When you look at the over all picture here, the government is trying to do a good thing but it is jinxed by health insurance complex models to deal with. When the reform law was enacted with time lines to meet certain commitments, the insurers were pretty complex at that time but just since the law was passed they kicked up the model and algorithm pressure. 
I wonder at times how much of their IT Infrastructure really falls under the MLR and wonder too about the capabilities of government to really dissect and get a fairly accurate projection? When you look at the numbers slated at $4 billion to accommodate these models and algorithms so we can all have insurance, it’s mind boggling. Now we have grants to help people get educated on how to navigate these complex models. I don’t care what you may think, the industry built them otherwise they wouldn’t be there in their IT Infrastructure and the expense to the government could be a little less. Read how complex event the training process is getting, it made my head spin so if that’s the case I can imagine the average consumer.
Health Insurance Navigators, the Consumer Version of a REC Office–HHS Grant Applications Available-Needed For Understanding Complex Policy Models Created by Insurance Companies, Too Bad They Won’t Just Create Simpler Models
I’m all for education and helping people but I think we have spun this just a little too fast for the average consumer to understand, and of course banks and insurance companies design it that way as complexities with an under educated nation of consumers means
they make money with math. It is what it is. The government is trying to work within the models and algorithms created, and not so much creating their own but merely tossing money at it over and over. If we had some “equals” on the government side that perhaps had a better understanding by employing department heads that can see this, the picture could very well be different and maybe moving in some different directions, but that’s a dream because we don’t sadly. Even the judicial system doesn’t fully understand the complexities of math and gee if we had a “hybrid” lawyer/tech” on the Supreme Court, well we would be cooking with gas as the old saying goes. This is more like the “Affordable Complexity Act” if you ask me:)
This brings up the next question and it’s a big one…
”Is complexity affordable in healthcare and otherwise”
…when you have banks and health insurance companies with multitudes of analytical data (half of which is useless with lack of accuracy and nobody checking as it is written to make money only) where does this answer lie. I’m not original in this though as a group of Australian banks also said that half of the analytics investments would be wasted and my contributed thoughts are here.
If you read the news there’s almost not a day that goes by where some algorithms get activated through coding and it takes away money or services from a group of consumers, that’s what does it…all is run on IT Infrastructure and every day too you read about companies, banks and more trying to squeeze out some non linear relationships that will give
the “pot of gold” results from some form of analytics that are born with data scientists tossing code and models all over the place to see if anything sticks to the wall. Granted this is not 100% of what is going on and there is some good work happening with data mining to present information for “human” decision making in healthcare, but you have all the side line stuff that gets predicated around the “data selling epidemic” we are now experiencing. It goes something like this: I created a query that showed and gave me value so now, how can I sell it and make money selling data”…all I need is a good marketing spin and just need to run some code and I’m business…”
Here’s yet another complexities example and you can see the frustration with CMS and the OIG with a suggestion of wanting CEOs of insurance companies to “Certify” the data they give the government on the over all Medicare Health Insurance Pricing page that is out there now. Government dealing with and working with complexities built by private industry with a first focus to turn profits and dividends for share holders. 
That’s nothing new of course but with data complexities they have tons of new tools to use. If you have paid attention to the recent “bitcoin” news…then you know “with software you can do anything” and scroll on down to the bottom of this blog and watch the Quant documentary to here Mike Oslinski who wrote the software for the sub prime scam and it was sold to all banks out there and we know the outcome. It was not his software but the way it was manipulated and modeled that you have to look at. Banks and insurers have been doing this for along time. If you want one more example of some silly Congressional activities along with the concern for working on fraud, read this bipartisan post, it’s gets everybody and basically really shows that many who are in executive positions still think that all of this “is for those guys over there” in other words, they don’t participate and what they say just verifies it all over the place. People like me read some of this and think..WTF…(grin).
As a matter of fact and this is how I think when I see news publications promising “trillions” in savings…bunk…nobody can do that today as some algorithm that people forgot was connected to some data comes out of nowhere and changes everything..it’s politically called “unintentional consequences” but translation with data talk, it’s an
algorithm or model they didn’t identify. There are budgets in the “trillion” dollar area for sure as well as expenditures too but when you see trillion combined with savings, just ask who’s trying to sell you something or Algo Dupe you into what they want you to believe:) I even question the savings articles that come out saying “billions” too and that’s a little trickier and you have to look more into the context there but still about half of what I read about those predictions I determine to be bunk as well with more Algo Duping taking place with the use of some Killer Algorithms. Watch all of the 4 videos in my footer here and you will be enlightened and don’t expect to get everything said but there’s enough that you can benefit from.
I also realize to create simpler models it takes some undoing and that is not done overnight either but it’s more of a “common sense” issue if you will…how much do banks and companies really need before they are trouncing consumers right and left with data and analytics that are never verified and are using steroid marketing to get more of their data? Happens all the time with being used out of context to make money too. Good video at this link to where you can hear companies to include NASA discussing “where do we find this value” with our Quants and analytics…it is what it is.
The gal from T-Mobile in the video really got my vote as she said “what we are doing is silly” and that’s first step to take a look and see if value is really being created or is this just another bunch of analytic created and marketed to make a buck. There’s both out there too, and telling the difference is a challenge. Even the Science and Technology folks are fed up with this same phenomenon happening over there, someone writing code for bucks with flawed material. Data selling epidemic keeps this rolling and why we need to license and tax data sellers.
Pseudo-Academia World of “Spam Type” Medical Journals That Will Publish for A Price Polluting Research Society–To Make a Buck, Back To Data Selling-Duped, Duped and Duped Again
So what we see here is a “reactive” government trying to throw money at keeping up with non verified math models and algorithms, but it is all they know how to do right now, keep throwing money to keep things moving…you know kind of like the Fed does over all to keep things moving, pretty close to the same thing. Without some executives
with “some” tech in their background we will stay on this endless circle as it’s all they know how to do and “equals” on the government side who think differently would make a difference. People that work with math and code think differently but we are consumers too and we see beyond and above things before they happen as we use logic and data mechanics to foresee, as that’s what we do and there’s folks out there a lot smarter than me.
There’s a lot of give and take going 
on to make this work but the give is on one side while the take is on the other side and two don’t seem to work too well from what I am seeing out there. In this post it kind of comes right down to a mathematical/algorithm explanation…these folks are pretty much just software companies that use algorithms and models to move money that impact the livelihood of all of us and nobody is checking for any accuracy and you drive yourself over the cliff in doing so. Bitcoin anyone?
Banks Are Actually Just Software Companies and the Same Can Pretty Much Be Said for Health Insurance Companies As Well-5 Unspoken Reasons Tech Projects Fail
“It is a technological arms race in financial markets and the regulators are a bit caught unaware of how quickly the technology has evolved”
Big Data Revolution-Dangers of Using It To Drive Ourselves Off a Cliff -Debunking Myths of Algorithms Replacing Humans In Decision Making Processes in the Healthcare Business (Video)
So here we go with the request for additional government money from HHS to help keep the “Affordable Complexities (Care) Act” moving forward. On side gives while the other takes and we are all caught in the middle of a “fantasy” type battle here, as “with software you can do anything”…watch that video in the footer..and reality with ethics seems to scoot further away from all of us, and consumers pay the brunt with fixing flawed data for one on their own dime where corporations make billions in profit selling…so toss more money I guess will be as good as it gets. BD
The Obama administration is trying once again to convince Congress to provide more funding for the health law’s insurance exchanges, which are set to begin enrollment this fall.
According to figures released in the fiscal 2014 budget request Wednesday, the administration estimates that the federal government will spend about $4 billion on those federal- and state-run marketplaces for individual and small businesses purchasing insurance coverage.
“This budget supports the operation of the federally facilitated marketplaces and provides for the assistance and oversight needs of the state-based and state partnership marketplaces as well,” Department of Health and Human Services Secretary Kathleen Sebelius said Wednesday. The money would fund exchange operations as well as education and outreach efforts, she said.
http://www.healthcareitnews.com/news/hhs-seeks-15b-insurance-exchanges?single-page=true
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