayed with Baygon.

Joe - Russ is just excited that there is finally a topic he actually knows something about, even if it is just software engineering. Usually he has to blockquote spam op-eds from his progressive idols Kohn and Krugman just to have an input.

Russ,

As usual, your characteristic euphoria of superiority has led you right past the point: The cost that I cited was for "slightly tweaked out-of-the-box search engine" — that is, a tool that compares the programs offered by RI's three insurers, perhaps factoring in the circumstances of the consumer (regarding available subsidies, etc.). Obviously, the fancier and more detailed it becomes, the more it will cost. That's exactly the point: the price tag is evidence that the government isn't just trying to offer an informational site, but to make itself even more integral to Rhode Islanders' access to healthcare.

What I fail to understand is how when representatives of the companies that are selling the product (the folks who approached me) back down from pushing their own product because the implementation is too complex, the government steps in to do it.

The problem isn't confusion about the plans or ability to access the 'buy now' button, it's the cost of the plans. These exchanges don't seem to do anything about that; they seem to make it worse, actually.

This whole thing reeks of politicians who know next to nothing about technology imagining that the technology can do something magic. The fact that we're not exactly sure what the exchanges are supposed to do or how they work should already be a harbinger of doom for the whole idea. In the end, I predict a fat contract to an IT consultancy for a product that never quite delivers, because the client never quite knew what they wanted.

And even if it fails, like every other loosely-specced and ill-defined large IT project with an open-ended contract does, it will be labeled a 'success' because it 'created 12 jobs in the knowledge economy'.

And given how this is being described, would it be SO HARD to get the anti-abortion crowd off our backs by having a checkbox that says 'only show plans that do not offer abortive reproductive services'?

Mangeek,

Well, first of all, don't presume to say "our backs." Whose backs? Or are the default for what is normal and good?

Second of all, the entire point of ObamaCare and these exchanges is to have the government dictate what must be available in all healthcare programs and who must pay how much for them.

Mythbuster #1: The Govt. does an extremely poor job of spreading the wealth but a great job of spreading the poverty. Just another failed program in the queue. Hussein and Russ will save us all with their progressive path to doom.

"don't presume to say "our backs." Whose backs?"

I meant that between Russ and I, and other pro-choicers. I sort of meant it to bring up the liberal paradox between 'we need this so people can choose what they want from their plan' with the accompanying 'as long as it's done OUR WAY'.

Talked about the Health Insurance Exchange on-air, over many months, on numerous occasions. Spoke with legislators about it prior to it failing in the GA. Then sent numerous email alerts out through RITP and the OSTPA.

Bottom line: it creates another level of bureacracy, some good-paying jobs for the few and absolutely no ability to provide affordable health insurance choices for individuals and small businesses in RI. Re-packaged spin is what it appears to be at this point in time.

By the way, recycled plan designs do not constitute choice to the extent that is required to drive down cost. This does not allow for intra-state purchasing. It most likely will allow for the further expansion of BCBS market niche in RI.

Staff member/consultant in RI's DOH (Koller's office) wrote a study comparing numerous states vatying abilities to actually deliver stated goals of an Exchange. That analysis clearly stated that it won't work in RI. RI still does not have market competition, key factor to drive cost.

"RI still does not have market competition, key factor to drive cost."

Yes. And as you said, Lee, implementing a federal Insurance Exchange will do nothing to bring market competition to the state.

This is the ultimate feel-good-yet-accomplish-absolutely-nothing government program. It wouldn't be quite so annoying if it didn't utilize hard-earned tax dollars.

Russ is just excited that there is finally a topic he actually knows something about...

Unlike some here who apparently think themselves experts on everything.

"...your characteristic euphoria of superiority"

Call what you like. Do I tell you you how to frame houses? Again, waaay beyond your depth on this one.

Second of all, the entire point of ObamaCare and these exchanges is to have the government dictate what must be available in all healthcare programs..

The great irony, of course, is that the bill to create this exchange was derailed by the folks on the fringe-right who think their religion should dictate which type of health coverage a woman in RI should be allowed to choose. Thus, the executive order.

That's only an irony to you because you're misrepresenting what happened. The "fringe right," including Paiva-Weed, apparently, don't "think their religion should dictate which type of health coverage a woman in RI should be allowed to choose." Rather radical pro-abortion extremists don't think Rhode Islanders should be able to avoid subsidizing killing unborn children.

I do like this: "thus the executive order." You're on record in favor of aristocracy and dictatorship, then, provided they serve your political views?

I know, I know. You're just smarter than the rest of us, so those supporting your views can't be expected to follow rules designed to hinder theocrats and other PYDLs (people you don't like).

On the matter of cost, why don't you educate us, Russ: How much would "a slightly tweaked out-of-the-box search engine for under $100,000"? Site-specific Google search is free. Our blog's search engine was free. I've created simple forms on my spare time... again, for free.

IF the "exchange" consists of a modest search engine, explanations of benefits, and some tables comparing features, then my suggested cost is reasonable. As you layer in features (from factoring in user eligibility in the search form all the way to processing the payment and automating the necessary paperwork), the cost will go up. That is the point of the post: the cost indicates the extent of the intended project.

"IF the "exchange" consists of a modest search engine, explanations of benefits, and some tables comparing features, then my suggested cost is reasonable."

If the exchange is the 'orbitz' or 'travelocity' of products put up for side-by-side comparison, it ought to be a job done by the companies selling the product, no? The three providers chip in to a small startup that builds the thing to-spec, then offer a small 'broker' fee when subscriptions move through the portal.