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Lessons From the Healthcare.gov Fiasco
Nerval's Lobster writes "In theory, the federal government's Health Insurance Marketplace was supposed to make things easy for anyone in the market for health insurance. But fourteen days after the Website made its debut, the online initiative—an integral part of the Obama administration's Affordable Care Act—has metastasized into a disaster. Despite costing $400 million (so far) and employing an army of experienced IT contractors (such as Booz Allen Hamilton and CGI Group), the Website is prone to glitches and frequent crashes, frustrating many of those seeking to sign up for a health-insurance policy. Unless you're the head of a major federal agency or a huge company launching an online initiative targeted at millions of users, it's unlikely you'll be the one responsible for a project (and problems) on the scale of the Health Insurance Marketplace. Nonetheless, the debacle offers some handy lessons in project management for Websites and portals of any size: know your IT specifications (federal contractors reportedly didn't receive theirs until a few months ago), choose management capable of recognizing the problems that arise (management of Healthcare.gov was entrusted to the Medicare and Medicaid agency, which didn't have the technical chops), roll out small if possible, and test, test, test. The Health Insurance Marketplace fiasco speaks to an unfortunate truth about Web development: even when an entity (whether public or private, corporation or federal government) has keen minds and millions of dollars at its disposal, forgetting or mishandling the basics of successful Web construction can lead to embarrassing problems."
Remember that this is only for people that live in states that tried to stall off the inevitable. I live in Kentucky and despite being a pretty red state we have a Democratic governor and he saw the writing on the wall. Rather than try and delay and delay it we have our own. Numerous other states did the same thing. I haven't heard anything about ours being down.
The reason for the mandate (and for the original single-payer system) is that currently the cost of health care for the uninsured is hidden in the "uncollectable debt" category in the hospital's accounts receivable. It's all the bills for ER visits and emergency care for people who can't pay. I was taught a basic rule back in high school business classes: you can't manage costs until you've got them laid out where you can see them. The idea was to get all health care being paid for and accounted for so we can see where the money's going and do something about the areas where it's costing more than it should. It was also to help with shifting the costs from expensive emergency care to much cheaper preventative care, the idea being that when people know they're covered by insurance they're more likely to go to the doctor before things get critical instead of putting it off and hoping they get better so they don't get nailed with a doctor's bill and ending up at the ER in critical condition. If you have no insurance the bill's going to be a killer either way so it makes sense to go for the chance to avoid it, whereas if you do have insurance the bill won't kill you either way so why wait and suffer more than you have to?
No, wealth is unaffected by inflation. Wealth is not a stack of dollar bills. You must me invested in the means of production to have wealth, and the value of that is determined by what's produced, not the currency in use.
Hyper-inflation destroys savings, not wealth. Usually, hyper-inflation also destroys economies and governments. And, of course, it would be hyper inflation: with no practical limit on how much the government could spend, it would try to spend infinity dollars on pork barrel projects and outright checks mailed to supporters.
I doubt people would but precious metals, though, there are several stable national currencies, easier to just us Canadian dollars or Swiss francs or whatever, if it came to that.
Socialism: a lie told by totalitarians and believed by fools.
I wouldn't be so sure.
In my experience of building e-commerce sites (over roughly five years) the actual *building* of the site isn't the difficult part. I've taken a barebones install of Magento (or Prestashop, etc) and themed the front-end, by myself, in just two/three weeks. Looking at this site, I can't imagine the front-end would take any longer.
The proverbial iceberg, though, is what you're looking at. The bits that take the most time are all the logistics bits like shipping, payment processing, which customers can purchase what, how are discounts handled, tiered pricing, product entry, admin training, etc. I would guess that 90% of my conversations with clients over the years involve some logistics bit, not whether the buttons on the checkout page are the correct color of blue.
And then to top all that off, you have the infrastructure to worry about. You aren't necessarily dealing with a web server and that's it. You might have a cluster of web servers that need to talk to a cluster of SOLR servers. You might have to implement solutions for payment processing servers.
In the end, these items all take a great amount of time not because of how complex they are to implement, but instead it has everything to do with the *people* that are organizing this information. Hell, can you just imagine the nightmare it must have been to get all the insurance companies to provide all their data/plans in a standardized format so they could be integrated to the store front?
In the end, though not unexpectedly, they ran out of time and testing was shat upon. Every relatively complex site I have ever built or worked on has had testing shat upon. Now that I have just a single site that I develop and work on, testing happens all the time since I am my own boss as far as deciding what I need to work on. For every other project out there where the developers aren't the ones that even have a say in what areas are focused on, testing will always be a second-class citizen.
Someone flopped a steamer in the gene pool.
It's a website that needs to be able to handle 3million visitors per day, with the majority of them being signups, or at least hitting the calculator. That's a lot of deep hits that can't be cached.
Then, add on a back-end that has to talk to insurance companies. These guys still have a tonne of Cobol code running around. There's nothing wrong with that (Seinfeld!), but I think it might indicate that their systems aren't necessarily built for online, real-time querying.
To recap, it is a multi-tier system:
1) Front end, performing user signup, and calculator.
2) Back end database. HIPA compliant, Sarbanes-Oxley compliant and able to deal with 100m customer records.
3) Feeds to remote systems, also HIPA compliant, Sarbanes-Oxley and other stuff.
So, you've got something that looks a lot like twitter (the back-end links), only more expensive because it needs to be Capital S secure, along with something that looks like an insurance company (the middle tier) and finally something that looks like a dot-com (front end calculator).
That's already a lot of hardware and software. "Free" open source doesn't actually save a lot of money here, since most of the money is in support (over 1/2 the 5year cost!). Now, triple it do deal with hot site failover, backups and other various disaster recovery plans.
Although they've had 3 years to get the system complete, the software was probably only developed in the last 10-12 months (at most). The rest of the time would have been spent in getting agreement on the data exchange formats with the insurance companies, deciding on a vendor to use for each part, and standing up an internal team to manage it. Then add in several parties involved playing schedule chicken with Congress, hoping for the whole thing to either be delayed or scrapped. Fun!
Finally, they went for a nationwide rollout for political reasons, which was guaranteed to result in peak traffic on day 0.
Not to worry. It is not like the customers of Healthcare.Gov are going to go shopping anywhere else. They have captured 100% of the market at the barrel of a gun. It is like the old American Telephone & Telegraph phone service, except they can go into your checking account for a billing dispute, or take your tax refund if you refuse to do business with them.
Sorry, you're just full of crap. Didn't you even read the summary of the summary about the bill? If you have insurance from *any* source, you don't need healthcare.gov. Even if you *don't* have healthcare now, you can still go to the state exchange... if you don't live in one of the Republican-run states that stamped their feet and refused to set up and exchange to help their own people.
Sure, I'll explain. Your $46,620 went two places:
1) You had no catastrophes during your payments! Yay! Now, your neighbor and his wife and kids (who have the same insurance as you) got into a rollover car accident. They managed between them to accumulate $600,000 of healthcare bills. The insurance-hospital-doctor contracts reduced that down to $275,000. So, a chunk of your $46,620 went to pay that. (And yes, still left the family with a near-impossible bill to reduce in copays.)
But if it had been *you* and *your family* then you might be more glad that your neighbor was there paying that amount for a part of your coverage, too.
2) Now, the insurance companies do not just need to pay the (minimal cost necessary for) health care... if they did, they'd charge you a lot less. Instead, they have to make a profit each quarter. Every quarter. Year in, year out, they have to post ever-higher profits. Or their little worlds fall apart. So, where they would have paid $350,000 ten years ago, they paid out $275,000 today to the health care team that took care of that family.
The next time you hear a commercial health insurance company, take a moment to look at their financials - look them up on Google Finance, or maybe their investor-relations website. How often do insurers take hits on their profits?
Hint: While most physicians have been treading water the last ten years, trying to make do with dwindling reimbursements, the insurance companies profits climb steadily higher. (And yes, the insurance companies may pay out more aggregate dollars each year in care, but I guarantee it is not at the expense of their profits.)