Friday, November 29, 2013

Against gratitude


Okay, not really. But I am personally uncomfortable with overt expressions of gratitude, and while I think this is mainly an emotional limitation on my part, there may be at least the ghost of a reasonable caveat in it.

As a teenager, I took a slightly unsavory pleasure in the science fiction of Robert Heinlein.  He not only entertained but also influenced and repelled me. He once wrote (through a character) that there was something sick at the heart of German civilization, and whether that's true or not, I think that the sickness he condemned clings to him, in a kind of gleeful authoritarianism. At the same time, some fragments of his cracker barrel wisdom stayed with me. One of his quirks, voiced by various favored characters, is an aversion to gratitude. As I recall at this distance, he cast it as a power play of the weak, a form of toadying, or guilt masquerading as love.  I think he's wrong to reduce gratitude to those impulses, though gratitude is certainly alloyed with them.  In a similar vein, though, he ridiculed worship, asking why an omniscient, omnibenevolent  God would require the saccharine praise of human beings. That was the question that really stuck with me. It gets at the heart of gratitude, since worship is mainly an expression of gratitude to God.

Such gratitude is -- should be -- a spontaneous expression of love. That's how those who voice it understand it.  But why does it express itself in "saccharine" praise?  In a Thanksgiving post, Andrew Sullivan's Dish suggested an answer:

A caveat for Ezra Klein

[updated, with a rather large caveat to the caveat...]

..who has a cogent set of questions about how well will be working as of Dec. 1 and going forward.  On one key question I think there's a moderating factor:
9. Where the Dec.1 deadline really matters is for people who've already had their plans canceled and who need to be able to sign up for a new one in time for it to start on Jan.  1. If the Web site isn't working smoothly for these people in the next week or so it'll be an utter disaster when 2014 comes and many of these people find themselves uninsured and some get sick.
Most people subject to policy cancellations in the individual market are probably not eligible for subsidies, since they've already found insurance affordable. That means they don't really need  They can easily get complete information about their options on ValuePenguin and then sign up directly with an insurer. [UPDATE: I'm afraid my premise here is severely compromised; William Ocasio reminds me that a recent Families USA study found that 71% of those currently in the individual market are below 400% of the Federal Poverty Level, and thus potentially eligible for subsidies. In practice, though, many people above about 270% FPL are not subsidy-eligible -- you only get a subsidy if the full cost of the benchmark silver plan exeeds a benchmark percentage of your income, and plan prices vary pretty widely from market to market. Still, probably more than half of those subject to cancellation are in fact eligible for at least some subsidy.]

Those who have received policy cancellations and are eligible for subsidies will need to get a subsidy application processed by hook or crook (that is, by online, phone or print application to the federal government) by Jan. 1. If they can't, I would imagine that some kind of retroactive subsidy payment will have to be worked out, after a lot of angst. For what it's worth, the subsidy-eligible probably won't be subject to rate shock, unless they're at the very top end of the scale, where the subsidy can shrink to near nothing.

Bypassing, cont.
Who needs

Thursday, November 28, 2013

"People analytics" should lead to better pay in all jobs

Anyone who reads Don Peck's deep dive into new advances in "the algorithmic assessment of workers' potential might be in varying degrees excited and disturbed by new means of predicting, assessing and improving performance. My chief reaction went in a different direction. The tests potentially highlight the huge performance differential in any type of work -- and hence, the value of good performance:
Teri Morse, the vice president for recruiting at Xerox Services, oversees hiring for the company’s 150 U.S. call and customer-care centers, which employ about 45,000 workers. When I spoke with her in July, she told me that as recently as 2010, Xerox had filled these positions through interviews and a few basic assessments conducted in the office—a typing test, for instance. Hiring managers would typically look for work experience in a similar role, but otherwise would just use their best judgment in evaluating candidates. In 2010, however, Xerox switched to an online evaluation that incorporates personality testing, cognitive-skill assessment,

Tuesday, November 26, 2013

Just what is the United States retreating from?

I have a problem with the way Mark Landler frames recent Obama administration diplomatic activity -- the scheduling of a Syrian peace conference as well as the interim agreeement with Iran:
At one level, the flurry of diplomatic activity reflects the definitive end of the post-Sept. 11 world, dominated by two major wars and a battle against Islamic terrorism that drew the United States into Afghanistan and still keeps its Predator drones flying over Pakistan and Yemen. 

But it also reflects a broader scaling-back of the use of American muscle, not least in the Middle East, as well as a willingness to deal with foreign governments as they are rather than to push for new leaders that better embody American values. “Regime change,” in Iran or even Syria, is out; cutting deals with former adversaries is in.
To call these initiatives "a broader scaling-back of the use of American muscle" seems to me a distortion of historical US foreign policy norms. Regarding Iran: when has the U.S. ever imposed military muscle to halt another country's (professedly peaceful) nuclear program?  It is only the bluster of the neocons -- the crew who blundered into Baghdad -- and of a Congress always eager to show fealty to Netanyahu that makes a preemptive strike at Iran seem like a kind of default response to that country's nuclear program.

Monday, November 25, 2013

Bypassing, cont

In prior posts, most recently here, I have explored the possibility that shoppers for health insurance on the ACA exchanges might bypass the still-balky with the help of information-only comparison sites ValuePenguin and HealthSherpa. Customers ineligible for a federal subsidy can already easily get all the information they need on these sites and then enroll directly with an insurer. For those whose incomes entitle them to subsidies, however, the subsidy application has been the roadblock, as it must be submitted directly to the federal government, either through or via phone or print application.

That may be about to change. Kaiser Health News' Julie Appleby reports, "Insurers and the Obama administration are testing fixes to designed to allow insurers and web-based brokers to directly enroll consumers who qualify for subsidies under the health law."  It appears, though that the fixes require insurers themselves to route the customer's application through -- that is, in the 36 states that have forced the federal government to run their exchanges.  Direct insurer processing of the subsidy application is still only an ask:

Sunday, November 24, 2013

C.S. Lewis: Joymongerer, democrat by default, less repressive than many of his critics, amateur philosopher

In honor of the 50th anniversary of C.S. Lewis' death on November 22, anappreciation that I agree with in toto:
I think Lewis was so compelling because, first, he was incomparable at evoking "joy" as he defined it. Whatever idea and yearning for "heaven" I ever had came from Narnia. Second, I think he had an intuitive -- not theoretical -- grasp of psychology -- he was one of those people who reads his own mind so well, he knows a good deal about how all human minds (and wills and emotions) work.The bickering of the children in The Magician's Nephew, Eustace's redemption in Dawn Treader, the seeds of human hatred elucidated by Screwtape -- and above all, the parental love turned to jealous gall in Till We Have Faces -- his greatest imaginative leap and rendition of the romance of the soul --have a kind of easy, intimate verity that give his spiritual dramas life.

At the same time, when it came to doctrine and apologetics, I think he was an unwitting sophist -- an honest sophist, if that makes any sense, because he fooled himself first...

Thursday, November 21, 2013

Red states' ACA exchanges: lab or slab?

Austin Frakt has launched a multi-post-and-tweet campaign arguing that the Affordable Care Act is an essentially conservative chassis amenable to conservative reform, and that conservative healthcare wonks should be aiming to mend it, not end it. (Subtext: they'd be doing just that  if they were not playing for Team GOP.)

The penultimate post in the series dangles conservative wonk-bait via a list of potential reforms in ascending order of disruptiveness to the current ACA structure, e.g., paring back essential benefits and allowing more catastrophic plans on the exchanges (not so disruptive) and creating high risk pools or universal zero- or low-premium catastrophic insurance (very disruptive).  But how to move GOP lawmakers and their think tank supporters off their "repeal and replace" schtick and onto a "revise and reform" track?

Frakt's most recent post suggests an answer by misdirection:
My conclusion is that the ACA is far more amenable to more conservative reforms than to more liberal ones. Of course, this could change. A public option could be added, for example. But, having had that political fight recently, I doubt it will. The most likely pathway leftward (in the sense of toward single payer) would be if the ACA failed in a sense that could be interpreted as market failure.

In fact, I do expect the ACA to fail in some states, but not in the ones that are most likely to adopt a state-level single payer program. Exchanges may fail where support for and enrollment into them is discouraged by political leaders and other institutions. Ironically, this is more likely to happen in states whose leaders are more ideologically supportive of market-based approaches.
If some state exchanges fail, and Republicans do not at that time control presidency, Senate and House, then what? Looking back at GOP state governments' refusal to run their own ACA exchanges, Jonathan Bernstein offers a might-have-been that's also, it seems to me, a may-be-yet:
Imagine if, right now, there were only a handful of states in the federal exchange, and some of the more aggressive and innovative conservative governors were running their own exchanges...suppose that several Republican governors had pushed for a deal in which they would implement Obamacare, including setting up exchanges in their states, if and only if they were given waivers and allowed to try some conservative policy ideas. The pressure would have been intense on the administration to allow at least some of them. After all, the administration never wanted to build all those different state exchanges in the first place. And certainly the president didn’t want obstruction verging on sabotage from Republicans across the board, as is de rigueur now. In order to get some Republican buy-in, there’s a very good chance Obama would have been extremely willing to cut deals, even if liberals would have been appalled at the results for the affected states.
Recall also that back in 2011 Obama supported legislation that would have moved the starting line for state waivers enabling alternative means of reaching near-universal coverage from 2017 to 2014 -- and further, that the administration has proven receptive to rather radical, privatized variations of the Medicaid expansion.

In short, O'Barkis is willing.  Too bad Republican governors and legislatures are more interested in sabotage than in genuine conservative policy innovation.  If and when, however, they're stuck with the corpse of a state exchange (or one on life support), and the ACA is still the law of the land, Republican governors may cook up some fetching Frankenstein monsters of their own. 

Wednesday, November 20, 2013

Who needs

[updated and corrected 11/22, per notes at bottom] may be obsolete before it's fixed.

Purely informational comparison shop sites ValuePenguin and HealthSherpa provide all the information that's supposed to be available on price quotes incorporating the user's location, income,  age and family composition for all insurers available to that user on the exchange. ValuePenguin provides plan details.  (Shopping without a login or completed application is also possible on, but there are limitations and inaccuracies.*)

The missing link has been the subsidy application. That has had to be done through, or through phone or print applications, both of which can be started by calling the number posted on  That application is the black box from which it's unclear how soon a completed application will emerge. As I've noted before, some insurers at least will take an application for a specific plan from a user who's started a subsidy application with the government, but that's a two-track and perhaps unsettling process

Now, though, the government is poised to let the insurers -- and online brokers, which also enable some comparison shopping -- take the subsidy application, according to HuffPost's Jeffrey Young:
Now these insurance issuers and brokers are about to get what they want. The Centers for Medicare and Medicaid Services is close to providing insurers with the technological capability to also take subsidy applications, as well as sell plans to customers, spokeswoman Julie Bataille said during a conference call with reporters Tuesday. ..

Online brokers eHealth, Go Health and about 30 others also will soon have this capability, Bataille said. "We believe that they are on track to begin their transactions as soon as possible. This is something that, obviously, they will make determinations about individually as they see how their system is interacting with ours, and they make their own assessments about the fixes necessary for them to begin their work." 
[Update: fixes currently being tested  have the insurers route their customers' subsidy applications through  It remains unlikely that insurers will gain direct access to the federal data hub that enables subsidy determinations.] 

The brokers could be a useful intermediary for some. eHealth  offers comparison shopping, with plan details for each posted choice, though in many locations it's far from covering all options on the exchanges. Within its own universe, however, eHealth will make your subsidy estimate, give you price quotes incorporating that estimate, hold information for any plan you select and notify you when enrollment is available on eHealth -- that is, when the site can initiate the subsidy application. A user should check their choices against ValuePenguin or HealthSherpa, however (I have found ValuePenguin's price quotes to be more accurate than HealthSherpa's in New Jersey).

If you want to eliminate the middleman, once the government allows third parties to process the subsidy application, you can use a non-transactional comparison site like ValuePenguin and then apply directly through the insurer offering the plan you choose. Many (I suspect most) insurers on the exchanges provide plan summaries online and enable online applications.

Once the government does outsource the subsidy application process, who needs Its front end, that is. All that really matters is the back end: whether an application can be processed accurately in reasonable time. That of course is the rub, and allowing third parties to initiate subsidy applications won't make the technological challenge* go away. But perhaps the insurers and brokers will be able to expedite the process on behalf of their prospective customers -- and enable a smooth shopping process. If insurers and brokers can take the complete application, all the government needs to do on the front end is refer users to functioning online brokers and the informational sites.

At present, those who are not eligible for subsidies can easily make an informed choice from among policies available on the exchanges and complete the transaction through the insurer or an online broker.

One caveat: "informed" choice is a relative term. Online (and print brochure) plan summaries are not insurance contracts, which are complex, though less prone to booby-trapping than before ACA coverage rules took effect. If I were buying on the exchanges (as I might, next year), I might still seek the advice of a real live human broker to scope out how the co-pays, deductibles etc. might play out.

* You can comparison shop on without filling out an application. But subsidy information won't be incorporated in the price quote (they refer you to the Kaiser calculator for that). And the price quotes I got for my wife and I in New Jersey did not take our age into account and so were way off.

** Not to mention the yet-unbuilt systems to process subsidy payments to insurers.

Update, 11/21: just recalled that eHealth has been somewhat notorious for poor customer service:  it gets two out of five stars on, and Rick Ungar spotlighted some customer horror stories when Avik Roy used the site to spotlight rate shock. Among the complaints: signing up at one price, getting enrolled at another. That should not be possible under the ACA. But the experiences do highlight possible pitfalls to using a middleman. Of course and the state websites should function at the least, in William Ocasio's  phrasing, as "public options to private marketplaces."   The point here is that complete effective workarounds while is still balky may soon be imminent, and that private online gateways may remain an important part of the landscape.

Update 2, 11/22: An earlier version of this post assumed that one could effectively ACA shop on eHealth. Prompted by the Anon comment below, I further tested eHealth and found that in many locations it does not include most of the plans available on the exchanges. I have amended the post accordingly. For the record, here is the original lead paragraph:
Online health insurance brokers like eHealth and purely informational comparison shop sites ValuePenguin and HealthSherpa provide all the information that's supposed to be available on price quotes incorporating the user's location, income,  age and family composition for all insurers available to that user on the exchange. eHealth and ValuePenguin provide plan details. eHealth will make your subsidy estimate, give you price quotes incorporating that estimate, and, for now, hold the the plans you select in a kind of provisional shopping cart. [Update: management/healthcare scholar William Ocasio of Northwestern tweets that eHealth omits some insurers. So results should be checked against ValuePenguin or other brokers.] 

Tuesday, November 19, 2013

Low-tech glitches on

I get that fixing dysfunction is a massively complex tech project.  But there are informational flaws on the site -- sins of omission and commission -- that would be easy to fix. I've encountered two.

For the first, call me stupid. There's a hole either in my tech savvy or my reading about ACA implementation -- or both.  But stupidity is rarely rare, and the designers of should have anticipated my need for one really basic piece of information.

From October 1 to November 15, I tried to create a login at at least 40 times.  For perhaps too long, I assumed that my failure was just the core failure of the site. Gradually, recently, it dawned that whatever the site's functional failures, most people by now could at least log in -- and were encountering further glitches when they tried to complete applications (see comments on this HHS posting). So I went on live chat and quickly learned the cause of failure: if you've blocked access to pop-ups, you have to turn off the pop-up blocker. I did so, and lo, my login is created.

Sunday, November 17, 2013

Status quo Sunday at the New York Times

I had the oddest sense of deja vu while reading Ross Douthat's column about the Affordable Care Act today immediately after reading Tom Friedman's column about Israel. 

Both were sleight-of-hand defenses of a status quo: an Israel continuously extended on theft of land and a welfare state in statsis that Douthat would not have adapt to mitigate new problems of wealth distribution and risk transfer.

Friedman's column is a mealy-mouthed plug for a book by Haaretz columnist Ari Shavit, which may well be better than Friedman's characterization.  It begins with an even-handedness trope: a plea to view "the real Israel, not the fantasy, do-no-wrong Israel peddled by its most besotted supporters or the do-no-right colonial monster portrayed by its most savage critics." Fair enough. But the column sanitizes the colonial reality, flashing briefly on a bloodless freeze-frame of expelled refugees in 1948 rather than engaging with the continuing and accelerating gobbling of the West Bank.  It then devolves into que sera piety: Palestinians should suck it up and get on with their lives. And by the way, the failure of two-state negotiations is all their fault:

Saturday, November 16, 2013

"Urged on by Netanyahu..."

During the Cold War, in the course of pursuing perhaps the most successful long-term foreign policy strategy in human history -- containment of the Soviet Union -- the United States did a lot of stupid, cruel, counterproductive things -- overthrow elected governments, prop up corrupt autocrats, support quasi-fascist insurgencies. It did all of them, though, in the perceived national interest, however short-sighted or ruthless the calculus of the decision-makers -- even when, in the case of Nixon, that perceived national interest was avowedly a matter of national prestige.

Imposing new sanctions on Iran now would be in a different category of foreign policy malfeasance. The Times editorial board's wording casually captures what's cockeyed:
A rare opportunity for a diplomatic resolution to the dispute over Iran’s nuclear program is at risk because many lawmakers, urged on by Prime Minister Benjamin Netanyahu of Israel, are insisting that Congress impose tougher economic sanctions, perhaps next week as an amendment to the defense bill. 

Wednesday, November 13, 2013

Working around summary

To distill the takeaway from my last two posts (1, 2): anyone with computer access seeking to buy insurance on the ACA exchanges can easily get all the information they need to select a plan while bypassing by visiting window-shopping sites ValuePenguin and HealthSherpa, as well as the individual insurers' sites once one has honed in on a single plan or a handful of top contenders.

Both sites prompt you for your location (zip code or state/county), the number and ages of people in your household, and your household income, and then give you specific quotes for all the exchange plans in your area. These quotes incorporate your subsidy if you qualify for one.  ValuePenguin provides plan details, and HealthSherpa provides contact information for each plan, including the identifying name of the plan in question. I appear to have gotten inaccurate price information in one location (Essex County, NJ) from HealthSherpa, but not from ValuePenguin, and the two provide identical price info at other locations I tested. The information on the two aggregator sites can in any case easily by checked against the insurers' own sites. The big insurers, if not all exchange participants, also offer subsidy calculators on their websites.

The catch is that as of now, the actual subsidy application has to be processed by the federal government, and the application process through the website has proved broken for many if not most users (I have not been able to establish a login myself). You can, however, apply over the phone by calling the number listed at and providing information orally, or you can ask the phone rep for a print application, which they'll mail. I reached a live person quickly, and he was ready to take a subsidy application from me, or so he said. Once you have an application case number, which can be sent by email if you apply over the phone, an insurer will let you apply for a specific plan, but you cannot seal the deal until the subsidy application comes through. 

The great unknown, I believe, is whether the federal government can process a phone or print application in reasonable time.  If so, the process need not be particularly onerous even if you cannot apply through the site.

P.S. should be able to perform the ValuePenguin/HealthSherpa function even if you can't log in.  It does not provide age-specific price information, however -- at least, it hasn't in my three attempts. And it sends you to the Kaiser Family Foundation  for a subsidy calculator.  The Kaiser calculator is a great tool, and has been around for a while, but it doesn't provide plan-specific information.

Monday, November 11, 2013

Working around, cont.


On Nov. 10 I spotlighted two public service websites, ValuePenguin and HealthSherpa, that appear to offer workarounds to the dysfunctional for people hoping to buy health insurance on the ACA exchanges.

Both sites take your location (zip code or state/county), the number and ages of people in your household, and household income, and give you specific quotes for all the exchange plans in your area.  ValuePenguin links to plan details, and HealthSherpa provides contact information.

To what extent do these tools provide a workaround the broken website? They provide all the information needed to make an informed choice, at least when checked against the insurers' sites.  One still has to go through the federal government to apply for a subsidy, but that can be done by phone or snail mail. The main question, for those eligible for subsidies, is how long the subsidy determination will take.

A shopper who is not eligible for subsidies can buy a plan directly from the insurer of her choice, with all the information that should have been available on easily obtained elsewhere. Below the jump, my experience initiating the shopping process.  I presented myself on the phone as someone planning to apply for a subsidy.

Sunday, November 10, 2013

A private-market patch for the ACA?

About ten years ago, I used to refinance my house. On the website, I punched in various vital statistics -- perhaps more than I'd be comfortable submitting today -- and, as advertised, received four bids from mortgagers.  Each sent offer details, I believe all by email.  Parsing the offers -- points, fees, etc. -- took some time, as with any comparison shopping for a financial product.  The small bank I went with gave me some heartburn by not approving the loan within the rate lock period, but they did extend that period, and I did get the loan at the advertised rate, within the estimated costs. It wasn't as easy as buying a camera on Amazon, but it was within reasonable expectation.

About seven years ago, I helped my older son, then 23, buy health insurance on New Jersey's bare-bones individual market exchange. There were basically three choices. AmeriHealth looked best, and they sent us a plan summary  -- I think three options at different price points.  We settled on not-terrible coverage -- at least, not terrible on paper, to my reasonably informed eye -- for about $180 a month.

Months ago, the Kaiser Family Foundation put up a provisional ACA cost calculator: punch in the number of people in your household, their ages, family income, and zip code, and get an estimate of the price of a silver or bronze plan, with and without the subsidy you qualify for, if any. It does not provide information for specific plans,however.

Now, it seems, there's a private-market, state-specific improvement, with pricing for actual plans and contact info for the insurers offering them:
I gave this a whirl, putting in my zip code, ages for my wife and me, and various income estimates. It works. There are no plan details (other than plan type -- HMO or EPO or POS), and I haven't called the insurers whose plans are quoted [update - see next post], but I would assume that they will send plan details if asked. [Update: per below, another site, ValuePenguin, appears to give more accurate price quotes, at least in New Jersey -- as well as plan details. Most insurers' websites do, too.]

Friday, November 08, 2013

The ACA as a framework for (further) conservative healthcare reform

Austin Frakt does AEI's James Capretta the honor of seriously considering* elements of Capretta's attempt (with Douglas Holtz-Eakin) to fill in the long-empty "replace" blank in Republicans' purported "repeal and replace" program for the Affordable Care Act. After spotlighting various lacunae as well as potentially workable elements in Capretta's "decentralized, market-diven alternative to the PPACA," Frakt comes to a core point, implicitly questioning whether conservative healthcare wonks are acting in good faith:
6...Democrats are well aware of the limitations and problems with the Affordable Care Act. Some are so troubling that the administration is considering some interesting proposals that would require Congress to act. Point being, there is leverage for some negotiation on some aspects of the law. And, crucially, some of the things Capretta has proposed fit within the structure of the ACA, such as allowing Medicaid enrollees to buy exchange plans (see Arkansas), capping the employer-sponsored insurance tax subsidy (see the Cadillac tax), or making exchange plans more catastrophic. But that brings me to …

Thursday, November 07, 2013

More than just a website: state efforts to make the ACA work (and the lack thereof)

We've all read by now that the ACA websites in states that are running their own exchanges (14, plus D.C.) are working much better than the federal site. What most of us may not have fully recognized -- though it's no doubt obvious to health and insurance professionals and people who have run social service programs -- is that establishing, running and marketing a functioning insurance marketplace requires a wholehearted commitment from state government.

Enticing insurers, policing insurers, and, above all, educating and wooing the uininsured public require expertise, commitment, money and accountability. Putting the program across in mostly low-income and low-information populations is a lot like delivering chronic care to those in need: it requires a lot of patient, informed, sensitive one-on-one contact.

Kentucky and California are two states that are going all out to make the Affordable Care Act a success.  The Huffington Post's Jason Cherkis recently did some great reporting in Kentucky, where Governor Steve Besheare, a Democrat,
is using all the powers of his administration to sell Obamacare, marshaling millions of dollars for branding and market research, heartwarming television spots and eye-catching bus ads. A hired army of true believers have held meetings across the state, spreading the word and rebutting misconceptions.

Monday, November 04, 2013

Joy eludes the Archbishop (Lewisian joy, that is)

Rowan Williams, a former Archbishop of Canterbury who's written a book about C.S. Lewis, seems, on the basis of this interview, to appreciate CSL for what I regard as the right reasons: his understanding of human frailty based on personal humility, his capacious and sympathetic grasp of literature, and, above all, his imaginative evocation of spiritual desire and experience.  I was pleasantly surprised, too (probably shouldn't have been; I'm not up on current theological currents) that he pretty much dismisses Lewis's agitprop-thin "rational" arguments for Christianity's literal truth.

All that said, Williams seems to misunderstand the keystone of Lewis's imaginative theology, the experience Lewis called "joy." Williams conflates that joy with more prosaic spiritual phenomena -- the psychomachia of everyday life --  that Lewis also evokes.  

Here's Williams' take on Lewisian joy:

Sunday, November 03, 2013

Subtext to the WaPo disaster narrative: Sabotage works

The Washington Post's tick-tock by Amy Goldstein and Juliet Eilperin on the decisions leading to the dysfunctional launch of is cast in a familiar genre: an anatomy of politicized administrative incompetence. And the piece does capture some likely bad decisions.

But the narrative documents a more basic fact, not hidden but acknowledged only secondarily: sabotage works. More specifically: in a two-party system, if one party gives itself over with fanatic single-mindedness to sabotaging the enactment of a major reform, it will succeed in some degree.