Killing health care with a thousand paper cuts (5×8: 12/18/13)


It’s been a few months since Minnesota’s health exchange website went live on the Internet and there’s only a week left until the cutoff to apply for coverage that starts on Jan. 1. The politicians involved have let themselves get into a particularly nasty pickle: If they admit the obvious, their political careers are at stake.

The obvious assessment is the system doesn’t work. That’s not to say it can’t work, given the time and brains that could be employed. But with a week to go, it doesn’t work well enough now.

When the two largest newspapers in Minnesota both agree on that point, it’s a good indication that it’s time to recognize the obvious.

The problem isn’t that April Todd-Malmlov, the MNsure boss who was sacked by her overseers last evening, went on a nice vacation to a warm place while Minnesotans navigated unnavigable waters. It’s that the move made her and the rest of the agency seem tone deaf to the plight of the people they’re employed to serve.

“The Board believes the organization is at a stage where it needs a CEO to manage both MNsure’s current challenges and position it for greater success in the future,” said MNsure board chairman Brian Beutner in a statement, a few days after Gov. Mark Dayton signaled for the executioner when he declared MNsure’s performance “unacceptable.”

It’s been at the stage for awhile.

Beutner didn’t face the reporters camped outside the closed room where the board was figuring out how to clean up the mess. Instead, he sent a spokesman — for the Department of Corrections — out with a press release.

From what we can tell from today’s stories, none of the participants in yesterday’s meeting returned any phone call from reporters looking for a better explanation of what’s going on. That doesn’t help dispel the image of an out-of-touch bureaucracy.

In its editorial today, the Star Tribune cited a growing — not declining — list of problems the system faces.

On Tuesday, an editorial writer on hold for an hour to the MNsure call center found out through the automated hold-time message that another problem has surfaced. Some consumers have received material indicating that coverage will start Feb. 1 instead of Jan. 1, likely the result of computer systems not being adjusted to reflect a recent move by the federal government to extend by about a week the deadline for coverage starting New Year’s Day.

The steady drip of problems undermines past reassurances from MNsure leaders that the majority of consumers have enrolled without snags. It also makes officials sound like they’re disturbingly disconnected from the site’s operations and tone-deaf to consumer frustrations. The timing of Todd-Malmlov’s vacation with Jim Golden, a top state human-services official working on MNsure’s rollout for medical-assistance enrollees, added to the sense that the site’s top brass are out of touch.

Meanwhile, the Pioneer Press, aligning itself with conservative opponents to Obamacare, reached a substantially similar conclusion about the current state of the process.

The board this week was expected to consider whether to exercise “active purchaser” authority, setting up additional criteria for plans offered on the exchange beginning in 2015.

“Ultimately, that’s only going to serve to limit competition and choice in the exchange,” said Bentley Graves, who directs health care and transportation policy for the Minnesota Chamber of Commerce.

Such a move also could put an advantage at risk: The ability of plans to compete this year helped give Minnesotans some of lowest premiums in the country, Graves told us.

“From a business perspective, we think the market is a good place to give people information and choices,” said Beth McMullen, health policy director for the Minnesota Business Partnership. “That’s why we generally supported the concept of an exchange. If we’re suddenly limiting those choices and saying, we know what’s best for you, we begin to be concerned.”

This can’t be fixed in a week. With an election less than a year away, opponents of health care “reform” have succeeded in their efforts to kill the system by a thousand paper cuts. Health exchange leaders are being fired in several other states, too. With an election less than a year away, it’s impossible for its supporters to concede the obvious point, which they’re going to have to do to.

And somewhere in all of this, there’s a person who needs to see a doctor.

Related: Separating fact from fiction in health care (Washington Post).

One-third of uninsured think Obamacare will hurt them, poll says (CBS).


As long as we’re on the topic of newspaper editorials, the Marshall Independent has evaluated the controversy surrounding Archbishop John Nienstedt, who stepped aside from ministry after allegations surfaced of inappropriate contact with a boy.

Through this all, we need to remember that most of the allegations of sexual abuse against the priests listed happened decades ago, and while that doesn’t take away the sharp pain felt by victims and their families still trying to heal, parents of young children today, no matter how much their faith in the Catholic church is shaken, must continue to support their church and those who lead it.

It’s up to them to decide if the archdiocese has handled this fluid situation to the best of its abilities, and it’s up to them to search inside themselves to determine when they’re ready to forgive and move on, if they haven’t already.

“They conspired to obstruct justice, if nothing else,” a reader countered. “This is clearly a job for the criminal courts, not only Catholic members.”


A North Dakota man is again free to post pictures and articles critical of white supremacists in Leith, N.D., now that a judge has lifted a restraining order against him.

Greg Bruce has been protesting the attempts by several white supremacists to set up camp in Leith. He runs a website and Facebook page calling attention to the actions of Craig Cobb by posting stories and pictures about him and his friends.

A woman claimed he stalked her to do so and won the temporary restraining order, which was lifted this week by Judge Bruce Haskell. But Haskell noted the irony of the free speech provisions of the Constitution which protect Mr. Bruce, the Fargo Forum reported:

Because he found no disorderly conduct, Haskell ruled that it wasn’t necessary to address whether Bruce’s actions were constitutionally protected. Still, he added in his ruling that the court “does find it interesting that Bruce cloaks himself in the right to free speech.”

“The Court assumes the majority of people in Leith, in Grant County, and in North Dakota do not agree with Neo-Nazi and separatist doctrines,” Haskell wrote. “However, the purpose of the First Amendment is not to protect majority, mainstream speech and ideas. It is to protect those with minority opinions, even if those opinions are repugnant to the majority. … Bruce wants the benefit of the First Amendment for himself, but is not prepared to provide it to those like Henderson with whom he disagrees.”


As we head for the darkest day of the Minnesota winter, we have the prospect of spring training for baseball to get us through. In the meantime, there’s the enchanting land of baseball parks in winter, which challenges our brains to process the unnatural in the natural world.

Target Field:

Fenway Park in Boston (More images here).

Citi Field in New York.

Progressive Field in Cleveland.

Fifty-nine days to the start of spring training.

Related: Blaine didn’t get Vikings stadium, but it’ll get the stadium dirt (Minneapolis / St. Paul Business Journal).


What’s the matter with kids today? They’re not that interested in driving cars anymore, National Geographic says. Is it a passing phase, it asks, “or have we finally erased the last traces of American Graffiti and the car-centric teen culture that once celebrated cruising, hot-rodding, and drive-ins?”

Bonus I: What’s not wrong with this picture?

Bonus II: Shoe-shining benefactor to Children’s Hospital to retire after 30 years (Pittsburgh Post-Gazette). (h/t: Matt Black)

Bonus III: St. Paul Pioneer Press offers buyouts, agrees not to oppose unemployment claims (Romenesko).

Should we be getting more of our power from nuclear energy?

Posting will be light in this space today. I’m out doing an interview.

Daily Circuit (9-12 p.m.) – First hour: New banking rules, fines, and settlements.

Second hour: Chaos in North Korea, Ukraine and Central African Republic.

Third hour: An update on HIV/AIDS research and outreach.

MPR News Presents (12-1 pm) – New York Times reporter Peter Baker, author of “Days of Fire: Bush & Cheney in the White House.”

The Takeaway (1-2 p.m.) – Zbigniew Brzezinski, former National Security advisor to President Jimmy Carter, on the Ukraine and Russia’s role in the region.

All Things Considered (3-6:30 p.m.) – At this time of year when holiday shopping is at its peak, many of the people behind the cash register or in the giant warehouses of online retailers often work for little more than minimum wage. Starting in January, expect to hear a lot of debate about that wage — currently $7.25 an hour — on Capitol Hill. President Obama and many Democrats plan to push for a minimum wage increase ahead of the 2014 election. MPR’s Brett Neely will have the story.

From the Lone Ranger to the sequel of the Smurfs, Hollywood recently bankrolled a big number of blockbusters. And many of them were a flop. The big studios also released some smaller, critically acclaimed films, like 12 Years a Slave. But those were financed by independent producers with deep pockets. NPR looks at the money behind this year’s movies.

  • MrE85

    #1) Agree with you on many points, except two. Not quite ready to declare health care reform dead. Badly injured, yes, but the patient is still breathing. Deadlines are going to be missed. But I don’t see a rollback coming. Also so much can happen in “less than a year,” I would not place bets on election outcomes, one way or the other.

    • I’m not saying health care reform is dead. But right now the people in charge of it are trying to drive a car with a flat tire on the rims because they don’t want to acknowledge the tire is flat. “If I can just get to the gas station.” Nobody ever makes it to the gas station without repairs costing twice as much.

      • MrE85

        That’s a fair analogy.

  • MrE85

    #5) This may be a good thing.

  • Matt Black

    I love the pictures of the ballparks in the snow. It’s like they are lying there dormant just waiting for Spring to come again. Comerica Park (Detroit) has a pretty different feel this year as it gets ready for part of the Winter Classic lead up.

  • DavidG

    #3) I’m not clear what actions Mr Bruce has taken to deny the white supremacists their free speech. Speaking out against them is not the same thing as denying that.

  • kevinfromminneapolis

    My issue with the former ED taking a vacation as rollout problems mounted is that no one within MNsure or the Governor’s Office recognized that you can’t have your leader taking a vacation when problems are piling up and a major deadline is approaching. By selecting the boss of the other person on the vacation, it tells me they still don’t take the enormity of their task and its problems seriously, or that it’s such a closed-loop mindset that they want to send an FU to their critics. Neither is good.

    Regarding its future, I’m reading a book that discusses the role of timing in business decisions. One of the things it covers is planning and executing exit strategies for when a product or initiative proves unprofitable or unworkable. It’s clear no such consideration is given here and, when I thought about it, I can’t recall a single instance where that was discussed in state government.

    • Dave

      In theory the vacation was planned and paid for long before the rollout. Still, it doesn’t look good. She should have had the foresight to not plan to leave for two weeks during the rollout. I simply can’t fathom what in the world was going thru her mind, or whoever she reports to. It doesn’t make any sense.

      I don’t know if she deserved to be fired, because now what? Is her replacement going to fix the problems better or quicker than she would have?

  • Dave

    Funny to see Google Reader’s death addressed in that picture. Luckily I found InoReader not long after Reader died, and I’ve been very pleased with it.

    • I went to Feedly and I’m perfectly happy with it. As a content producer, I’m concerned that people just stopped using RSS.

      • kcmarshall

        I thought RSS was the technology used to auto-post to Twitter (kidding, sort of…) I used to be a heavy Google Reader user and Twitter is the only aggregator I use now.

    • kevinfromminneapolis

      I mainly replaced it with Flipboard and clicking more links on my social accounts.

  • rosswilliams

    And the alternative is? With the deadline a week away, apparently those in charge understand is that their only real alternative is to do the best they can. They can’t just sit in the lunchroom and complain about it the way the chattering class can.

    • The alternative is to pull it down, delay the implementation and get everything working. Fortunately, the actual financial penalty, isn’t for another three months and it’s possible by then that it will get fixed. But there’s no real evidence in any track record so far that would lead a reasonable person to put money on it.

      You simply can’t have people, as we learned this week, going through the signup process and then being told later they have to do it all over again because they were given bad information.

      So you say “you know what? This isn’t working so we’re going to stop, take the site down, get it working, and we’ll get back to you.”

      That’s a reasonable alternative. It’s probably THE most reasonable thing to with a bad product. But it’s also death for politicians.

      So, pick your poison.

      There’s nothing politically courageous in putting lipstick on a pig.

      • rosswilliams

        :”The alternative is to pull it down, delay the implementation and get everything working.”

        Where is the evidence that is really an alternative? You want to tell people who already have signed up that they should find insurance somewhere else? I am sure that isn’t really what you mean, but then I don’t think you know enough about the situation to know what you really mean.

        No one should be paying any attention to media blather. It is usually neither well-informed, not thoughtful. Its just interesting and provides fodder for lunchtime conversations.

        • I’m not sure what you’re asking me. The people who have already signed up would still get their insurance once their premium is paid. They’ve navigated the system and no longer need the interface. They’re not the issue.

          Media blather. I get it and I understand the rush to characterizations like that. That’s part of the politics game. Nobody denies that.

          But the real challenge here is separating real life from politics for now. You’ve got a system that isn’t functioning. Do I know how to code to fix it. No? Does that make me uninformed? I don’t see how.

          Two weeks ago people were told to no longer submit paper applications because they’re too backed up. Got it. Now we find people who went to the trouble find out it was for nothing because the system gave them bad information.

          What’s the mystery here. What’s the solution to providing bad information? Provide good information. What’s the alternative to not providing access? Provide access. What’s the alternative to –as the Gov. says — something that’s “unacceptable?” Make it acceptable.

          If the system can do it, fine. But this isn’t happening in a vacuum. Confidence is being undermined and people are walking away.

          If we can put down our political allegiances long enough to acknowledge this, that would be a good step to saying, “wait, this is crazy; we’d never put up with this in a private business and we shouldn’t be trotting this out before it’s time either.”

          That’s a reasonable response that you’re free to characterize as the ludicrous approach of people having lunch. I get that.

          But that political colorblindness is also what’s gotten us to a point we didn’t need to get to.

          Providing efficient access to health care and protecting political careers are, for whatever reason, incompatible ideals at the moment.

          • rosswilliams

            So the people who already signed up would still get subsidies for their health care if they qualified, while everyone else would be cut off? Well, of course you don’t mean that. As I said, you don’t really know what you mean. Its just the “we have to DO something” scream of ignorance.

            “That’s part of the politics game.”

            Exactly, you are playing the “politics game”. It has nothing to do with what would be the best course for people who are trying to get health care coverage.

            “Do I know how to code to fix it. No? Does that make me uninformed? I don’t see how.”

            Yes it does. But it doesn’t really surprise me that you don’t think so. There are also a lot more important things you don’t know and are part of both identifying and solving the real problems.

            “we find people who went to the trouble find out it was for nothing because the system gave them bad information.”

            Has that really never happened to you before? Would you seriously suggest Amazon shut down because you heard a story that said it had happened to someone on their web site? Would you suggest they stop shipping stuff because someone didn’t get their order?

            How exactly would shutting down the entire health care exchange help people? How do they get their insurance by January 1st absent the exchange? When you have a real solution to that, you can accuse those who are trying to come up with a solution with politics. Until then, pot meet kettle.

          • If you’re asking me if Amazon would’ve taken a horribly flawed system offline when it rolled out a similar product and fix it, the answer is “yes,” I think it would have.

            I don’t believe Bezos’ strategy would be to say, “Are you going to believe me or lying eyes?”

          • DavidG

            But Bezos wouldn’t have a Federally mandated deadline hanging over his head like MNSure does.

          • And why is that federally mandated deadline an immovable object?

          • rosswilliams

            Because the folks at MnSURE have no control over it and it would be pretty stupid to change the federal law based on problems at MnSURE. Are you seriously arguing that the entire Affordable Care Act should be shut down and people left without insurance?

            I guess Target ought to close its stores since anyone who has shopped there in the last month had their credit card information stolen by criminals. Or maybe the credit card companies ought to shut down all those cards and issue new ones to their customers. We all know its just politics that is preventing that.

          • Ah, good then. We’ve reached the straw man part of the discussion.

          • rosswilliams

            No, you started that with a straw man about politics preventing a shutdown of MnSure and ended it with a monty python video. All very entertaining, I am sure your advertisers, including Target, will appreciate it.

          • OK, now we’re at the “he started it stage.” Swell.

            As mentioned in the original piece, the politics of the situation prevents acknowledging the obvious, which is why, as Larry Jacobs noted, the DFL engaged in a bunker mentality and why the administration itself was less than forthcoming on the ills of the process. until you do that, you can’t really fix it.

            But what if they had been able to without fear of political repercussions. What if they didn’t roll it out on October 1? But waited. What if they didn’t head for the bunkers, but called in the troops and said “this isn’t right, let’s not put out a garbage product”?

            Instead they put it out, and suggested it was only a flesh wound when mounting evidence confirms its not … and here we are at the last minute, the opportunity to fix it having been lost via the bunker mentality and now your sideis saying, “are you crazy, you want to take it down NOW and fix it, there’s only a week left in the deadline for people to sign up for January 1 coverage?”

            Yep, that’s right. There’s only a week left.

            How’d that happen?

            Same way political disasters always happen.

          • rosswilliams

            Probably the same way the Target disaster happened or the Apple Maps disaster or hundreds of other distastrous initial technical roll outs. But you seem to miss something. The health exchanges are not the only or even the most important feature of the Affordable Care Act.

            You are complaining about people having to fill out forms twice, while the law was targeting the problem that people lacked access to medical care or were ending up bankrupt from getting sick. Which is the big problem and which is a minor glitch. As far as I can tell, not one person has died as a result of the web site problems. Its only a HUGE problem in terms of the media-generated hysteria it has created. And yes, that IS political and the responses to it by politicians are by definition political. So what?

            The stage we are at is the “lets change the subject” stage. But I would agree with you, the decision to take paper applications without adequate resources to process them was political panic in response to media hysteria. But shutting down mnSURE now would be a similarly stupid overreaction, only on steroids.

            By the way, who is Larry Jacobs and why should I pay any attention to his opinion?

          • You describe an interesting scenario but it’s not true. The media didn’t report on the backlog of paper forms until after MNsure had already sent a notice to navigators that they were no longer accepting paper applications. The letter is what alerted the media and up until that time, the now-departed boss of MNsure didn’t reveal that fact until a reporter for MPR asked her about it.

            I don’t really see your attempt at creating an equivalency between insisting on a functioning, accurate, data-breach free, consistent application process with a desire to return to the days when people would go bankrupt because of illness, as much more than an intentional distraction.

          • HealthPartners and Medica now extending the payment deadline for coverage. See what you can do once an honest assessment of a situation is revealed? That wasn’t so hard.

          • rosswilliams

            Almost ALL the national insurance companies nationwide agreed to extend the payment deadline. What good would that do if MnSure had shut down people buying insurance as you suggested they should.

            I agree, a lot can and is being done. What does that have to do with this silly argument that they should throw up their hands and junking the whole thing?

          • Well, I tell you, I’m done trying to get you back on track when you make up silly positions and then ask me to defend them.

            But let me ask you, suppose it’s October 2 and we get a more honest assessment of what’s going on and someone, realizing that, rather than avoiding any possible admission of fault, just says “yeah, you know this really isn’t ready? Let’s make it work right?”

            What would happen? My guess is the vultures on the other side would jump, which is why we didn’t do that. Who could blame them?

            But what’s the effect of not doing that? I’d submit it results in us getting to the point where your side says “we can’t pull it down and fix it now, there’s only a week to go?” As if that’s the fault of the people recommending we get this working properly .

            Maybe it only would’ve taken a month, had the proper forces been marshalled, and then it’s November 1 and, voila, the thing works. And there you are, almost two months away from the deadline, and a system that’s working fine.

            Why not do that?

          • rosswilliams

            The only silly position is the one you made up “The alternative is to pull it down, delay the implementation and get everything working” and which you keep defending with equally silly positions.

            What you miss, is that the web problems look like a typical high tech startups with lots of problems and bugs. The mistake made was in not anticipating that and providing a break-in period.

            Blaming those problems on politics is the kind of ignorant response you get from politicians. Which is what you did. Suggesting that they panic and “pull it down” is the sort of ignorant solution you get from politicians. Which is what you did. So the problem here IS politics, yours.

            I suspect that the people actually responsible could make you a long and detailed list of things they should have done differently. But they don’t have that luxury. They have to work on fixing things going forward while fending off a bunch of hyperventilating media and politicians who are more interested in drama than solutions.

          • Well, there you go again. I never suggested or wrote anything about panicking

          • rosswilliams

            “You describe an interesting scenario but it’s not true. The media didn’t report on the backlog of paper forms..”

            This appears to be irrelevant to your claim. The backlog was a result of the decision to accept paper forms in the first place. When the media reported it is absolutely without any relevancy.

          • DavidG

            But it is put up with it in the private sector. Take as just one example: Apple Maps. That was released way before it was ready. Did Apple delay its launch, or say, “oops” and revert back to Google Maps as the default until theirs was ready? No, they slogged it out, and are still slogging it out as they work to improve its usability. (Though the project lead did lose his job)

          • Go listen to Larry Jacobs’ interview on Daily Circuit.

          • DavidG

            uhm…Got a synopsis?

            That’s like asking Stevie Wonder to go study the Mona Lisa…

          • He said the DFL has had a “bunker mentality” all year, hasn’t been transparent or honest about what’s been going on, understating the depth of the problems.

          • The difference between how the problems have been officially portrayed and what they’ve actually been.


          • rosswilliams

            Bob –

            MnSURE has an independent board largely because people wanted to keep it out of politics. Frankly, it sounds to me like you are frustrated by that . They are continuing to try to do their job instead of reacting with sufficient drama to the media’s hyperventilating. The problem here is YOUR injection of politics, not the MnSURE board’s.

  • Snow on the ground at the old Met.