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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."
Just let the government create money (as banks do) to fund services.
So we don't need any taxes, then? Heck, we don't even need any government bonds for funding! Why half-measures, why not send $1M to everyone? I wonder how that would end: "since we adopted the leaf as the currency, we're all rich!". I can see no flaw in this plan.
Socialism: a lie told by totalitarians and believed by fools.
As a software engineer, I'm very curious about where this $400 million went. In all the articles about this project, I've never seen a breakdown of where the money was spent, at least at the granularity of people/hardware/software. Typically software projects spent most of their budgets on people, but a $400 M project that is basically a year old implies on the order of thousands of employees. That can't be right? Did they get dinged by ridiculous licensing fees from the usual suspects? Where did the money go?
Hmm, they've been developing the software for the last two or three years, and the shutdown began the day the site went live, it's extremely unlikely that the one impacted the other.
Or are you suggesting that Obama decided to treat Healthcare.gov like the WW2 memorial, and deliberately sabotage it? Hint: making your biggest achievement as President look bad is NOT a way to build a legacy....
"I do not agree with what you say, but I will defend to the death your right to say it"
This
made me laugh.
I've been in the unfortunate situation of working for a government agency when Booze Allen Hamilton came in to help make changes and improve things. They did much of the former and none of the latter.
Typically, dealing with whoever was going to actually use the process they were changing was something the Boozers did just to check off an item on a list. They did not listen to users because they assumed government employees were all idiots and could tell them nothing they really needed to know about the processes they were about to change.
Personally, if I were going to change business processes that had been in place for decades I'd want to talk to the people who work the current processes and find out how they work before I started trying to think up better ways of doing things. BAH never did that. They brought in workers for planning sessions, listened for a couple of days, then distilled the results of those discussions into a document of findings that was obviously written before the research ever started and contained exactly zero input from the field workers who truly understood job requirements.
Boozers, in my organization, were almost universally so convinced that their shit didn't stink that they were worse than useless. In the course of years of contacts with them, I met exactly ONE who listened, learned, and improved things.
Based on those past experiences, I can only surmise that the folks responsible for this current fiasco simply said "Oh, we don't need to talk to anyone from the government about how they run web sites that stand up to incredible traffic swings. We know what we're doing."
And some idiot government executives trusted them.
I don't know who to be more disgusted with.
You may be joking, but I think you're right.
Most states have this worked out pretty well for car insurance. There's a great market, you buy it just like anything else with no exchanges needed, it's just another service. If you're especially high risk, the insurers are required to take you as a customer at government-limited rates, but in return everyone is required to buy insurance. Seems to work well for all involved, and for 90% of customers the government is just not involved in the purchase process (nor is your employer, nor any other third party).
Socialism: a lie told by totalitarians and believed by fools.
I don't know about you, but does the site really need links and JS from ad sites (like doubleclick, chartbeat), YouTube, and Facebook, as well as whatever googletagmanager and optimizely provide - as noticed by what I had to temporarily allow in NoScript - to simply make the site work to, you know, helps people get access to healthcare insurance?
It must have been something you assimilated. . . .
This happens every time a major new internet service is launched. And it _always_ will. See, here's the problem: at launch everyone is interested and wants in. After a few weeks/months the interest dies off and the site hits a BAU point. So if you're designing one of these sites you're stuck either:
a. Spending billions on infrastructure for 3 months tops of high volume and then getting ripped to shreds in the press for 'wasting' all that money. or...
b. Taking your lumps up front and waiting a few months for people to forget about it.
The guys running healthcare.gov opted for 'b.', and I would too. The kinds of people that just want to say bad things about the ACA would have a field day with 'a.', with 'b.' they'll have to acknowledge (or at least ignore) the fact that in a few months it'll be working more or less as intended.
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
"...but I seriously had no idea it would be this bad."
How would you design a Healthcare Extortion Racket?
"New York State's healthcare plans range from Fidelis Care's 'Bronze' plan at $810.84 per month to $2554.71 per month for something I didn't bother to look up because if I had $2500+ a month to spend on doctors, I'd buy a doctor and have him/her live with me and dole out pills like I was Michael Jackson. The deductibles - the amount you pay out of pocket every year before you the insurer has to give you anything at all - are outrageously high. Fidelis Care Bronze has a $3000/year deductible per person. I'm in pretty good health; it's a rare year I spend that much on doctors. After the $3000/year deductible, they pay 50% of your bills. So if you rack up $5000/year in medical bills, you pay $4000 and they pay $1000. Pretty damned crappy."
Repeat, from my JE.
"Flyin' in just a sweet place,
Never been known to fail..."
I learned that most people fail to understand the importance of a good software architect.
The problem is worse than that. Most folks don't understand how hard and expensive good software is to develop and deploy.
Remember, most folks only see the stuff that works. Nobody remembers Yahoo, Google or Amazon when they where struggling to keep the servers alive. We barely hear about Netflix when they are down... This stuff just works and most don't have a clue the effort that goes into making that happen.
Obama's administration was in *WAY* over their heads trying to put the infrastructure in place for the marketplace. NOBODY tries to field a complicated website at full capacity on a single day, at least nobody who's actually been successful at this. You ALWAYS soft start and ramp up to production goals. The whole idea is as unworkable as the website implementation turned out to be. But that's politics. Make confident assertions about things you have no clue about.
But that's government for you. Doing STUPID things in a big and expensive way then throwing money at the problem to fix it.
"File to fit, pound to insert, paint to match" - Aircraft Maintenance 101
I buy individual insurance for $165 a month. That is with a $500 deductible, and 0% coinsurance. My plan will be illegal on jan 1st, because it does not cover maternity care amongst other things. My plan is the equivalent of a platinum plan on the exchange. I just got quotes for a platinum plan with the same deductible, and quotes ranged from $420-$700 a month. Fuck you, and everyone else who thinks this law is a good thing. It just destroyed my ability to buy insurance. BTW, I am not even eligible to use the exchange. I applied, and my application was denied because my income was too low. I was told my only options for healthcare, was to enroll in medicaid or buy insurance on my own outside the exchange. It just so happens my income is very low right now, because I am starting a business and living off a capital loan.
I think the fact that the Lincoln Memorial was just so easily defaced is contrary to your argument and I get the impression you've never visited D.C.. I've walked through the WWII memorial in the middle of the night with no guards or cameras around. President Obama has practically admitted to making the Govt Shutdown and Sequester hurt because he's for larger government. Shutting down the WWII memorial, and the Nordmandy beaches in France, and State/Federal co-sponsored monuments ARE political acts.
In 1986 and 1987, 2 articles appeared in the literature by physicians from Cook County Hospital in Chicago detailing the extent of patient dumping to that facility (1, 2). The authors defined dumping as “the denial of or limitation in the provision of medical services to a patient for economic reasons and the referral of that patient elsewhere” (1). The majority of such transfers to Cook County Hospital involved patients who were minorities and unemployed. The reason given for the transfer by the sending institution was lack of insurance in 87% of the cases. Only 6% of the patients had given written informed consent for their transfer. Medical service patients who were transferred were twice as likely to die as those treated at the transferring hospital, and 24% of the patients were considered to have been transferred in an unstable condition. It was concluded that this practice was done primarily for financial reasons and that it delayed care and jeopardized the patient's health. This practice was not limited to Chicago but occurred in most large cities with public hospitals. In Dallas, such transfers increased from 70 per month in 1982 to more than 200 per month in 1983 (1).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305897/
Well, yes. This is the basic problem solved by mandatory health insurance (Obamacare) - you generally don't need expensive healthcare until you've lost your health, and thus can no longer pay for it. As you said, a very similar situation to SS, where the problem is that many don't save for retirement unless forced to. If you want you can think of it as a subsidy of the old by the young, but it's no less correct to think of either as a form of forced savings. (Not that "your" gold coins are sitting somewhere in a vault, because they aren't, but that doesn't really change anything).