Op-ed pick: What went wrong with the federal health care exchange?

In the New York Times, Ezekiel Emanuel suggests some fixes for the troubled healthcare.gov site and lays out how the Obama administration got it wrong by being slow, bureaucratic and insular.

Massachusetts has had years of experience with its exchange, and there are private exchanges, like eHealth, where individuals can shop for insurance. In addition, many states, like California, Connecticut and Kentucky, had already spent around two years building their exchanges, gaining experience and proving it was possible to create a good customer shopping experience. It does not appear that the Centers for Medicare and Medicaid Services or its contractors spent much time reviewing these models and adopting best practices.

Emanuel has a five-step process to not only get the site up and running, but to make sure the “young invincibles” sign up.

…the Americans who are likely to endure the frustrations are those who most need coverage — older people with expensive health problems. If the site is too much of a hassle, the healthy 20- and 30-year-olds the system desperately needs to enroll won’t go through the trouble. Everything should done to make their purchasing experience smooth.

Read his entire plan here.

  • Hillary

    What difference does it make?

    • Jim G

      Do I need to worry about you, Hillary? I mean we’re in the SAD season, right? Exercise does tend to lighten one’s mood. So do I?

  • Nick

    I still save allot on gas and time ..

  • Duane

    Why is Gov Dayton and the DFL so obsessed with increasing tax revenue by finding more items to tax? There are two other ways to deal with the budget problem. First you cut out unnecessary expenses and secondly you work to improve the business climate and generate more tax revenue through increased employment and a stronger economy. Can we get this message to the legislatures?.

    • kennedy

      Small correction: This is not a new tax, this is collecting an existing tax that is often being evaded. The change being proposed is to have retailers collect the tax and pay it to the states rather than relying on citizens to self report. It’s great to talk about closing loopholes until they close one of yours.

      • Duane

        Minnesota has never had to pay sales tax on clothing, food and many services. We have never had to self report any of these purchases. The same held true for any tax exempt items that were purchased on line. There was no tax evasion.

        • Duane

          I stand corrected, this tax refers to online taxable sales, in that case we should look at equalizing the tax with in-store purchases; however, my comments regarding increasing tax revenue only through increasing taxes alone still is relevant.

        • GregX

          tax is due on internet sales of non-clothing… books, food, wine, spices, sports equipment, computers, … all of it … if unpaid … that is illegal for Minnesotans.

          Sort of like its illegal to speed, even if everyone else is doing it and even if you don’t get pulled over.


    • GregX

      incorrect analysis. (1) internet companies are unfairly underselling bricks & mortar by not paying sales tax. this is modernization. (2) our current system is overly dependent on income and real-estate… this is an effort to lower the load on those two and broaden tax “coverage” to reflect the economy we have today. Way more service + sales income, way less manufacturing and wage income.

      As for cutting expenses – yeah .. that too.

      the state has been converting to automation/online to replace hiring staff. consultants are hired to avoid paying pensions. services are being dropped or service levels are being decreased. most state agencies have reduced staff size every year for the last 10 years through retirement attrition.

      if it isn’t fast enough for you … make this promise to your community.. you will cease using: sewer, water, police, fire, courts, libraries, roads, sidewalks, bus, patented products, restrants that pass health inspections, licensed businesses of any kind, 911, … … OK ??

      • http://mprnews.org/ Eric Ringham, MPR News

        It’s not just that the bricks-and-mortar operations are being undersold. They also seem to be hollowing
        themselves out — offering fewer items on-site, and referring customers to their websites.

  • Steve the Cynic

    Not much. The sales tax notwithstanding, I prefer actually seeing and touching the product, and I consider “showrooming” unethical. I support applying the sales tax to internet sales, because it’s only fair.

  • Jeff

    I’m not sure if this would even be legal since this is interstate commerce, this is akin to charging a tariff on a state level which is definitely illegal. Maybe it would make more sense to charge sales tax at the location where the store selling the item is located.

    As far as the question would paying sales tax on online purchases change my shopping habits…I would have to say they would not change my shopping habits much. The online stores seem to always have significantly lower prices, I can analyze products much easier and compare prices from the convenience of my home not have to outside in this weather. Besides, who wants to be harassed by a bunch of teenagers/young adults who have no clue about the product I want to buy in a normal retail store? I recently returned a Christmas gift with a receipt at retail store, it took 30+ minutes, two attempts and two calls to the manager to get a simple return and exchange done…I have found that it’s much easier to return things online. I even had an incident where I was not allowed to return an item at a retail store within 3 days of the purchase with a receipt AND the item was defective (thanks Best Buy).

    • GregX

      14 states have established a “physical presence” with several vendors ( Amazon, etc.) because of warehouses, offices, etc. that establish the necessary link to allow taxing. As a result – and to avoid further court cases …. Several national online vendors have established a 2-prong solution …
      (1) lobbying congress to create the national sales tax (2) interim agreements to begin paying bulk sales tax collections to states based on customer billing address – should congress fail ( he he he) to act.

  • BJ

    Shipping cost almost are always higher than taxes, so only when I can’t find something local do I look online.

  • Linda

    I dislike driving all over town trying to find something. I’d rather click the mouse a few times and get what I want without driving to two to three stores, or more.

    Also, many of the items I buy online are not available in local stores, and making those purchases from specialty retailers online is my only option.

  • Jim G

    Nope. I usually only purchase items on-line that I can’t find at the local stores. Vacuum bags and a replacement filter for the dryer being my most recent purchases. I need them so of course I’ll pay the small added charge of sales tax. I don’t live life with a tax calculator in my pocket like tax aversives must have in theirs.

  • Gary F

    I don’t buy that much online. Clothing and ammo and an occasional out of print CD. There is no ammo to be had, and I don’t buy many clothes except shoes over $100.

    I am against it if it just means more spending. Pay back the school districts and shore up the pension funds AND GO HOME! STOP SPENDING MORE MONEY! JUST GO HOME EARLY FOR ONCE! GEEZ, IT’S NEVER ENOUGH PEOPLE.

  • GregX

    I shop where I shop. If I need to see it, touch it to know I’ll buy it – I go to a store. Otherwise … I buy form where I find it when I need/want it. Tax makes little or no difference … total price does…. Meaning that if … I have 80$ spend … and it costs $80.09 , I’ll spring for the 9 cents. If it costs $113.61 … it wasn’t the tax the killed the sale.

  • David

    This makes complete sense. Dayton proposed taxes on items over $100, so I’m not sure if that would be every $100 total, or on specific items that are $100 or more, like jackets, watches, business suits, etc.

    Either way, if you want Best Buy or other brick and mortar stores to stay open, you need to level the playing field. It is a competitive advance that need to be fixed.

    Increase the tax the sin items too, like cigarettes, soda, and liquor.

  • Wally

    I have a sales tax license, and I pay sales tax on my online purchases. It’s only fair.

  • Susan WB

    Not really. I shop online for convenience, not to dodge taxes.

  • Bobbye Larson

    Web site sales tax would be very difficult for our small family-owned business, in which most of our sales come from all over the country. Having to collect and manage sales tax would mean having to hire another person just to manage them. We already bring money to Minnesota from all over the country, and having to charge sales tax would just punish us.

  • AndyC

    Not really. I would still shop for deals, online or in the store, after I have used Consumer Reports and online reviews to compare products. It’s the big ticket items that make me feel guilty for buying (tax free) online. I support Governor Dayton’s proposal as I watch a tax-paid snow plow go by.

  • Mishka

    I’d love to see the sales tax fairly applied to internet sales, so that our local stores aren’t at such a disadvantage. If anything, I’d probably shop online more, knowing that the state is getting their fair share.

  • RICK S

    Yes, it definitely would change my shopping habits – I would purchase less on the internet and overall, purchase less in total as sales taxes are a major deterrent for purchases, especially big ticket items like cars. The bigger question I have, is why can’t the State of Minnesota live within its means like it citizens have to? We can’t “raise our salaries” because we have a budget deficit and spend more than we make. Minnesota should not rob its citizens of more of their hard-earned cash because politicians want to spend more money. If internet purchases are taxed, then the overall sales tax rate should be reduced so it is tax revenue and does not further burden the states residents with higher taxes in a already high-taxed state. Live within your means MINNESOTA – play by the same rules as your residents have to!

  • Renae

    Nope. I buy online for either convenience or because I can’t find the product I want in stores. Easier to search online than run around town. I don’t do a lot of online shopping, but I have never made the choice based on tax.

  • Roy Wehking

    No. Buy on-line, pay.

  • Roy Wehking

    The state needs to cut, but also, local merchants should have a level playing field.

  • belize boy

    Nearly on the dot, 99% of workers in Minnesota do not work for the Mayo. The state of Minnesota should be investing in people, not places.

  • TML

    This is absolutely a good use of state funds and a much better use than some others I can think of. The money would not be funded up front but over 20 years, only if the tax revenues from the clinic are there and would go towards community infrastructure improvements. I can’t blame Mayo for requesting that if they invest $3+ billion dollars into the Rochester campus that they know that the infrastructure to support the investment will be there. They could just as easily invest it in the AZ, FL or GA campuses. That they want to focus on MN should tell us something.

  • Fred Garvin

    ” how the Obama administration got it wrong by being slow, bureaucratic and insular.”
    You left out the scores of lies about the website being ready and tested given under oath to Congress by Obama officials since March, 2011. The only question is whether those lies rise to perjury.
    You left out the explicit lies about keeping your health care insurance and your doctor made by Obama throughout the summer of 2009 as he campaigned for Obamacare.
    Come on. Call it what it is.

  • Fred Garvin

    Come on, why did MPR waste space quoting Ezekiel Emanuel–a well-known liar and Obama groupie?
    There are plenty of credible sources out there–anyone named Emanuel is not in that group.

  • Fred Garvin

    “the Americans who are likely to endure the frustrations are those who most need coverage :
    Huh? Why do the young who tend to be healthy need health “insurance”? NO THEY DO NOT!
    It’s Obamacare that needs young healthy folks to pay for Obamacare. When the young figure this out, down goes the Obamacare titanic.

  • AndyBriebart

    It went wrong? I think most folks on the left haven’t came to that point yet. But, now I guess it’s OK because the NY TImes says so.

  • LibertarianUSA

    Gee, maybe because the government is spearheading this effort? I feel for the people that are watching their plans disintegrate in front of their eyes, only to be told they have to buy a different plan that will cost them 200% more. There’s stories all over even though the MSM does not like to report it.

    You wouldn’t lose your existing insurance, they said. You can keep your doctor, they said. It’s all lies. They can’t even run the websites correctly, how are they going to manage people’s health?

    This law needs to be scrapped. The only people hurt by this are the middle class and all those people that thought this was “free” are starting to see the truth.