DHHS Preparing 'Tech Surge' To Fix Remaining Healthcare.gov Issues

itwbennett writes "It's no secret that the healthcare.gov website has been plagued by problems since its launch 3 weeks ago. On Sunday, the Department of Health and Human Services said that it's now bringing in the big guns: 'Our team is bringing in some of the best and brightest from both inside and outside government to scrub in with the [HHS] team and help improve HealthCare.gov,' the blog post reads. 'We're also putting in place tools and processes to aggressively monitor and identify parts of HealthCare.gov where individuals are encountering errors or having difficulty using the site, so we can prioritize and fix them.' Other emergency measures being taken as part of what HHS calls a 'tech surge' include defining new test processes to prevent new problems and regularly patching bugs during off-peak hours. Still unclear is how long it will take to fix the site. As recently reported on Slashdot, that could be anywhere from 2 weeks to 2 months."

Comments

How about they just scrap it entirely?

[Anonymous Coward]

Single payer - have everyone buy into Medicare. Done.

Re:How about they just scrap it entirely?

[drfred79]

That's the exact opposite economically to produce affordable healthcare for the whole nation. Sure poor people will have little incentive not to come in for every cough but someone will pay for it. That will tax our whole economy, not including dead weight loss inefficiencies.

Re:How about they just scrap it entirely?

[rubycodez]

you're confused. the whole reason we pay three times or more what more advanced countries do (yes kiddies, U.S. is not #1 for healthcare) is because of the big insurance and big healthcare full of fat cats lining their pockets. that system has to be destroyed. ACA just gives it more money. single payer might be viable solution but it will burn down some huge corporations. however, don't believe the lie that those big corporations are the main contributors or participants in our economy, people and small/medium business are the bulk of it.

Re:How about they just scrap it entirely?

[Unordained]

The ACA exchanges are specifically designed to (a) help people buy in larger pools for discounts and (b) induce competition between insurance companies, to reduce prices.
Where we don't have as much pressure is in healthcare, because people are not naturally inclined to go to a physician billing himself as the cheapest on the block. We as patients don't know how to evaluate the quality of the care we get, or its value, so we cannot effectively price the services we buy.

Re:How about they just scrap it entirely?

[Jeremiah Cornelius]

That's the exact opposite economically to produce affordable healthcare for the whole nation. Sure poor people will have little incentive not to come in for every cough but someone will pay for it. That will tax our whole economy, not including dead weight loss inefficiencies.

Cut the 3 billion sent to Israel's military every year. Why subsidize the Israeli social welfare system, when they have a booming economy and the US has bread lines?
 

Re: How about they just scrap it entirely?

[Anonymous Coward]

Breadlines? Where?

We have SNAP, and it's actually underfunded because Republicans want us to believe we can't afford it and the poor are rolling in the dough. But the tax burden is at historical lows and the economy has no problem concentrating wealth upwards. Money in,t flowing down.

Re:How about they just scrap it entirely?

[Salgak1]

Or even better, apply the O'Rourke Circumcision Principle. All budgets get cut, 10%, off the top.

Stop ALL foreign aid. Means-test ALL transfer payments to individuals. And prohibit the use of proprietary software: MANDATE open-source.

And most importantly, Limit ALL Congressmen to 6 terms max, lifetime, and all Senators to two terms max, lifetime. If it's good enough for the President, it's good enough for them. . .

Re:How about they just scrap it entirely?

[mc6809e]

you're confused. the whole reason we pay three times or more what more advanced countries do (yes kiddies, U.S. is not #1 for healthcare) is because of the big insurance and big healthcare full of fat cats lining their pockets.

Saying that they line their pockets with money may be a fact, but it's not a reason.

The reason we collectively spend so much is because we have government spending competing with private spending for a finite amount of healthcare services.

It's this competition for limited services that bids prices up for everything. And as prices rise, some people are priced out of the market, justifying more government spending to help them, which further increases prices.

Re:How about they just scrap it entirely?

[rubycodez]

hahaha, so all extra money goes into R&D? Guess again, I'll start you with a hint, 30% is "administrative" costs

Re:How about they just scrap it entirely?

[phantomfive]

Where we don't have as much pressure is in healthcare, because people are not naturally inclined to go to a physician billing himself as the cheapest on the block.

The way to make up for that is by allowing customers to know the outcomes for various surgeries in the hospital. Once customers know the price and the outcomes, they can make informed decisions.

Price and outcomes are not always related. For example, a hospital that does many heart surgeries could be very good at them, and also very efficient, so they can do them more cheaply. Whereas another hospital that doesn't do many heart surgeries will need to charge more as a result, and also will have worse outcomes.

Whether prices are published or not, outcomes should definitely be published, because making that information public will be an incentive for hospitals/doctors to improve treatment even if nothing else changes.

Re: How about they just scrap it entirely?

[drfred79]

And the amount of people on SNAP is increasing, therefore inflating faster above the cost of other important government programs. Don't state the solution without the problem.

Re:How about they just scrap it entirely?

[johnlcallaway]

The reason we pay so much for health care is:

1. Availability BECAUSE of widespread insurance. This drives up demand and screws with pricing since the people using it don't have to pay based on the type of service received. You see the same thing in our college education system, as the availability of 'free' education has gone up via grants and student loans that delay the financial pain, the costs have risen for essentially no improvement in services. When the lie took over that 'everyone has to have a college education to get anywhere', and everyone bought into it, it became far more expensive. The same type of lie has invaded our medical system; that 'everyone has to have access to health care, no matter what the real costs are'.
2. Newer, more expensive treatments. My fibula was broken in a motorcycle crash. The billed costs to fix it were over $72K and included a three day hospital stay, a plate in my ankle, several follow-up visits with the surgeon, including one more surgery, and months of physical therapy. 50 years ago, they probably would have thrown a cast on it in the emergency room and I would have limped the rest of my life. The facts are that people are receiving more and better treatments and living longer and better than they ever have before, and it's costing a crap load more money than it used to.
3. Duplicate/litigious-avoidance medical testing because insurance pays for it. I found it interesting when I had a high-deductible plan and started to question tests how many the doctors really didn't need to do but did so 'because insurance covers it'.
4. Insurance companies are some of the lowest margin companies in the US that have driven down health care costs by forcing hospitals and doctors to accept lower payments. It's a double edged sword, while they have helped drive costs down, the increased demand has driven it back up.
5. Tax laws and accounting procedures used by healthcare providers. Ever wonder why your hospital bill is $40K, but the insurance only pays $12K?? The $12K is the 'negotiated rate', while the $40K is the full rate. Everyone who fails to pay results in a $40K write-off for the hospital, not a $12K. And if you are in a car crash in many states, the hospitals can go after the at-fault person for the $28K difference. A friend of mine, who had chosen to not buy insurance where she works, needed an expensive procedure. When the hospital was offered cash, they took 50% off the price. So don't tell me that the prices being charged are real.
6. Lack of transparency/competition coupled with government subsidies. Why is it auto repair facilities have to give a detailed estimate and are held to it, yet our hospitals don't have to?? My son, who doesn't have insurance, hurt his ankle and went to the hospital. He wanted to get it checked, and being a responsible person was going to pay for it. The hospital was unwilling to tell him how much it was going to cost, so he left. However, the next day they called him back and told him they were able to get the state insurance program to pay for it.

No one is entitled to affordable health care, there is no reason why everyone should be able to have liver transplants regardless of income level. We should have access to fairly priced health care that we can work out the details of paying for it. And choose whether or not it's worth the money to us as individuals. Not the government deciding.

Re:How about they just scrap it entirely?

[Bugler412]

(former HMO IT guy) That 30% administrative cost is driven primarily by the hideous complexity of health care billing brought on by the mutli-payor insurance setup we have today. Every single line item on a hospital bill must be evaluated for who pays for it. That takes a lot of skilled labor in classification of each individual item. Then throw various mixtures into the mix of who allows what to be done, various contractual pricing schemes not seen by the individual consumer, etc. etc. etc. It's a God awful mess in there. THAT is where the administrative costs come from. Not from corporate profits. and seriously, do you think a government operated bureaucracy would have LESS overhead in its' operation? What planet do you live on if you think that?

Re:How about they just scrap it entirely?

[Presto Vivace]

Mod parent up! Pass HR 676, Medicare for All.

Re:How about they just scrap it entirely?

[johnlcallaway]

That looked a lot better when I previewed it ....

Re:How about they just scrap it entirely?

[drfred79]

Would you say the "Management" Costs of Great Britain's Single-Payer System are:
a) Minimal and fair
b)More than they probably should be compensated for a fair and equitable system

If you answered b than you are correct. Wait? Doesn't that mean that it doesn't matter which economic system we use cronies will find a way to pay themselves too much? Gee, that sounds like an inherent problem anthropologically not economically.

Re:How about they just scrap it entirely?

[Anonymous Coward]

Yeah. Because Medicare is an already-insolvent service that is already underpaying doctors to the point that many refuse to accept it as payment.

Brilliant plan...

Re:How about they just scrap it entirely?

[iserlohn]

Hospitals in the UK don't even have a billing department. Administration costs in the NHS is orders of magnitude less than in the US.

Re:How about they just scrap it entirely?

[drfred79]

Proof or didn't happen

Re:How about they just scrap it entirely?

[nine-times]

Which limited services are you referring to? What's the limit?

Re:How about they just scrap it entirely?

[davester666]

Insurance companies would lose lots of money by being cut out as middlemen, and hospitals would not be able to overcharge nearly as much.

Thus, it will never happen, because for-profit always beats every gov't program, and the more middle-men you have, the more efficient the whole system is.

Re:How about they just scrap it entirely?

[rubycodez]

Wrong thinking, you don't understand the business. Corporate profits are of no import to the discussion, you the consumer pay COSTS. Lining pockets can be done as COSTS. Let me tell you of former employer, 25% of U.S. claims went through their systems, they were contracted by major insurance companies and much of claims processed automatically, then outlier line items flagged for human review. That is about COSTS, my former employer and every fat cat executive and owner were COSTS.

Re:How about they just scrap it entirely?

[Unordained]

That information is already available, to some degree, to Medicare and private insurers. They use it to determine how much procedures should cost, and apply pressure (by paying only that amount) to hospitals and providers to drive down the price; they use the incentives of "preferred" status to route patients to cheaper (but still effective) care. A big buyer like Medicare can do that. Large private insurers can do that. Individuals who need emergency heart surgery, and have the choice between two somewhat-nearby hospitals? Not so much. They don't have the time, they don't have the data, they don't have the choice.

Re:How about they just scrap it entirely?

[phantomfive]

You don't even need to cut the budgets. If we merely kept them from growing, the debt would disappear over time.

Re:How about they just scrap it entirely?

[rubycodez]

no, the ACA is designed to increase COSTS on most the working people who already have insurance, and put it into the positive feedback loop of insurancehealtchare provider

we as patients do know how to evaluate the declining quality of the U.S. system, the ratings and statistic are public information. we are not in the top ten countries with the best healthcare, we pay two or three or more times what the care can be had in other places.

Re:How about they just scrap it entirely?

[rubycodez]

not true, the $0, there is taxation for it. however, the costs in USA are two or three or more times (depending on who did study) those other first world countries.

Re:How about they just scrap it entirely?

[shadow169]

Not say that is a bad idea, however you may not be aware that it has some very negative consequences within itself. Once the outcomes of all procedures are made publicly available, health care providers (such as surgeons) will start to refuse to perform procedures on patients who do not have a very high probability of success. In addition the general public will look for simple "pass/fail" information on the outcomes, when that is a completely unrealistic way of looking at it. The cold hard truth is that surgical outcomes have too many factors for the general public to be able to make a well informed decision on.

Re:How about they just scrap it entirely?

[Unordained]

in what way is the ACA designed to do so? by what method, and what's the loop?

yes, you're correct that we have a pricing problem. i don't think any of us disagree on that point. the problem is what to do about it. we didn't get to this point because of the ACA.

Re:How about they just scrap it entirely?

[clarkkent09]

Annual per taxpayer cost of healthcare in the UK (NHS budget/number of taxpayers) is higher than the average health insurance cost per year in the US.

Re:How about they just scrap it entirely?

[judoguy]

So, you want to replace large greedy corporations with...

the largest, greediest most inefficient corporation. One that use lots of guns to enforce it's will.

Hey, what could go wrong?

Or perhaps we can enforce a market with true competition. Which is not what we have now. "Oh Noz! Can't do that!" People must be forced to do the right thing by a vast, inefficient, "compassionate", smarter-than-we-are totalitarian state.

Re:How about they just scrap it entirely?

[stymy]

The administrative overhead for the NHS is 5%. The US is probably the least efficient system in the OECD world. Source:http://business.leeds.ac.uk/news-events/item/articles/2011/January/why-the-nhs-reforms-could-result-in-more-not-less-managers/

Re:How about they just scrap it entirely?

[dywolf]

no.
just no.
that is no where near the reason, and whomever modded you up isnt familiar with the industry or its cost drivers AT ALL.
healthcare resources are no where near scarce in this country.
the high costs are in no way shape or form being caused by a limited supply unable to keep up with demand.

Re:How about they just scrap it entirely?

[Lendrick]

Technically speaking, he would have paid for it in taxes, but it would have cost half as much.

Re:How about they just scrap it entirely?

[umafuckit]

Price and outcomes are not always related. For example, a hospital that does many heart surgeries could be very good at them, and also very efficient, so they can do them more cheaply. Whereas another hospital that doesn't do many heart surgeries will need to charge more as a result, and also will have worse outcomes.

I wonder if that's true. Why will a hospital doing fewer heart surgeries have to charge more? Do you have a citation for that? If a place is doing heart surgeries then they're tooled up for it and ready to go. The difference is if they're doing a given procedure 50 times a year or 500 times a year. The more practice they have the better they are, but I don't see why doing it only 50 times a year would make them more expensive.

Re:How about they just scrap it entirely?

[rubycodez]

last I checked the ACA would be enforced by that large greedy corporation's IRS, guns and all

Re:How about they just scrap it entirely?

[mc6809e]

Which limited services are you referring to? What's the limit?

How about the time available to doctors and nurses to treat people? They can only treat so many people.

And there are psychological limits, too. Doctors and nurses may have time but not the will to devote 80 hours a week to watching people die.

There are also equipment limits. An MRI requires scarce materials and scarce skills to assemble.

There are countless things that limit the total amount of healthcare available.

Don't think like a mere consumer, where the perceived limit on what's available depends only on the money in your bank account. That's putting all the focus on the demand side of the equation. Try to see the big picture. To do that, you have to look at the supply side, too. The supply of most things is limited (ultimately by physics).

Re:How about they just scrap it entirely?

[Karmashock]

That's just failing up. If they f up then it should get scrapped.

Re:How about they just scrap it entirely?

[tbannist]

Not from corporate profits. and seriously, do you think a government operated bureaucracy would have LESS overhead in its' operation?

In a word: yes.

What planet do you live on if you think that?

Earth. Down here in reality we can look at every other developed nation and see that they all have some form of universal health care and they all have lower overhead. According to a World Health Organization study the average is 4% for other countries with a maximum of 7%. As I understand it, in the U.S. overhead costs run from 7% for the largest company plans to 30% for individual plans (and the smaller the pool, the larger the percentage dedicated to overhead). So the worst out of 58 other countries is as good as the most efficient private health insurance plan in the U.S. and the average is almost twice as good as the best U.S. plan and 7 times better than the worst U.S. plan.

Re:How about they just scrap it entirely?

[dywolf]

1: Nope.
2: Nope.
3: Contributes, but nearly as much as people think.
4: Nope. In fact the opposite. Hospitals can get away with charging more because the insurers act a a shock absorber, insulator, between your wallet and the true cost of care. they dispute some, but not all excessive costs, because they act more as a match maker between patients and hospitals than a representative of the patient. in fact, it can be argued that hte true commodity is the patients, and the customers are the hospitals.
5: Nope. Red herring. It contributes, but negligibly so.
6: Finally got one right. Lack of competition and economic pressure. This single factor is responsible for the majority of high cost of healthcare in this country. Quite simply, healthcare costs so much because it can. Because they can get away with it. Because there is a middleman between our wallets and the caregivers, that sheilds us from direct costs. Because healthcare isnt like a car sale...you're not going to walk away from life saving surgery because it's too expensive.

It's as a simple as that. Number 6 is the single most important factor, all others are either false or negligible.

http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-introduction/
http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-red-herrings/

We should have access to fairly priced health care that we can work out the details of paying for it. And choose whether or not it's worth the money to us as individuals.

Again: no one actually does that. No one is ever going to do that. If I tell you you need to take these pills, that cost 100$ per pill, or you will die, you're not going to walk away and just accept death. People just dont do that. and since you care to mention government...the single most cost efficient sector of our healthcare system IS the government run single payer segments: Medicaire/Medicaide.

Re:How about they just scrap it entirely?

[dywolf]

midread number 5. somehow.
youre right, the rates arent real. because of number 6.

if you havent read the time article (from march?) about high costs, you should.
that, along with several analysis and papers linked on incidentaleconomist.com all point to the same thing: its costs so much simply because they can. things like charging $20 a pill for generic tylenol, literally out of the same bottle you can buy at the store that costs only 4 bucks (~5cents a pill). or charging for room and board...and then seperately charging for use of the sheets, laundry of the sheets, etc..things that wuold logically be already under "room and board".

Re:How about they just scrap it entirely?

[LynnwoodRooster]

Interestingly, without "for-profit", there is no income tax - and thus the lion's share of Government revenue goes away. It is in Government's own interest to pump up for-profit entities, to maximize its own income; it's just a great "benefit" that it can do so whilst increasing control and regulation of those same for-profit entities and thus gain tighter control of its own destiny, independent of the will of the people.

Re:How about they just scrap it entirely?

[Valdrax]

All budgets get cut, 10%, off the top.

Tell you what -- why don't you apply that at home? Pay 10% less for food. Pay 10% less for clothes. Pay 10% less for luxuries.

Pay 10% less for your rent. Pay 10% less for your utilities. Pay 10% less for your loans. If you get injured, offer to pay your doctor only 90% of the bill. Do it right now, and don't incur any additional expenses in reducing these costs, because that comes out of your total budget too.

It turns out that many government agencies & programs are not only running right at the red line but are actually underfunded. Also, there is often a cost associated with not paying something that makes it more expensive than just paying it. 10% across the board cuts are the kind of thing that sound nice when you're just talking numbers, but there are people and contracts and obligations and Congressional mandates that aren't so easily cut.

Re:How about they just scrap it entirely?

[Qzukk]

And when you add back the 20%+deductibles and other out of pocket costs that the insurance in the US makes the patient pay, how does it compare? Otherwise you're saying that paying for all of it is more expensive than paying for some of it, which isn't exactly earth shattering news.

Re: How about they just scrap it entirely?

[Oligonicella]

Republicans want us to believe we can't afford it and the poor are rolling in the dough

Bullshit. Bullshit made by feeding the bull straw.

Re:How about they just scrap it entirely?

[nine-times]

How about the time available to doctors and nurses to treat people? They can only treat so many people.

I'm not sure that counts as a limited resource, since it doesn't explain why we can't scale up on doctors or nurses to meet the demand. After all, we do have unemployment. I'm not saying you don't have a point, but you're being very picky that we get down to the reason why things are so expensive, and your explanation doesn't quite seem adequate. Scarcity of materials for MRIs could be a real limit, but it would only explain why MRIs are expensive. Why is the aspirin in hospitals so expensive? Aspirin isn't meaningfully limited.

This isn't a simple supply and demand issue.

Re:How about they just scrap it entirely?

[Heshler]

Thank you, please upvote this someone.

Insurance companies, hospitals, and doctors all profit from prescribing a $20000 surgery when a $1000 drug will work 95+% as well, or even better than the surgery. Without our own personal WATSON, no amount of information a layman receives will help us make an informed decision. The only solution is a government-administered single payer system for all essential healthcare for everyone. Private insurance can top it up for those who can afford it.

Re:How about they just scrap it entirely?

[Xyrus]

Why did you write a wall of text? Here's a brief summary: Poor people deserve to die.

That's really what you want, isn't it? The haves can have health care, the have-nots can die in a gutter someplace. And this will be better for everyone.

Unfortunately for you, other more socially advanced nations have provided strong counter-examples to your Rynd-esque sociopathic utopia.

Re:How about they just scrap it entirely?

[iserlohn]

Buying private cover in the UK is surprisingly cheap. A top-up plan for a family of four that covers extras like private hospital rooms and private surgical procedure cost as little as 30 pounds a month. This is because the care offered by the NHS is already to a high standard. Private providers need to compete in order to make people feel that additional insurance has value.

The NHS spends roughly 14% on admin costs within the past decade, less than half of the US. While not an order of magnitude in base 10, it's a very big difference.

Re:How about they just scrap it entirely?

[Unordained]

If doctors have the choice between getting paid by (a) Medicare, which is trying to lower costs by actually paying less for services, or (b) private insurance, which can (and does) raise rates every year to pass costs along to the insured, OF COURSE doctors would prefer to see patients with private insurance.

But you'll note that if we took that choice away, things could be different. France, for example, uses a single-payer system (mostly -- you can get supplementary insurance) and most (not all) doctors agree to the equivalent of Medicare rates, to get the vast majority of patients referred to them. There have been complaints, rarely, from the providers. Not that they weren't paid enough to stay open, but maybe that they needed more money in order to invest in new/upgraded equipment (e.g. x-ray). What you DID NOT see was a whole country going without doctors, because the doctors just didn't like the lifestyle they were being provided with. It is doable to apply sufficient pressure to keep costs under control -- but in a multi-payer system, it's a lot harder.

Medicare's insolvency is mostly the result of baby-boomers, and would work itself out over a long enough period. But it's a system where we accept surplus, but not deficit. So while we don't complain about the highs, the lows become fatal. It's hard to average something out under those circumstances. Same with the US Postal Service -- not letting them rake in large profits, yet complaining when they haven't been able to save up money in the good years to pay for the bad ones.

Re:How about they just scrap it entirely?

[Skapare]

If doctors get measured by success in this way, then they will be inclined to avoid the more risky patients.

Re:How about they just scrap it entirely?

[iserlohn]

I don't know where you get your numbers but UK healthcare spend is 8% of the economy while in the US it is over 15%. You can compare all of these stats and more at the Commonwealth Fund.

Hey, how about some graphs to illustrate the point?

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/PDF_1533_Anderson_multinational_comparisons_2010_OECD_pfd.pdf

Re:How about they just scrap it entirely?

[iserlohn]

The Canadian single payer system is a single payer per province. How hard is that to understand? If the federal government in Canada wants to standardise the billing practises they can of course, but then people like you will complain that the federal government has too much power.

It's also telling that you missed out the UK. That's true single payer system. A very large majority of procedures aren't even billed for in the traditional sense as most hospitals are public managed under the NHS.

Re:How about they just scrap it entirely?

[iserlohn]

Just a few hospitals' list of departments. Try calling them yourself and ask for billing. You'd probably be transferred to admissions.

http://www.uhb.nhs.uk/contact-a-department.htm
http://www.ruh.nhs.uk/finding/maps.asp?menu_id=3
http://www.chelwest.nhs.uk/your-visit/wards-and-departments

Re:How about they just scrap it entirely?

[LifesABeach]

The Health Care Insurance investors couldn't agree with you more. Their time is coming to an end, but don't worry for them. They'll just move their money into Crop Failure Insurance, if they haven't already.

Re:How about they just scrap it entirely?

[lgw]

I've done just that. More than once. That's why I hope to soon be independently wealthy. I've gone from spending 105% of my take home pay to 40% (admittedly, not all at once, but the first 10% is quite easy).

It's not actually that hard, it's just a matter of priorities, and realizing you're not entitled to something just because you really want it. And it's the only long term plan for financial success. Cutting spending is within your power, and it works. Spending what you think you should be earning is the worst sort of foolishness.

Re: How about they just scrap it entirely?

[Jeremiah Cornelius]

The pillage economy.
http://www.youtube.com/watch?v=QPKKQnijnsM

Re:How about they just scrap it entirely?

[iserlohn]

Someone has to decide what your insurance covers in the end. Actuaries have jobs to do. Insurance companies set coverage policies. If you happen to fall foul of one, or if your insurance company decides to decline your claim for whatever reason, what recourse do you have?

The National Centre of Clinical Excellence sets standards on what is covered and not under the NHS. This is all transparent and you can lobby to change this if you so desire. Contrary to popular belief in the UK, the NHS is not a third world healthcare system. In fact, it rates highly among developed nations. Life threatening illnesses are prioritised and taken care of immediate. Cancer care is generally very good. Those areas that are not, are generally improving.

Re:How about they just scrap it entirely?

[drfred79]

No, your claim that administrative costs are orders of magnitude less than the U.S. . I want to see that. Billing is done through the Tax Collection department regardless.

Re:How about they just scrap it entirely?

[Anonymous Coward]

Well, yeah, actually, that's what I do want to do, because it FUCKING WORKS. All over Europe and the rest of the industrialized world, single-payer health care systems work.

Also, your assertion about efficiency is unsupported by fact, at least from the perspective of dollars spent by *consumers* compared to results. And your assertion about greed makes no sense at all. A for-profit corporation is *inherently* going to try to maximize profits (and, for public corporations, shareholder value). That's its central purpose. A government organization may be staffed by corrupt individuals who are going to line their pockets, but it's not inherently hell-bent on extracting the most money from the customer/client as possible.

Look I love the free market, I made my money as an entrepreneur, and in a lot of cases I think it could be a lot freer than it is right now. But there's just some situations in life that are more like single-round Prisoner's Dilemma than anything else. In such cases (adopting for the moment your bizarre all-or-nothing worldview in which any infringement upon personal choice is "totalitarianism" and economic pressure is "holding a gun to your head"), someone is limiting our choices in the short term in a way that provides an optimal long-term outcome for most if not all. Unless you're so ego-bound that you'd rather rot in prison with your buddy basking in the glory of your unfettered choice to rat each other out than walk, I don't see the problem here.

Mind you, the reason I know that big-L Libertarianism is a religion more than anything else is that, confronted with basic game theory, most hardcore Libertarians choose to deny the possibility that any such situations exist in life, or they decide that the pessimal outcome is somehow a *good* thing, instead of just admitting that one size does not fit all.

Government *can be* better than industry at some things; there's countless examples in other countries of functional governments. Maybe if we stopped treating it like an enemy, and started treating it as a social obligation in a civilized society, we might not be in this mess in the first place.

All that said, I hate the ACA and I think we've got an out of control entitlement culture. I just don't think throwing the baby out with the bathwater will help anyone except the already powerful.

Re:How about they just scrap it entirely?

[Urza9814]

No one is entitled to affordable health care, there is no reason why everyone should be able to have liver transplants regardless of income level. We should have access to fairly priced health care that we can work out the details of paying for it. And choose whether or not it's worth the money to us as individuals. Not the government deciding.

So Nikola Tesla's life is less valuable than Kim Kardashian's?

Re:How about they just scrap it entirely?

[Urza9814]

Yea, I work as a consultant for one of the big national pharmacy chains, and from what I hear there are some prescriptions where we just eat the cost ourselves because it's cheaper than actually getting the person's insurance to pay for it...

Re:How about they just scrap it entirely?

[rubycodez]

my friends and relatives including my wife who went to other countries for major surgery and dental work would disagree with that 40% number

Re:How about they just scrap it entirely?

[daninaustin]

This is exactly right. When faced with a deficit, the responsible thing to do is to downsize. You may not be able to downsize your rent in the short term due to a lease, but this problem has been going on for many years. They need to cut costs across the board and 10% isn't close to what is needed.

Re:How about they just scrap it entirely?

[jedidiah]

> That information is already available, to some degree, to Medicare and private insurers.

In other words, it's really not.

Someone claimed that the US spends 3x more on medical care. That number could easily be accounted for due to bogus inflated hospital billing rates. The stated price and what gets paid vary wildly. These rates are treated like trade secrets and are greatly discounted if you are a large corporation.

If you are just Joe Schmo, you could get raked over the coals.

Re:How about they just scrap it entirely?

[jedidiah]

> in what way is the ACA designed to do so?

Ultimately, it's about income redistribution. Those of us that can afford insurance are going to be subsidizing those that cannot.

Beyond that, the ACA regulates what products you can buy. It seeks to deny you options that allow you to better manage overall costs. It also regulates what and whom can be covered in a manner likely to increase premiums.

The do-gooders despise the idea that some of us might be self-reliant and seek to undermine that. They also despise the idea that we may choose to spend more for a better option.

Re:How about they just scrap it entirely?

[iserlohn]

I already responded in the post below. Ok, several orders of magnitude may be a exaggeration for effect, but only slightly. NHS admin costs are less than half than in the US as a percentage of health costs. Health costs in the UK is also half of that in the US. Per capita, health admin costs are 2 orders of magnitude lower in the UK compared to the US.

You can find more stats like these at the Commonwealth fund. NHS admin costs are summarized in papers available online as PDFs.

Re:How about they just scrap it entirely?

[iserlohn]

Actually, you can spend all the money you want to get all the care you want in the UK. You can buy private coverage, or your employer can buy it for you. The UK system is not a single payer system like Canada. The NHS as a nationalised health service covers almost care to a high standard, but you can buy as much add-ons as you want. There are private clinics and hospitals that welcome your custom.

Re:How about they just scrap it entirely?

[Unordained]

The cost information is available. But the original statement was about costs and outcomes -- and there, it gets harrier, because the billing system we use isn't really setup to help the insurance company (private or not) track how conditions are related to each other over time. They can, and do, guess. But it's tenuous at best, and as you switch insurance companies, your history doesn't cleanly move with you. So determining exactly what the original commenter wanted -- whether you were overpaying for the outcomes experienced -- is a problem not yet entirely solved.

I haven't seen a source for the 3x value. AFAICT, it's in the 20%-100% more range, depending on the study and the metric (per capita, adjusted for GDP, equivalent care, etc.)

Random example, citing data from various research: https://www.medmutual.com/~/media/Files/Healthcare%20Reform%20PDFs/Report%20Healthcare%20costs%20in%20the%20US.ashx

Re:How about they just scrap it entirely?

[Unordained]

The income redistribution was already happening, except it happened in spurts (when people went to the ER, couldn't pay, and the hospital passed along the loss) or through the courts (when people went bankrupt, and we all paid for it when their creditors passed along the loss.)

Insurance, by its very nature, is always re-distributive. Those who don't need (today) pay for those who do (today). It evens out, eventually (there's no reason to expect those who are currently rich to be naturally healthier over their entire lifetime), but in the short term it's redistribution. We redistribute for basic needs -- food, shelter, and healthcare. We've had a mandate to that effect since 1986, under Reagan. It's not a particularly partisan issue to say that our fellow man doesn't deserve to die of some curable disease just because he can't currently pay for care. And it's not unreasonable to say we'd rather he go see a doctor while the problem is easy to fix, rather than wait until the last minute -- by doing so, he's doing us a favor (if we're footing the bill.) We may subsidize his care today, but if he recovers and thrives, he'll be paying back into that same insurance pool too.

We generally regulate what products people can buy. We do that with securities. With drugs. With food. Weaponry. Animals. ...

We have certification requirements for plumbers, lawyers, electricians, and yes, doctors. Does that increase the cost of the services? I'm pretty sure it does -- but the regulation wasn't done without reason. When you look at the history of deregulation of these industries, you see all sorts of calamities. A cheap self-described electrician can set fire to a whole neighborhood. A quack doctor could easily cause a pandemic. We're all affected.

Self-reliant today, but what about tomorrow? Will you willingly accept to be left in the gutter by the rest of society in your hour of need, because you deserve no better? Money is secondary to me. People come first.

The ACA does not prevent you from paying more, if you want to. So I'm not sure what that's about.

Re:How about they just scrap it entirely?

[dcollins]

Too sensible. Shit like that is what triggers the assheads to shut down the government.

Re:How about they just scrap it entirely?

[rjstanford]

The way to make up for that is by allowing customers to know the outcomes for various surgeries in the hospital. Once customers know the price and the outcomes, they can make informed decisions.

No, they won't. When you're working at $25K/yr, comparing surgeries that have costs of $250K (10% survival rate) vs $500K (12% survival rate) makes no difference whatsoever. You can't afford either one, so either you get nothing at all or you go for the expensive one (since you'll be bankrupt after either).

Re:How about they just scrap it entirely?

[rjstanford]

Last time I ran the numbers (a year or so ago), the combination of US income and payroll taxes for someone making 80K USD were approximately equal to the income and NHS taxes for someone making 50K GBP (basically equivalent). That's including the employer portion of both, of course. IIRC the UK taxes were about 500USD over the US ones - but, of course, they included full health care (including copays and deductibles) for a family, whereas the US ones didn't.

Re:How about they just scrap it entirely?

[steve_ellis]

This is because the care offered by the NHS is already to a high standard. Private providers need to compete in order to make people feel that additional insurance has value.

Apparently feeding & providing water to patients is gold-plated service, far beyond the "high standard" that NHS offers: http://www.dailymail.co.uk/news/article-2287332/Nearly-1-200-people-starved-death-NHS-hospitals-nurses-busy-feed-patients.html

Re:How about they just scrap it entirely?

[rjstanford]

Don't forget somewhat better outcomes too :)

Re:How about they just scrap it entirely?

[rjstanford]

Would you say the "Management" Costs of Great Britain's Single-Payer System are:
  a) Minimal and fair
  b)More than they probably should be compensated for a fair and equitable system

  If you answered b than you are correct. Wait? Doesn't that mean that it doesn't matter which economic system we use cronies will find a way to pay themselves too much? Gee, that sounds like an inherent problem anthropologically not economically.

And yet even with that fact, they're half of the US system's costs. What does that imply, do you think?

Re:How about they just scrap it entirely?

[Salgak1]

You say you can't cut food costs ?? You can't buy basic foods in bulk, and cook your own meal, instead of that overpriced microwaveable entree ? You SURE you must hit Starbucks, you can't brew a pot of coffee at home ?? As noted by others, it's not tough at all: cut the pre-made and the name brands, and you've probably ALREADY saved 20-30%. Coupon. Buy on sale, and stock up. It's simple, rational, and WORKS. . .

Re:How about they just scrap it entirely?

[nurb432]

The ACA exchanges are specifically designed to (a) help people buy in larger pools for discounts and (b) induce competition between insurance companies, to reduce prices.

If you honestly believe that was the goal, you are a fool and deserve the socialist world you support. Enjoy your cheese and bread, while it lasts.

Re:How about they just scrap it entirely?

[mc6809e]

no.
just no.
that is no where near the reason, and whomever modded you up isnt familiar with the industry or its cost drivers AT ALL.
healthcare resources are no where near scarce in this country.
the high costs are in no way shape or form being caused by a limited supply unable to keep up with demand.

I think you're laboring under a misconception of what demand is in an economic sense.

Demand isn't simply want or desire or need. Demand is also the ability to pay for some good or service.

With this definition, supply IS able to keep up with demand through the price mechanism. Prices increase to suppress demand so that supply and demand match.

Now there are plenty of costs that the supply side is burdened with which makes satisfying demand at lower prices difficult. Maybe that's what you meant.

I'd like to hear your theory, though.

Re:How about they just scrap it entirely?

[phantomfive]

Hey look, by finding a dubious corner case, you proved the rule wrong. Or not.

Re:How about they just scrap it entirely?

[bugs2squash]

I don't know, there's a lot of people drawing reasonable paychecks on the back of this health system being such a cluster. What would all the medical billing specialists do ?

Re:How about they just scrap it entirely?

[kwbauer]

"I'm not sure that counts as a limited resource, since it doesn't explain why we can't scale up on doctors or nurses to meet the demand. After all, we do have unemployment." How many unemployed doctors and nurses can you point to (besides ones laid off for misappropriating medications and such)? Do you really want the newly unemployed rear tire installer from the Ford factory diagnosing your chest pain? How about the inner-city high-school dropout?

Re:How about they just scrap it entirely?

[kwbauer]

Is Switzerland more or less advanced than the US? Does it have better or worse health-care than the US? How different is the Swiss system from the US system?

Re:How about they just scrap it entirely?

[kwbauer]

Including a member of the House of Reps from Wisconsin who voted for Obamacare with the claim that it would be as good as Medicare.

Re:How about they just scrap it entirely?

[Woundweavr]

(Current HCIS Developer in a Billing Application) Considering Medicare/Medicaid already has considerably lower overhead and the NHS in the UK have much less Administrative costs, I think you perhaps are not well informed on overhead costs.

Re:How about they just scrap it entirely?

[Woundweavr]

Are you seriously arguing that people are wrong thinking while misusing the term "costs" in capital letters three times?

Consumers don't pay "COSTS". Consumers pay "PRICES." This is a fundamental concept in economics and lacking comprehension of it means no discussion of economics is worthwhile. If consumers didn't pay prices that included profit, then the entire system wouldn't function.

The insurance company negotiates "PRICES" with the hospital/hospital network, set where the hospital can make a profit (even if its non-profit, since they can then use it to expand, increase pay, etc). Or the uninsured individual pays a considerably higher "PRICE" for the same treatment both because of the laws of economy of scale, because hospitals can write off losses at higher rates for non-payers in those cases for tax benefit and because collecting from self-pay accounts requires additional man hours and almost always results with a higher Accounts Receivable average.

Individuals and employers pay insurance PRICES, set by the insurance companies for various plans. Those prices do include profits. They have to pay for advertising, lobbying, claim processing, price negotiation and maintenance of price lists, bill collection from employers/purchasers of insurance, legal fees, executive pay and yes profit for shareholders as well as paying for healthcare itself.

This is why Medicare/Medicaid has much lower costs. First, they set prices, rather than truly negotiating them. A single procedure will cost two different amounts at different hospitals even with the same insurance, but not under government coverage. Second, they don't advertise, they don't negotiate, they don't have shareholders or profit, they don't have bill collection. Medicare overhead is 1-2%. Private insurance varies from 11% to 30% depending on what you include.

http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/

Re:How about they just scrap it entirely?

[Zouden]

If that's the case how does the US spend a higher percentage of GDP on health than the UK?

Re:How about they just scrap it entirely?

[dave420]

Well, technically speaking, the price difference to him between having the injury and not having the injury is 0. That's kind of the same as "not paying" in any meaningful sense.

Re:How about they just scrap it entirely?

[dave420]

The taxes are not "huge", as the overheads for care are far lower. No hundreds-of-thousands of paper pushers in the middle, just government-run hospitals doling out government-paid-for treatments and medicine. The outcomes are definitely comparable. I have no idea why you are arguing against it. You're the one wanting to pay big corporations for your health care, yet you rail against taking them out of the picture entirely? Your logic is, *ahem*, "broken".

Re:How about they just scrap it entirely?

[dave420]

Daily Mail. Oh dear.

Re:How about they just scrap it entirely?

[dave420]

The government doesn't decide anything. You'd go to the hospital, and get treatment as soon as possible. Or you can spend $50 a month and get top-notch private treatment exactly as you want it (and for your family, too), when you want it. The private option is still there (and for less than you pay in the US), but most people don't need to take advantage of it as the public option is perfectly adequate. You are arguing against spectres which don't exist. It's sad.

Re:How about they just scrap it entirely?

[Jeremiah Cornelius]

Money NOT spent on the Military, by their Apartheid government, can then be freed for entitlements.

Re:How about they just scrap it entirely?

[Unordained]

Then enlighten us all: what was the goal, how am I wrong? Show me what you see, so we can get on the same page. What feedback loops do you see? What subterfuge do you detect? What ulterior motives do you suspect? What slippery slope are we going down? You might be right, but you won't convince me with generalities.

Re:How about they just scrap it entirely?

[nine-times]

Do you really want the newly unemployed rear tire installer from the Ford factory diagnosing your chest pain? How about the inner-city high-school dropout?

As a nurse, after undergoing training? Sure. As a doctor, after completing medical school? I don't see why not.

Re:How about they just scrap it entirely?

[lsatenstein]

Not say that is a bad idea, however you may not be aware that it has some very negative consequences within itself. Once the outcomes of all procedures are made publicly available, health care providers (such as surgeons) will start to refuse to perform procedures on patients who do not have a very high probability of success. In addition the general public will look for simple "pass/fail" information on the outcomes, when that is a completely unrealistic way of looking at it. The cold hard truth is that surgical outcomes have too many factors for the general public to be able to make a well informed decision on.

===
If there is no threat of lawsuit, surgeons will try their best to give the patient quality service. Do you do your least on the job? Do you feel you don't need to do a good job. Do you feel, at the end of the day, that you had a successful day. Did you measure that in dollars or completion of a project or deliverable?

Why is a surgeon any different. He wants to save lives, and to achieve a feeling that what he does is worthwhile. Money is not the primary motivator.

Re:How about they just scrap it entirely?

[nurb432]

The end goal is single-payer.

Re:How about they just scrap it entirely?

[Unordained]

You're really not giving me much to work with, there.

Single-payer was the original goal for the Democrats, yes. They dropped that rather quickly as it was clearly unpalatable to the Republicans. Instead we went with a Romney-care type of plan, already setup in Massachusetts. The individual mandate to buy at least catastrophic insurance with tax breaks to help people acquire it, were proposed by Mark Pauly and endorsed by the Heritage Foundation, during the 90's fight over Clinton's attempted healthcare reform, and was sufficiently popular to attract republican co-sponsors at the time. They didn't dream up the ACA, but some of the exact things we complain about now, were already being considered then, and in much better light.

So this is a compromise, of sorts. It's been hard-fought to get this far. With Republican calls to repeal & replace, do you really expect the Democrats to make any headway on pushing forward to single-payer? We've come this far; any attempt to push further would in fact jeopardize the gains.

I happen to think it would have been a better idea. It would have absolved religious employers from any paternalistic sense of responsibility for the use of "their" insurance dollars for contraceptions or abortion. It would be, in many ways, simpler to implement than what we're going through now. We already have several such systems at the state and federal level, we wouldn't be starting from scratch. But hey, we don't always get what we want, so too bad.

But would it be the end of the country? Many other OECD nations have such systems (but are also different from us in many other economic respects) and it hasn't killed them. It hasn't enslaved their population. It hasn't single-handedly killed their economy nor worsened their health. When we compare ourselves to them, we often forget that they are demographically and geographically different from us, and it's quite possible there's nothing we can do to stop the trend of resemblance, because it has more to do with aging populations and exhaustion of unexplored resources than it does whether we have single-payer insurance or not. I say that, knowing I'll still hear about what communist hell-holes every other country in the world really is. Even Canada. (Poor Canada.)

So, I don't see how we'll get there from here, and even if we do, I don't think it'll be the end of the world.

But more importantly, because this was the question you were purportedly answering, I don't see how the ACA is really just a cover-up, a front, a facade, a farce, a feint, a ploy to get us to single-payer insurance. You have not demonstrated -- nor even hinted at -- any such link. I'm not going to do your work for you, either. As they say about books: show, don't just tell.

Re:How about they just scrap it entirely?

[volmtech]

That, and the AMA limits the number of doctors. I had a childhood friend who is a premier pediatric plastic surgeon now. He almost quit medicine because he couldn't work the long hours residents are supposed to. He just needed more sleep than they would allow. Many do quit. Many more are turned away from school because seats are limited.

Re:How about they just scrap it entirely?

[volmtech]

Medicare and Medicaid are single payer. Over 10% of the budget goes to fraud. Wouldn't total single payer be just as fraud ridden? The ACA just enriches the insurance companies. The exchange debacle seems custom made to make everyone HATE dealing with (and paying) insurance companies. Single payer will end all that. To eliminate the fraud we will have to go to single provider also. All doctors will be government employes and all hospitals government ran. Problem solved.

Re:How about they just scrap it entirely?

[Unordained]

For a look at what the Medicare fraud rates are, please see:
http://www.politifact.com/truth-o-meter/statements/2013/jun/17/peter-roskam/rep-roskam-says-medicare-fraud-rate-8-10-percent/
(does not support "over 10% ... goes to fraud".)

For a comparison of public and private insurance fraud, you could start here:
http://www.renalbusiness.com/news/2009/06/fraud-prevalent-in-private-health-insurance.aspx
(private and public suffer about the same rates of fraud)

The ACA requires insurance companies to take everyone, even those with preconditions. It also requires them to pay out at least 80% of their revenue as medical payments, capping their administrative and profit margins. While 20% isn't great, it's better than some insurance companies have been doing, and it's a start.

What will it take to prove to you that the current "debacle" is not intended to make everyone hate insurance companies? What will you say when things start running smoothly in a few days or a few weeks? Do you need surveys re: public approval-ratings of the medical insurance industry, to detect a sudden shift? (I couldn't find any such survey results, sadly.)

I don't see how anyone would argue that single-payer solves the fraud issue. There's no obvious mechanism for it. I don't see how anyone would accept that argument, either. I therefore don't see how that would be the natural progression of things.

Even other socialist (nearly communist!) countries with single-payer health insurance systems, don't turn their doctors and hospitals into government employees and government institutions. (Example: France.) Maybe they should, I don't know. But we would have to seriously alter our pace of change to possibly overtake and surpass them in the way you're suggesting. And with our gridlock, I'm just not seeing it.

There are probably others, maybe even some more recent, but here's the GAO's report on the lessons we could learn from the Canadian health system, which parts we might consider importing, including cost comparisons. This is from 1991. http://archive.gao.gov/d20t9/144039.pdf

Re:How about they just scrap it entirely?

[volmtech]

No matter who pays soon it wont be enough. I have no insurance and pay about $50 a month for the doctor visit and one prescription I need. My mother in law has diabetes and also needs dialysis three times a week. That's not counting the month or two each year she spends in the intensive care unit. Eight years so far and five or six more, she's doing pretty good right now. Great for granny but how many $three hundred thousand a year patients can you (I'm disabled) afford to support.

Re:How about they just scrap it entirely?

[crimson tsunami]

Waste and inefficiency.

Re:How about they just scrap it entirely?

[daninaustin]

Rice, beans, and ramen noodles are cheap. People can eat a lot cheaper than they are normally used to.

Not that interested in the teething problems

[Albanach]

Personally, I'm not that bothered by teething problems. Plenty of sites have experienced them. Yes, there are many ways they could have been avoided, but they weren't, and they will undoubtedl be fixed.

More interesting would be to know what penalty clauses are in the contracts? If they were absent, it's a whole lot clearer why these problems have hit. There was simply no financial incentive to design a site that could scale appropriately.

Re:Not that interested in the teething problems

[John Jorsett]

Personally, I'm not that bothered by teething problems. Plenty of sites have experienced them. Yes, there are many ways they could have been avoided, but they weren't, and they will undoubtedl be fixed.

Even assuming that to be true, fixed by when? The law has hard-coded dates in it, and insurers have vast sums at stake predicated on the numbers and types of people signing up, the premiums they'll get, and the subsidies they'll receive. If things slip, lawsuits will fly and it's logical to assume that taxpayers will be on the hook for damages. Not to mention the people who are losing their coverage at work who were expecting to be able to sign up via the exchanges. This disaster has knock-on effects that will resonate thru all sectors of the economy and society, and to call them 'teething problems' is far too dismissive.

Re:Not that interested in the teething problems

[Unordained]

Do we have data showing that penalty clauses either (a) guarantee good rollouts or (b) make the process of getting to a good roll-out [eventually] cheaper? It works like insurance, so you wind up paying for it up-front in the contract anyway...

Also, do we have details on what's going wrong or why? I keep seeing headlines frothing at the mouth, but am given short-shrift on details. Things like:

In a blog post, the Department of Health and Human Services said some users of HealthCare.gov "have had trouble creating accounts and logging in to the site, while others have received confusing error messages, or had to wait for slow page loads or forms that failed to respond in a timely fashion."

O...kay?

In other news, Facebook took an outage. They have plenty of incentives to keep their stuff up. Where's the outrage?

Re:Not that interested in the teething problems

[phantomfive]

Personally, I'm not that bothered by teething problems. Plenty of sites have experienced them. Yes, there are many ways they could have been avoided, but they weren't, and they will undoubtedl be fixed.

The bigger question is whether the entire ACA will be run the same way.

Re:Not that interested in the teething problems

[Dahan]

Yes, please, lets mention them. Or wait, we can't because they haven't been stopped. Anyone who had difficulty one day, has been able to get through later that day or the next day at worst. Remind me again what your dictionary has listed for "disaster"?

"Anyone"? It only takes a single counterexample to disprove that, and here I am. I signed up for an account on Oct 1--took me a couple of tries, but I was eventually able to do it. Got my confirmation email, confirmed it, and my account should be active. However, I have never been able to actually log in. When I try, I get a red error message under the username/password boxes saying, "The information you entered isn't valid. Review this information." If I use the "Forgot Password" link in an attempt to reset my password and enter my username, I get an email with a password reset link--so my username is obviously in the DB and associated with the right email address. But when I click that link, I get a page that tells me that "We weren't able to process your request because we couldn't find a Marketplace profile that matched the information that you provided." Wut.

And although it only takes a single counterexample to disprove a universal, I'm certainly not the only person having the exact same problem. Do a web search for those error messages and you'll find many others saying the same thing.

Re:Not that interested in the teething problems

[Anonymous Coward]

Personally, I'm not that bothered by teething problems. Plenty of sites have experienced them.

There is more at work here than "teething problems" There are two parts to this mess: the front end which is basically a shopping cart, and the back end which is an interface to state and federal systems, plus a rule engine.

The shopping cart part is not rocket surgery. Amazon, Netflix, insurance companies with a website, pretty much world + dog have done this.

The back end part is the nightmare. It needs to interface to data systems for 50 states and a bunch of federal ones including the IRS. That alone would be bad enough. But it also, and here is the kicker, is a rule engine that turns a 10,000 page law into into working code that produces internally consistent outcomes. Good luck with that part!

Re:Not that interested in the teething problems

[LynnwoodRooster]

Even more, more interesting, is what are the penalties applied to individuals who cannot sign up for Obamacare in time because of a broken website. If it's still broken by March 15th (the deadline for individuals to sign up), will the IRS still enforce its penalties, given that the tool the Federal Government provided didn't work?

Re:Not that interested in the teething problems

[Unordained]

I'd prefer to be concerned for the people who have been waiting to finally get insurance at a reasonable rate, and don't get it as soon as it's available. The penalty the first year is extremely low anyway.

But you should note that people can still sign up over the phone or in-person. The website isn't the only method. So ... it's not really a good excuse for not signing up.

Also note that the individual States were given the option to take federal money and do this better than the federal government, and many refused to do so. As a resident of such a state, I can blame it, on top of the federal government, for any such failure.

licensing

[AliasMarlowe]

Or bring it into compliance with the GPLv2 or BSD3 licenses.

Re:licensing

[DoofusOfDeath]

Serious question here: So are they subject to DMCA takedown notices?

Re:licensing

[SteveDorries]

I think they would be, but maybe not, I'm not sure if "Sovereign Immunity" applies in this case. Then again, who built the site, actual honest to God U.S. of A. government employees, or did DHHS hand a fist full of cash to some random company and tell them to make it work? If it's the first, who really cares none of that has a copyright restriction to begin with, if it was a contractor it's their fault they need to comply with the license and are the ones to go after.

Re:licensing

[lgw]

So apparently while the website's not working you can call the Healthcare.gov help line at 800-318-2596. That's easy to remember as 1-800-F1UCKYO.

That's so funny I thought it was urban legend, but as far as I can tell it checks out. If that's an elaborate prank, I stand in awe of the prankster!

Re:licensing

[LifesABeach]

Considering the number of out of work Engineers in America, which foriegn owned U.S. subsidiary got this "follow on" contract for a web page?

Re:licensing

[LifesABeach]

I confirm it. All I need now is for some BRIC nation's phone service to be answering the phone. Because lets face it, if non americans break U.S. law, they always feel terrible.

How about this...

[msauve]

Defund the NSA, and repurpose their data center for this. Two birds with one stone.

Re:How about this...

[Capt James McCarthy]

How about defund both and give me my money back. I don't want to pay to listen to phone calls and could care less about paying for someones birth control.

Re:How about this...

[SJHillman]

Throwing more hardware at a software problem... that sure sounds like a government solution

Re:How about this...

[HairyReptile]

Okay, so we should continue to deny women coverage for birth control while insurance companies will pay for Viagra.

Re:How about this...

[SJHillman]

Odd, my insurance company covers birth control but not Viagra.

And don't forget that Viagra has uses beyond just sustaining erections... unless it helps your argument, then by all means forget it.

Re:How about this...

[Salgak1]

Hate to rain on your parade, but pregnancy is not an illness or a dysfunction. That being said, insurance is willing to pay for birth control if that's what's in the contract. Some employers CHOOSE not to include that in their insurance contracts, often for religious reasons. . .

Re:How about this...

[msauve]

Your statement is obviously true. If they fixed the software, the whole thing could run on a spare 386 PC.

Re:How about this...

[SJHillman]

The problem isn't a lack of hardware, it's largely issues with the software. So adding more hardware to fix a software problem is like putting a bigger engine in your car because you have a flat tire. It might let you power through it, but it doesn't fix the problem. Likewise, fixing the flat tire doesn't magically let your car run off an electric toothbrush... but it does let the car run off the engine it already has.

Re:How about this...

[Anonymous Coward]

Birth control also has alternate purposes.

Re:How about this...

[LynnwoodRooster]

My wife's birth control is covered; I've never asked about Viagra or Cialis for me, but I assume if it was prescribed by our primary care physician I would get it covered. Just like my wife's birth control.

Re:How about this...

[microbox]

could care less about paying for someones birth control.

It's arguably cost neutral.

Mythical Man-Month

[Anonymous Coward]

"Our team is bringing in some of the best and brightest from both inside and outside government"

Re:Mythical Man-Month

[Bite The Pillow]

If the incompetents stop working, or are consult only, the skill level will rise and no more people will be added.
It is likely that a delivery date with follow on support has the headcount winding down anyway, so people are moving on to other projects to destroy already.

Re:Mythical Man-Month

[hrvatska]

It's not so much that they are throwing more bodies, but that for such a high profile web site they are just now bringing in the best and the brightest. Why weren't these people working on this project from the beginning? I don't know that it would have mattered though, as the main problem seems to have been that too much of the requirements were not well defined until too late in t he development cycle. Software projects get delayed all the time, but this one seems to have been pushed out before it was thoroughly tested. My guess is that plenty of people knew this thing was half baked, but that the release date couldn't slip for political reasons.

Re:Mythical Man-Month

[bobbied]

Mod this up.. Mythical Man-Month logic says this too shall fail and will do so by spending HUGE sums of money to get the software later.

Re:Mythical Man-Month

[CrimsonAvenger]

but that the release date couldn't slip for political reasons.

And legal reasons. Remember that everyone (who is not eligible for Medicaid) who doesn't have health insurance that is acceptable under the ACA by Jan 1, 2014 is liable for a tax penalty in the 2014 tax year.

Brooks

[DoofusOfDeath]

Part of me wants to send Obama a copy of, "The Mythical Man-Month". Another part of me wants to just sit back and watch.

Re:Brooks

[Anonymous Coward]

I am sure the president himself is personally project managing this.

Re:Brooks

[DoofusOfDeath]

I really didn't feel like trying to work through the HHS org chart and telephone directory to find the name of the project manager and contracting officer in charge of the project. So I wrote, "Obama" as a symbol of the Executive branch, instead. But please, feel free to post someone more specific if you like.

Re:Brooks

[Mr D from 63]

The web coding is a lot like the Obama-care act; nobody knows whats in it.

Re:Brooks

[rubycodez]

then it is truly screwed, he is out of his depth on this. Those dreamy eyed fools who made the ACA did not realize the implications of it needing an massive IT infrastructure that cannot be crapped out in 3 years and tested for all of ONE FREAKIN DAY when it was completed this month (!!!!). pop up the popcorn kids, this train wreck will be worthy of a Fugative sequel

Re:Brooks

[Anonymous Coward]

So what. We passed it, and we now mostly know what is in it. With the website, we released it, and we now know what is in it. It's the truth, and it worked both times. This is how both government and technical projects should work. Instead we're left with obstructionist Republicans that don't want to release anything to discover what is in them.

Re:Brooks

[bobbied]

Part of me wants to send Obama a copy of, "The Mythical Man-Month". Another part of me wants to just sit back and watch.

I'll do both. I'm sure there is nobody who in the administration that would actually take the time to read that. After all, It's full of OLD ideas that have been discussed before. They are only into "new" ideas...

Re:Brooks

[J Story]

I might be over-pessimistic, but I predict that the IT will fail disastrously.

I read somewhere that there are 3 million lines of code holding this together. If that's true, then it will take months for the new guys just to understand it. Then, bug-fixing is going to introduce more bugs. Ultimately, everything will be scrapped in order to start over. (Of course by then a private company would have gone out of business, but we are talking about the limitless resources of the federal government.)

Purportedly, one of the reason that legacy systems persist is that it is literally impossible to replace them. Some googling will show a number of expensive failed government IT projects. This one may be one of the most visible, however.

Re:Brooks

[plopez]

That is why I am so frustrated with software development and am attempting to leave the field all together.

That sounds like a good plan

[Minwee]

"But we need that baby NOW! Bring in even MORE women!"

I'm going to have to go with Agent Zed on this:

"Gentlemen, congratulations. You're everything we've come to expect from years of government training."

Bad Medicine

[drfred79]

How is taking over more of the economy an even better idea when the DHHS can't even take over half of medicine? Single-payer is dead in the water and immoral. There is no real way to kill the entirety of Obamacare but Congress should work to mitigate its impending harm.

Re:Bad Medicine

[odigity]

Wow. Someone is still trying to reach out with logic and real compassion? (as opposed to the fake compassion of socialism)

I fear you're heading for -1 land, considering the /. political demographics...

Re:Bad Medicine

[PseudoCoder]

When the state is your god, you consider it sovereign over all and turn over your will, freedom, respect, devotion and everything you can offer to have it protect you, feed you and care for you. The statist masterminds have yet to achieve this version of heaven they have dreamt up, and they have no interest in mitigating anything. It is the new "moral" imperative to hurt the many to help a few and nationalizing healthcare is key to doing so. See below:

http://youtu.be/r2Kevz_9lsw

And they don't think it's dead in the water, they're just going to take their time in doing it.

http://youtu.be/3sTfZJBYo1I

http://youtu.be/926bPZiQhgY

Re:Bad Medicine

[drfred79]

Single-payer is immoral simply from a realistic point of view. Medicare is bad but increasing the size of the cattle yard with richer people reduces the quality of care for poor people. Under single-payer systems the cost of healthcare is below market equilibrium so people use it more than they truly need. If you truly want poor people to receive medical services for cheap or free reduce the quantity that receive it to just those who need it.

Re:Bad Medicine

[Unordained]

Would you care to explain how single-payer (if we implemented it beyond the current scope of seniors and disabled and poor and children) would be immoral?

Re:Bad Medicine

[drfred79]

I thought I just did? Adding rich people to the queue dilutes the quality of care for seniors, disabled, poor, and children. Singe-Payer systems rely on giving care at below market rates, incentivizing use. Rationing care comes into play. Do you think rich people won't find a way to receive more of that rationed healthcare than they need? If you want to help the poor, help the poor. But roping in the other 80% of people to help the poor fails to meet any efficiency test.

Re:Bad Medicine

[Unordained]

(a) efficiency is not morality, you haven't answered the question
(b) how is this about adding rich people to a queue?
(c) all group coverage (single or not) attempts to drive down prices over time
(d) rationing, if it occurs, is a short-term problem, which the free market (training medical personnel) should fix
(e) healthcare isn't a luxury to be consumed willy-nilly; if we have to implement a system to prevent rich people from using up available healthcare man-hours on themselves, when we already have a long-standing mandate to help everyone ... I won't feel bad about it. Just because some rich dude could in theory foot the bill for draining a city of its entire water supply, doesn't mean we should allow it to happen. The free market works for the betterment of humans, not the other way around.

Re:Bad Medicine

[khallow]

(a) efficiency is not morality, you haven't answered the question

Another way to say this is that when you make a system inefficient, you're taking away from part of the system.

(d) rationing, if it occurs, is a short-term problem, which the free market (training medical personnel) should fix

Not if costs are kept down. The signal to increase supply of something is by rising price. This also rules out a free market as a result.

Re:Bad Medicine

[Unordained]

The impetus to increase supply comes when people notice that they could be making a profit by increasing supply. If costs are kept down but supply is not keeping up with demand, there's still a profit to be made in filling the gap and sucking up whatever demand there is, even at the set price. Rising prices are just one potential signal that such a gap exists. Everyone complaining about shortages despite the availability of funds would be another.

We should note that we have already experienced healthcare supply shortages over the years, even without the ACA. The free market never guarantees that anything will be smooth, fast, or automatic. Just because people live longer and need more care, doesn't automatically cause more college students to go into nursing in preparation. There's a causal (well, almost causal) chain, sure, but it's long and convoluted. Signals get lost along the way. Let's not paint too rosy a picture of life under a laissez-faire regime.

Re:Bad Medicine

[drfred79]

First I'd like to thank you for logical and level-headed arguments against my arguments. I will try and treat you with the same level of respect. I think your tactic of questioning is adding to the discourse instead of the normal taking away that happens here.

(a)If your active goal is to help the poor receive medical care, which is a moral goal, than knowingly reducing the effectiveness of your solution to supplant your goal with one of single-payer healthcare hurts your solution. Its immoral to knowingly hurt the poor's healthcare to offer universal coverage. Omnipresent bureaucracy inherent in a single-payer system allows those who dictate the rules to unilaterally subvert them. This favors the rich over the poor.

(b)Universality in a single payer system means you're only adding those who had previously afforded healthcare on their own to the previously poor-only government run healthcare. Sure there is a middle class. But they had previously had the earnings to pay for their healthcare.

(c) Single-Payer systems reduce costs two ways, through rationing or raising taxes. Raising taxes has the detrimental effect on the economy and employment. Rationing cares seems to always happen to the poor and never the rich, hence why its immoral. But since you've incentived the overuse of healthcare with below equilibrium expenses to patients you will always have cost overruns. Additionally, bureaucracies are horrible at placing blame so if there is mistakes, cost overruns, of inefficiencies there is no incentive to fix them.

(d) You are mixing two economic principles. Rationing is created through government interference in a market for political reasons. Rationing never happens in a market based economy because the marginal unit price can always be changed. If one unit of healthcare is available then people will bid for that last unit. Everyone who is willing to pay it will pay it. So in a free-market that is shifting equilibrium and will be temporary because the higher price paid will increase the amount of trained medical professionals. In a single-payer system there is no incentive to educate additional people because that increases costs and the cost might be more than the intangible cost of just rationing care. Regardless it refutes your point (c) because you can't increase supply to meet below market price demand. You will never reach equilibrium.

(e) I agree that the free market works for the betterment of humans. Single-Payer systems are the exact opposite because you are taking away the freedom of the individual and bestowing those freedoms and responsibilities on the government. Governments are inherently corrupt because you are centralizing power. If only one man in a village has a death ray then that man is the ruler.

Re:Bad Medicine

[khallow]

If costs are kept down but supply is not keeping up with demand, there's still a profit to be made in filling the gap and sucking up whatever demand there is, even at the set price.

No, the low price may mean that there isn't a profit to be made. Even when it does, the low profit margin means that it'll take longer to build up the capital needed to respond to changes in demand or improve services.

Re:Bad Medicine

[Unordained]

That's really more an argument against any form of wealth redistribution, ever. It would imply not only that progressive tax rates are immoral, but that it's immoral for anyone to ever receive a benefit they didn't pay for equally -- such as being a pauper citizen of a nation with a standing military to defend it. In fact, you would need to either get a job and pay taxes, or be thrown out. I suppose such a regime is plausible, and +1 on logical consistency, but maybe outside the scope of the current discussion on the potential drawbacks of the ACA vs. single-payer healthcare?

Re:Bad Medicine

[Unordained]

RE: (c) Single-payer is not single-provider, there's still a market at play. The economies of scale, the group purchasing power, are what allows the insurance provider to apply pressure the individuals couldn't, and to monitor for systemic irregularities in ways individuals couldn't. This is already true with individual (large) insurance companies. It's already true of Medicare. But they're not insane; they don't mandate that all providers cost the minimum that any provider could possibly charge. They know they're gliding over choppy waters, so they apply statistical rules, to find the likely price-point based on the variation seen, and apply a small tolerance on top of that. They communicate out-of-band (not just bills and checks) with providers, to make sure the quality of care isn't impacted. Medicare already gets input from the industry on what procedures should cost, yet still pays less than other insurance companies -- while there's the potential for abuse, it's not the norm.

RE: (e) My point is that where the free market can work, we should use it. It's a good system for solving certain types of problems. But there's nothing inherent in the algorithm that makes it applicable to any and all markets, for all time. We as humans have our own physical needs and desires, and it behooves us to examine each situation individually, to determine which approach will work best. We should not blindly strap ourselves to free market ideals, only to be at their mercy. The Invisible Hand has no compassion, it cares not whither we wish to go.

Is this form of insurance less efficient than a totally-free-market at providing care to those who can afford to pay for it? Yes! But the two approaches don't solve the same problem. The ACA (etc.) is trying to make sure everyone gets practical access to care. Once you introduce such a requirement into the specification, it changes everything, including how you measure success.

There are issues with centralizing power, yes. But inherent unavoidable intractable corruption to the point of uselessness and counter-productivity? I wouldn't go that far. Civilization has yet to throw Government to the curb as a tried-and-failed idea.

Re:Bad Medicine

[ScentCone]

Would you care to explain how single-payer (if we implemented it beyond the current scope of seniors and disabled and poor and children) would be immoral?

Because only a smaller number of slaves will actually be doing the work that actually pays for it.

Should a minority of the people spend some portion of the day working to provide housing, food, shoes, and everything else that's considered mandatory for a minimally pleasant life for other people, or face jail for not doing so? The people that say yes are indeed endorsing something immoral.

Re:Bad Medicine

[drfred79]

Confession: Dependent on criteria I don't think anyone should receive redistributive income based on relative wealth. I think there are cases necessary based on a minimal level of criteria of disability. There are companies such as Skilcraft that work with a significant amount of people with disabilities to improve their confidence and provide them with earned income. Social Security and Unemployment are forms of insurance and retirement funds that are paid into. Incentivizing work and allowing government provided Federal benefits is a minimal evil. Yes, we are on tangents and I will try and answer/respond to your other points later.

Re:Bad Medicine

[drfred79]

RE:RE:(e) I take a cross-philosophy point of view. Nature is free market. The invisible hand is cruel but balanced and nuanced in ways we cannot completely measure and understand. One of my favorite economists is Bastiat and I refer to him constantly on this website for government solution answers. Other than Bastiat's broken window hypothesis he also supposed that there are immeasurable reactions to any government imposed alterations to the free market. One time on this website I mentioned Newton's Law of Equal and Opposite Reaction but people got mad at that. But I digress, any short term or measurable benefit from government interventions or distortions of the free market can be just as beneficial from not ruining the perfect balance.

Re:Bad Medicine

[Unordained]

Nature by default is a dog-eat-dog world, yes. And I respect the self-consistent philosophy that claims we should leave it as is. I don't think we can measurably claim that it is "good" or "better" in any sense, though, because by asserting we should not intervene, not design, not move beyond, we remove from ourselves the agency to set goals and develop solutions to achieve those goals. If we're not trying to achieve anything, there's no way to measure success. Is the natural world succeeding? Unanswerable. Do I accept that we should trust that it works in magical unmeasurable unknowable ways? No, I think we should apply science to the social realm just as we do with everything else. I think we should strive to find a real solution, not throw up our hands and trust to the winds, simply because they already exist. But again, I respect the self-consistency of your worldview.

Re:Bad Medicine

[Unordained]

Factually:
(a) It is entirely possible for you to become a pauper in this nation, and not have to work to support anyone else. Society will instead try to lift you up. So if you don't like the idea of supporting others, you have an option, though an unpleasant one. We make it purposefully unpleasant so people will not want to stay in that state forever.
(b) You do not face jail time over this. By law, the penalty for not carrying personal health insurance is only a tax liability, except here the IRS is not allowed to levy property, and may not file criminal charges (which would be required for jail time.) [1]
(c) I'm asking how this is different from what we already do. The social contract by which we help support each other, by taxes or otherwise, has been in place for a century. I'm fine with arguments for a purely dog-eat-dog world (really, I'm okay with that), but that's not my question here.

[1] From the Congressional Research Service, copy-pasted from snopes.com:

The Internal Revenue Code (IRC) limits the means the IRS may employ to collect the penalty established in the [PPACA]. First, the taxpayer is protected from either criminal prosecution or penalty for failure to pay the penalty. Second, the IRS is prohibited from either filing a notice of federal tax lien (NFTL) or levying any property in an effort to collect the penalty. There is no prohibition, however, on establishing a statutory lien against the taxpayer’s property. No additional limits are placed on the IRS using correspondence or phone calls, either through its own employees or through private collection agencies, in an effort to collect the amount owed. Additionally, no restriction was placed on the IRS's ability to use the refund offset as a means of collecting the amount due.

Those who are required to pay the penalty for failure to maintain minimum coverage but choose not to do so will be subject to increases in the amount owed due to interest and late payment penalties imposed on the penalty after it has been assessed by the IRS.

A taxpayer who chooses not to pay the required penalty may ultimately forfeit more than the amount of the penalty if that taxpayer is ever in the position of having an overpayment to the IRS for any reason, since the refund offset applies not only to overpayments shown on original tax returns, but also to any subsequent adjustments, for example an audit by the IRS that results in an overpayment. Further, as explained above, it is possible that the IRS could present its claim when property is being sold and collect both the original penalty amount along with accrued interest and applicable penalties

Re:Bad Medicine

[ScentCone]

So they can't take your house or other property unless you happen to be selling it? Ah.

And of course they can garnish your wages, which could cost you your house and other property, too.

It is entirely possible for you to become a pauper in this nation, and not have to work to support anyone else.

But if you want to work for yourself to make yourself more than a pauper, you do end up working to support other people who don't, by law. So, the only way to avoid being a slave is to assign yourself to poverty?

Re:Bad Medicine

[Unordained]

I haven't seen anything indicating they have the ability to garnish wages to collect on the penalties. I'll wait for you to cite a source.
Yes, they could use the lien system to force you to pay up using the proceeds from the sale of property. They wouldn't outright take your house though.

My point was that the default position is not a kind of slavery. In fact, you should remember the reason for our current approach to debt -- debtor's prisons and poor houses went terribly. We've already tried them. Putting people into slavery because they're indebted or poor only further impoverishes us all. It made it all too easy for the default situation to be slavery, when all else fails. We thankfully have a bankruptcy system, because we recognize that grinding people to dust for past failures isn't always the best way forward -- but it does have a knock-on effect, yes, as losses are forwarded and spread through the system.

So you have three options:
a) put yourself in a position to receive aid from others
b) sit exactly at the break-even point (hard to do because of conflicting laws and differing definitions of poverty line and sliding scales and whatnot)
c) leave the country as we know it (leave, change the laws, or create your own country)

But again, the concept that we live in a very mildly socialist state is nothing new, certainly not related to the ACA. Even before the individual mandate, if you had sufficient income, you would pay taxes to the benefit of yourself and others. To avoid this, you still had to stay sufficiently low on the income scale. So ... nothing new. That's the social contract we have in place today. I'm sorry you feel so abused, I'm happy for you that you're self-sufficient. Should you, someday, no longer be self-sufficient and need a helping hand, we won't hold a grudge.

Platform

[bugs2squash]

Which platform did they use to implement this ?

Re:Platform

[Mr D from 63]

Which platform did they use to implement this ?

Democratic, I believe.

Re:Platform

[DoofusOfDeath]

Which platform did they use to implement this ?

Having worked for the government in the past, I can only assume it's a combination of Ada, and a proprietary language written by an intern at IBM in the 1980's, and Welsh.

Re:Platform

[omnichad]

A couple wooden stilts and some cardboard

Re:Platform

[angryfirelord]

Must be an oracle database.

Re:Platform

[bigwheel]

Powerpoint. Because software runs best on an overhead projector.

Re:Platform

[Anonymous Coward]

Gwir, Ada mae bron yn amhosibl i ddarllen.

Re:Platform

[bugs2squash]

According to Wikipedia: JBoss was developed by JBoss, now a division of Red Hat. Licensed under the terms of the GNU Lesser General Public License, JBoss is free and open source software

Re:It's a lost cause

[larry bagina]

It's not about helping the poor; it's about feeling good for helping the poor. Whether the poor are helped or not is irrelevant.

Self-Fulfilling Prophecy?

[Tablizer]

I've heard an interesting angle but have yet to confirm it.

Allegedly the DHHS originally assumed most states would run their own website for such because a lot of the service comparing info is state-centric anyhow.

However, many red states refused to go along out of their usual anti-federal-government stance. This put more burden on the DHHS to handle the red-state traffic and their state-specific logic, and Congress refused to fund the extra resources needed.

If this is the case, then the GOP is creating a self-fulfilling prophecy.

Re:Self-Fulfilling Prophecy?

[drfred79]

Another conspiracy theory I heard was that Democrats wanted Obamacare to fail so that in ten years they'd propose fixing it with single-payer. Since Obamacare can't fund itself and the website is a tort law travesty which sounds more likely?

Re:Self-Fulfilling Prophecy?

[jeffmeden]

I've heard an interesting angle but have yet to confirm it.

Allegedly the DHHS originally assumed most states would run their own website for such because a lot of the service comparing info is state-centric anyhow.

However, many red states refused to go along out of their usual anti-federal-government stance. This put more burden on the DHHS to handle the red-state traffic and their state-specific logic, and Congress refused to fund the extra resources needed.

If this is the case, then the GOP is creating a self-fulfilling prophecy.

Add to that the pool of Fox reporters constantly clicking "Refresh" on the main page hoping for an error screen to appear so they can screenshot it and make it into a half hour news segment, and yes the load was more than the system was designed for. Given that users have from Oct 1 to Dec 31 to successfully sign up before any consequences of any sort (in this case they are tiny) kick in, the service doesn't need the availability of a stock brokerage or bank in order to be successful. Yet, it's being echoed over and over that the exchange "is a failure" simply to score political points.

Re:Self-Fulfilling Prophecy?

[SJHillman]

It's a little true, but with a lot of spin. They were warned (by the GSA iirc) months in advance that their estimates for site traffic were way, way, way too low. It wasn't any last minute surprise that 36 states are using the Federal website instead of running their own.

Re:Self-Fulfilling Prophecy?

[Mr D from 63]

Allegedly the DHHS originally assumed most states would run their own website for such because a lot of the service comparing info is state-centric anyhow.

Leave it to the great defenders..... the GOP is responsible for the bad assumptions of the DHHS.

Re:Self-Fulfilling Prophecy?

[Tablizer]

If their first attempt failed, then a second try would have much less political backing than Ocare. It's not a very smart strategy even if the conspiracy were true. Most politicians don't plan 10 years down the road anyhow.

Re:Self-Fulfilling Prophecy?

[ErichTheRed]

I think the more likely situation, if there was a conspiracy at all, would be that they would wait for the private insurers to have a crack at this for a few years, then people would see that no one's rates will decrease and that the private companies are just pocketing the difference.

I'm all for single-payer, complete with death panels. NHS in the UK has huge costs too, but at least they know when to give up on treating someone. (See the Quality-Adjusted Life Year -- we need a metric like that in our healthcare system.) We'll see if I get my wish.

Re:Self-Fulfilling Prophecy?

[Tablizer]

If you word the bill funding for the worse case scenario, then some law-makers will complain about the "socialist padding".

Re:Self-Fulfilling Prophecy?

[Mr D from 63]

If you word bill funding for the actual & probable scenarios, then it may look too expensive to justify.
If you word bill funding for the inadequate, you get inadequate.

But funding is not the basis of my response, although it is a nice tactic shift away from the ridiculous contention that the GOP is to blame for the website fiasco.

Re:Self-Fulfilling Prophecy?

[Tablizer]

How can you predict what angle politicians will take 3 years into the future? They are an opportunistic bunch. Look how stupid the 9/11 panic made the US. Your argument is not making sense to me.

Re:Self-Fulfilling Prophecy?

[Mr D from 63]

How can you predict what angle politicians will take 3 years into the future? They are an opportunistic bunch. Look how stupid the 9/11 panic made the US. Your argument is not making sense to me.

Let me help. In 3 years, the GOP will still be against this law. That is not hard to predict.

My argument does not make sense to YOU because you forgot your original point, which was to blame the website failure on the GOP. You shifted to this being some kind of budget issue, which by the way there is no evidence that budget was a cause, and thereby you enabled yourself to claim confusion rather than backing up a ridiculous assertion.

Re:Self-Fulfilling Prophecy?

[BlueStrat]

I think the more likely situation, if there was a conspiracy at all, would be that they would wait for the private insurers to have a crack at this for a few years, then people would see that no one's rates will decrease and that the private companies are just pocketing the difference.

I'm all for single-payer, complete with death panels. NHS in the UK has huge costs too, but at least they know when to give up on treating someone. (See the Quality-Adjusted Life Year -- we need a metric like that in our healthcare system.) We'll see if I get my wish.

You sound like you'd be a huge admirer of George Bernard Shaw.

http://youtu.be/OBZsTf6oLfY

Strat

Re:Self-Fulfilling Prophecy?

[LynnwoodRooster]

I've heard an interesting angle but have yet to confirm it.

Allegedly the DHHS originally assumed most states would run their own website for such because a lot of the service comparing info is state-centric anyhow.

However, many red states refused to go along out of their usual anti-federal-government stance. This put more burden on the DHHS to handle the red-state traffic and their state-specific logic, and Congress refused to fund the extra resources needed.

If this is the case, then the GOP is creating a self-fulfilling prophecy.

Is that why blue States like Ohio, Florida and Pennsylvania - which voted for President Obama - did not implement their own exchange, but red States like Kentucky, Idaho, and Arkansas implemented an exchange?

It's not a red State/blue State thing, but a Federal Government/State thing.

Re:Self-Fulfilling Prophecy?

[LynnwoodRooster]

Given that users have from Oct 1 to Dec 31 to successfully sign up before any consequences of any sort (in this case they are tiny) kick in, the service doesn't need the availability of a stock brokerage or bank in order to be successful. Yet, it's being echoed over and over that the exchange "is a failure" simply to score political points.

What happens if the exchange is not stable nor ready by December 31st? Do those who have not been able to sign up still have to pay the penalty because the Federal Government couldn't get the website working?

You must use this site and register and sign up by the 31st or pay a penalty. Of course, if the site simply doesn't work you still get to pay the penalty...

Re:Self-Fulfilling Prophecy?

[Tablizer]

I'm not sure those two are necessarily unrelated. I just floated the claim; the devil's often in the details, and they haven't arrived yet.

Re:Self-Fulfilling Prophecy?

[Tablizer]

And if you have zero insurance, the laws of nature are your "death panel". I'm not going to try to figure out "Palin Logic" because my current plan doesn't cover migraines.

Re:Self-Fulfilling Prophecy?

[Mr D from 63]

99% of the time "I've heard an interesting angle but have yet to confirm it." (or similar) = "I'm completely making this up" or "I have no clue whatsoever but I like this idea so I am posting in anyway".

Come back when you have these magical "details" that are apparently coming your way but eluding the rest of the nation. Meanwhile, I'll just assume you are as clueless as your responses indicate.

Spot-checking healthcare.gov

[dkegel]

Just how broken is it? Let's find out.

I tried creating an account early Sunday morning and failed.
I tried again Sunday evening, and it worked... on Firefox, anyway. On Chrome, logging in took me to a blank screen.
( See https://plus.google.com/u/0/113779301404424240904/posts/2mxh2wPTein )

If you try creating an account on healthcare.gov, reply here with what happened. Let's see how broken it is.

Re:Spot-checking healthcare.gov

[Anonymous Coward]

Tried Sunday AM. From a tablet, no less. Succeeded, with about 5 minutes of effort.

Re:Spot-checking healthcare.gov

[stillpixel]

Worked in OSX via Chrome, very quick actually.. Monday @ 12 noon Eastern time.

Re:Spot-checking healthcare.gov

[tacokill]

Where do you think your information is going?
Let's check back in about 18 months.....

Re:Spot-checking healthcare.gov

[khallow]

Apparently, the performance varies between states since some of the states have their own systems which work rather than the federal default one. I recall hearing that California and New York both had working systems.

Re:Spot-checking healthcare.gov

[ScentCone]

Creating an account and actually proceeding to use it to explore rates and whatnot are different things. How far did you go with it?

Re:Spot-checking healthcare.gov

[dkegel]

I only logged in, since I live in a state that doesn't use the Federal system, so I didn't want to fake my address (beyond saying I lived in a different state, which was good enough to get past the account creation process).

Re:par for the course

[drfred79]

In the private sector that which does not live on its own is terminated. Obamacare is on life support and there aren't enough young gullible people to support it.

Phoenix project?

[whitelabrat]

Not enough stupid? Lets do surge of stupid!

Monitoring?

[connor4312]

We're also putting in place tools and processes to aggressively monitor and identify parts of HealthCare.gov where individuals are encountering errors or having difficulty using the site

So... they didn't already have such a system in place? My faith has been completely restored in the competency of their developers...

That will be effective

[phantomfive]

This statement may be an oversimplification, but "adding manpower to a late software project makes it later". The application in this case would be, why didn't they have enough workers on the project to begin with?

Re:That will be effective

[John Jorsett]

This statement may be an oversimplification, but "adding manpower to a late software project makes it later". The application in this case would be, why didn't they have enough workers on the project to begin with?

A more interesting question is why many of the major beltway tech companies one would expect to find attached to a huge government tech project aren't present. My suspicion is that when they saw the specs (or maybe the lack or vagueness of them) and the due date, they declined to participate.

Re:That will be effective

[DoofusOfDeath]

This statement may be an oversimplification, but "adding manpower to a late software project makes it later". The application in this case would be, why didn't they have enough workers on the project to begin with?

A more interesting question is why many of the major beltway tech companies one would expect to find attached to a huge government tech project aren't present. My suspicion is that when they saw the specs (or maybe the lack or vagueness of them) and the due date, they declined to participate.

A more interesting question is, how does light manage to act like both a wave and a particle!

Re:That will be effective

[phantomfive]

That's an interesting thought........

Government Thinking

[sycodon]

Thirty Million out of 300+ million supposedly don't have health insurance.

So, lets write a plan that affects all 300+ million instead of one that addresses the 30 million.

Brilliant!

Re:Government Thinking

[AlphaWolf_HK]

Yes, because a law that dramatically alters the way your insurance company will do business is just not going to change things for you.

Seriously how naive can you get? I've yet to meet a single person who works in the health care industry who told me that this plan isn't a train wreck in the making, one of them even intends on getting out of the business entirely.

Re:Government Thinking

[GodfatherofSoul]

That's not insightful. The problem is lots of us who have insurance have been getting a raw deal. Including getting dropped when you get sick, having coverage capped, losing a job for being sick and being unable to afford a new plan after you get well (preconditions). The ACA isn't about just those 30 million, or they would've just expanded Medicaid.

Re:Government Thinking

[sycodon]

Tweaks...not a wholesale rewrite of the entire medical/insurance system.

How about we address the costs instead of redistributing them?

Re:Government Thinking

[AlphaWolf_HK]

I like how if you complain about government overreach, it's now fashionable for somebody to suggest somalia, as if there's nothing in between this mess and that mess.

Really you have to be a total moron to not be able to understand the difference between anarchists and libertarians. Libertarians want a government, the difference is they want a government that protects you from others rather than you from yourself. Liberals want the later, such as banning trans fats and soft drinks.

And this change for the sake of change is stupid. Personally, when I look at the prices for services that people pay for out of pocket, I notice how cheap yet good they are. Two months ago I paid $40 to get a full dental exam, x-rays, cleaning, and scaling. Meanwhile that same place bills insurance companies $250 for the same service. Why is that? Because when people shop around, they save. Insurance gets rid of the shopping around part because you don't even need to concern yourself with the cost.

Look in other areas traditionally not insured as well - some places offer Lasik for less than it costs to get a new pair of eyeglasses in some cases. I'm not eligible for Lasik (due to keratoconus) but an eye exam usually runs me about $30, whereas insurance companies typically pay about $50.

This is why health care costs are so expensive in the US - and the solution, according to people like you, is more insurance?

Re:Government Thinking

[deadboy2000]

Nice to meet you. I work in the health care industry, there are groups at my company that have been focused on the ramifications of the ACA since it was passed, and our general consensus is that it's entirely manageable. The only fear, uncertainty, or doubt that I see is coming from the tragically misinformed, and those with an underhaded agenda!

Re:Government Thinking

[LynnwoodRooster]

Equal protection? Is that why I can buy insurance across state lines, must report my ethnic background on Federal forms, or carry a firearm throughout These United States? There is plenty of State AND Federally-imposed unequal protection.

Re:Government Thinking

[Unordained]

Hey look, more "damned if you do, damned if you don't" logic -- AlphaWolf argues he (?) doesn't know any insiders who think it's good law (argument from authority, terrible, but whatever), so I provide such an example (not that it matters one whit), and now being in-the-know is a bad thing. I love you guys, really I do.

Re:Government Thinking

[Unordained]

And your evidence or argument is ... ?

That aside, the analogy's terrible. Obama won the majority in the popular election, the ACA (originally a Republican plan from the 90's) passed both the House and Senate, the United States Supreme Court mostly upheld it ... that's not "the captain" embarking on a reckless plan by himself.

Re:Government Thinking

[GodfatherofSoul]

Insurance IS redistribution!

I would never call this bill mere tweaks. I can't believe *anyone* would call this bill mere tweaks. Now, as for costs, there are some things that the ACA does. For one, it caps profiteering by the healthcare insurance industry by forcing at least 80% of expenditures to be used on actual healthcare. Second, it makes healthcare checkup plans far cheaper so that people don't ignore small health problems, then run to the ER when their pancreas explodes. I'd google for some of the other cost control measures.

Personally, I wanted a whole-hog UK healthcare system completely run and funded by the government and making doctors and nurses federal employees. What we've got is the best compromise that we could get through Congress. People are criticizing features of the ACA like they slept through the 2 years of rancorous public debate. It's a miracle that we got as much passed as we did.

In the future, when the idiots in this country crying about socialized healthcare understand what it actually means, I foresee a government-run public option being dropped into Obamacare. I also see other future changes like larger penalties for the John Waynes who declare they don't want insurance, but run to the ER when their pancreas explodes.

Re:Government Thinking

[Unordained]

And during the Iraq War, it was fashionable to suggest that us liberals go to France. It's all fun and games.

As you well know, what providers charge insurance, and what insurance pays, are very different things. I myself have seen plenty of providers who charge the uninsured exactly the same amount they charge for the insured -- except the insurance company never pays that amount. The uninsured get screwed in those situations.

The last stats I saw indicated that vision and dental insurance were a wash -- you didn't really save or lose money by using insurance. That's probably due to the fact that regular "checkup" visits of this type are non-emergency, or even optional. You could go another year without a cleaning. Your current glasses might be good enough for a while. You have the time to shop around, the services are fairly straightforward, there are lots of providers in a given area, and if you don't like any of their prices, you won't die from neglecting your own health for a while longer.

That, however, is not the case for all "medical" services. In fact, you'll note that the ACA specifically does not mandate dental and vision coverage for adults. It's not the problem-area they were going after, because the market for those services works differently from, say, cancer treatment.

Your examples are great. They just don't cover the same gamut as the ACA. Different markets, different behaviors.

Re:Government Thinking

[sycodon]

NOooo.

The health industry is heavily regulated; just about every aspect. The cost of regulation is built in from the Doctor's office to the operating room to the MRI machine. Obamacare doubles down on this. Government is a huge driver of costs and to suggest that it is not responsible for reducing them is just plain stupid.

Re:Government Thinking

[Unordained]

The jab was very specific: legislators can't just write a law "only for 30 million uninsured". The law is the law, for everyone. How it affects people, obviously, varies. We can't write laws without "if/then/else" clauses.
Here, the ACA did not drastically change the landscape for the 85% of people who already had insurance; it did make changes, but it's not the same as saying the government tried to solve a problem 10x larger than it needed to.

Ethnic background? As far as I can tell, when that's requested, it's always voluntary, and gathered for statistical purposes to detect bias in employment or other decision-making by different agencies of locations... Unless there are examples of abuse, that seems like a generally good idea.
It's a little different, of course, if you're a member of a Native American tribe, where some entitlements are provided as a result of your membership.

Re:Government Thinking

[Oligonicella]

"I've worked for years in healthcare IT (insurance AND healthcare provision, government AND private)"

I've worked with government IT for decades and this has everyearmark of the same thing that the IRS has been going through since the 70's. It's a train wreck now and will continue to be so.

Our educated opinions cancel each other.

Re:Government Thinking

[sycodon]

Didn't really pass the House. It was "Deemed" to have passed, whatever the fuck that means.

Also, it is a tax bill (Robert's said so) and it originated in the Senate so it is defacto unconstitutional. We'll see how that plays out. Don't be surprised to see the Democrats want it both ways.

Re:Government Thinking

[LynnwoodRooster]

The jab was very specific: legislators can't just write a law "only for 30 million uninsured". The law is the law, for everyone.

They do it all the time - with exemptions for fiscal or racial standing. You don't get a subsidy/tax cut because you make too much. You do not get preferential treatment for Government bids because you're the wrong gender or race. Legislators thrive by writing targeted laws and working to buy-off/pander-to small segments of the population, and build their own coalition of power.

Re:Government Thinking

[squiggleslash]

If you understood the concept of "Insurance", you'd understand it is all about the majority having a small inconvienience in exchange for protection from something that'll happen to a small, unknown, minority..

Leaving that aside however, the big changes that effect the 270 Million are there to benefit the 270 Million - that is, the reform of how your insurance company deals with you. It'll be harder for you to lose insurance once something happens to you that was the specific reason you got insurance in the first place. You're not going to find the money suddenly runs out because you've expended some lifetime benefits limit.

I agree it sucks, and we should replace it with a single payer system like Medicare for all, but it's simply ridiculous to argue that the changes that affect 300 million people are there solely for the sake of 30 million who aren't insured today. They're not. That's almost completely seperate.

Re:Government Thinking

[sycodon]

I'm sure Obamacare will work out fine...except for these people and many others like them.

If you like you plan, you can keep it...NOT.

Re:Government Thinking

[sycodon]

Here are some misinformed people. Guess they were misinformed that they could keep their plan if they wanted.

Re:Government Thinking

[sycodon]

Wrong.

Do you think Food Stamps are for everybody or just those eligible due to income?

Same thing with potential legislation for health insurance. If you can't afford it, then this (theoretical) legislation is applicable.

Re:Government Thinking

[Unordained]

Yes, that was a simplistic promise that could not be kept.

A baseline definition of health insurance had to be created, for a mandate to have such insurance to have any weight at all. To say "you must have something that someone somewhere titled "ur totally ahsome helth ensurince" or else pay a fine" would be asking for people to sign up for bogus $1/year "insurance", yet still be a burden on their fellow man when they actually fell ill and needed more than the cursory care covered by their "insurance".

So if a line in the sand had to be drawn for the law to work at all, then of course some people would fall on that side of the line. It was inevitable, and they shouldn't have stated the situation so simplistically. I can't apologize on their behalf, but I can agree it was misleading.

In better news, many of the people being forced to shop for insurance are, in turn, finding they can get cheaper and better insurance through the exchanges. If you feel an emotional attachment to your healthplan, though, I can't help you there.

Re:Government Thinking

[Unordained]

You really didn't get my point about "if/then/else" clauses, did you. Nor what I mean by a "jab". I'm sorry I've so thoroughly failed to communicate.

But to take your point seriously: could they have legislated ONLY that people without insurance, must get some? And not touched anything else, such as the definition of minimum insurance coverage, which cascades to people being unable to keep their current plan? No, I don't think they could have, because of how it would have been gamed. Any change to a system is going to have knock-on effects throughout the system, and they had to tackle this holistically. Not to do so would be reprehensibly reckless. So yes, they had to write the law for 300 million, not 30 million.

Similarly, food stamps are for everybody, in the sense that anyone /can/ become eligible for them. (Well, barring exceptions. I recall something about Florida and drug-testing?) The laws are the same for everyone. How they get applied depends on the circumstances. The laws governing food stamps apply to more than just the people receiving them; there are also laws regarding those who are not eligible (and what happens if they get their hands on some), on retailers (accepting, reporting). So ... yes. The law is for everybody, even those not actively receiving benefits.

Re:Government Thinking

[sycodon]

Pig in a Poke
Lied
mislead

Of course, if people knew the truth, they would have opposed it even more fiercely.

So Obama is a fraud, Obamacare is a fraud, and you are perfectly fine with that. What does that make you if not a shill for Big and oppressive government?

Re:Government Thinking

[sycodon]

Your statement was that you could not create a law that addressed the fact that 30 million are without insurance and not impact the other 270 million. Clearly you fail because laws that affect only the target population are passed all the time.

The Food Stamp laws do not require that I do anything unless I need them. So clearly that law does not affect me. I am not forced to purchase anything. I don't have to prove to the IRS that I purchased anything. I will not pay a penalty for not purchasing anything.

The same kind of legislation could be created for Health Insurance. But, evidently, you think like Big Government.

Re:Government Thinking

[Unordained]

It makes me just another citizen, but you can label me as you wish.

A shill would have close ties, possibly financial motives, that are not disclosed. I can only promise that I have none such; I have employer-provided healthcare at the moment, with which I'm quite satisfied, and this law changes nothing for me at the moment. Do I, like everyone else in this country, have something to gain or lose from it? Sure, but that doesn't make me a shill. I'm sorry if you don't see the difference.

The law was no secret. Hundreds of legislators had a chance to hack on it. It was published for all to see. What matters in the end is the law itself, not what any politicians (even Obama) have said about it -- they all have their own, usually self-serving, take on it. What about Palin and her dreaded Death Panels? That was a misrepresentation too (which some 30% of us apparently still believe). Find me a politician who never lies, never represents, never withholds, never steers or manipulates, never ... yeah. We can't make ever law depend on every politician being a model citizen, we'll never get anywhere at that rate.

Re:Government Thinking

[Unordained]

I can't say I like "Big Government", but whatever. I do like good practical solutions to real problems.

You seem to think we could have solved the uninsured problem without affecting anyone else -- would you care to expand on that? Maybe we could all poke holes in your proposal, until you understand the complexity of the problem, the inter-relatedness of the issues, the side-effects you would cause. Maybe, given enough time, and enough revisions, we would arrive at a workable plan. But you probably wouldn't like it. Real-world problems often require complex solutions.

I do find it unfortunate that we don't require every law passed to come with the equivalent of source-code comments, explaining the necessity of each provision in the law, or how pieces work together. As simple as it looks to armchair legislators, it's not. Even the legislators paid to do the job, often don't realize how their changes will affect a system. They don't have a good test environment, and the simulators can only do so much. (The CBO, for one, tries to setup such simulations.) But they still have to try their best, I'm sorry you don't like the result.

Re:Government Thinking

[Bloomy]

The bill did originate in the House, but as a bill concerning tax breaks for members of the military. After it passed the House, Senate Democrats added the healthcare provisions to it, and were able to pass it during the few months when they had a filibuster-proof majority. After they lost their supermajority in the Senate, Congressional Democrats decided the clearest path to law would be to drop the House's original legislation and try to pass the bill the Senate amended. To get enough House Democrats on board to pass it, it was agreed to pass a follow up bill removing some provisions and Obama reinforced the Hyde Amendment preventing federal funds from being used for abortions. The amended bill barely passed the House and was signed into law. The follow up bill originated in and passed the House, and since it was written to only cover budgetary items, it couldn't be filibustered in the Senate and passed there as well, though with an amendment that was re-passed by the House.

Re:Government Thinking

[microbox]

How about we address the costs instead of redistributing them?

Yeah, let's create a marketplace where insurance companies compete on level terms, and also introduce regulations to make sure that people aren't discriminated against for things outside of their control. Then you'd have: the ACA!!!

Re:Government Thinking

[riondluz]

You failed to mention what the anarchists want.

Empirically, what we have is something nobody wants, that's slow and stalled out of the gate, which is part of a bigger system that is also dysfunctional; but which all the leadership in humpty-dumpty-ville cannot fix.

I think possibly that anarchy is the belief that we don't need leaders, we can lead ourselves.

What is likable about single-payer (all medicared?) is that one's healthcare is no longer coupled to one's employer. That, beyond all else, is its saving grace. Something even a (currently) healthy youngun can grep.

What we have now is a gig that can only be managed with cost-shifting.

Re:Government Thinking

[kwbauer]

No real change? False.

Re:Government Thinking

[kwbauer]

So you say that there is nothing wrong. One of my personal health-care providers has been trying to figure out how this will affect his practice and he can't. So I say there is something wrong.

When an insurance company makes public that it noticed the government web-site had signed the same person up for three different plans then something is wrong.

Re:Government Thinking

[kwbauer]

Then why do i have to pay for my insurance while those 30 million won't. Why do millions get a nice little government issued debit card that is magically refilled every month that allows them to purchase food at the grocery store and convenience store but I don't? I don't think that equal protection means what you think it means.

Re:Government Thinking

[rjstanford]

I'm sure Obamacare will work out fine...except for these people and many others like them.

If you like you plan, you can keep it...NOT.

And when the FDA came out I'm sure that there were people complaining that they couldn't buy the cheap sausage that was 30% sawdust anymore either. The policies that were cancelled - according to that article - were ones sold to people with pre-existing conditions; as someone who's been in that boat before, those policies are inexpensive because they have a clause in them that doesn't cover you for the sickness that you already know that you have.

Anyone with an insurance policy that meets the (really quite reasonable) minimum standards of care guidelines should be able to keep it - and, for the most part, has been able to as well.

Re:Government Thinking

[Unordained]

No, it means exactly what I think it means. That the law applies to everyone in theory, and some in practice. If you were to become destitute, it would apply to you. A safety net is useless if it ensnares everyone all the time.

Why do some people receive assistance? Because a long time ago, we decided it was (a) cheaper (b) logical and (b) more humane to make sure that when people get too low on the totem pole to even have money to invest in themselves to start to dig themselves out of the hole, we should lend a hand. That humans, while they are also animals, do not have to behave like animals. Natural rights don't protect your belongings, only violence does. If you get a large population of poor people with no hope, you can either cheaply try to keep them happy and give them hope or you can hire a whole lot of mercenaries. When you have lots of poor people out of work, you can let them go without healthcare and becoming breeding grounds for diseases, you can let them starve; or you can keep them alive, nurse them back to health, help them get an education, and they will pay you back tenfold when they get a job again and can contribute to the economy and move everyone forward. And when we have poor out-of-work people, we can ignore them at our own peril, only to find ourselves outcasts in the next economic downturn, when a bubble bursts or our wife divorces us or jobs move to another country or we have a terrible crop failure, and we can reap what we sow.

But to correct you: not all 30 million are getting free health insurance. The subsidies are on a sliding-scale, so that as people work their way out of poverty, we support them less.

Tech Surge?

[omnichad]

Maybe they can swing by all the other failed government IT projects while they're at it. Maybe they can take a shot at Virtual Case File for the FBI. Throwing money at a problem - especially a government IT problem is not going to work.

Tracking

[Anonymous Coward]

I don't understand the comment about putting in tracking information to see where people are having problems. Healthcare.gov already has at least 4 systems in place to track people's use of the website:

Google Analytics (cookies: _ga, __utam, __utmb, __utmc, __utmz, __utmv)
Chartbeat (cookies: _chartbeat2, _chartbeat_uuniq)
Pingdom (cookie: PRUM_Episodes)
Optimizely (cookies: optimizelyEndUserId, optimizelyBuckets, optimizelyCustomEvents, optimizelySegments)

If they can't figure out where the problems are with all of those running, what else do they need?

Re:Tracking

[NikeHerc]

Healthcare.gov already has at least 4 systems in place to track people's use of the website

You forgot one: the NSA.

Tech surge? Sounds bad.

[wjcofkc]

This does not sound promising. When they say they are bringing in the best of the best to fix this ASAP, best of the best better actually mean something in this case. Otherwise throwing more of what caused this mess in the first place at it will only cause more trouble.

I also have to think: due to the substantial importance, essential timeliness, and over all sensitivity of this gigantic project. Why didn't they simply bring in "the best and brightest from both inside and outside government" to begin with, possibly averting disaster in the first place?

Not that the current situation surprises me in the least. Every tech-minded individual saw this coming.

Re:Tech surge? Sounds bad.

[Fallen Kell]

Because that costs money and creates jobs. Both of which according to the GOP the government doesn't have and/or can't do.

Re:It's a lost cause

[Mr D from 63]

Not to worry, we can all just stop giving to charities that used to help folks with health problems. And we can feel even better that we are paying for some folks who don't even want health care.

Re:Should not be a federal program

[SJHillman]

I nominate for worst analogy of the day.
Zero of the fifty states are sovereign, nor has any state ever been (any state that was once a sovereign nation gave up that sovereignty upon acquiring statehood). There is a separation in powers between states and feds, but it is absolutely nothing like the UN and member nations. The UN cannot make and enforce laws in member nations, the Fed can make and enforce laws in states. You could argue that healthcare is the responsibility of states, not the Fed, but that's a completely different argument than the one you're apparently trying to make. It's more like a county government forcing each town within it to enforce new dog license laws.

Re:par for the course

[geminidomino]

In the private sector that which does not live on its own is terminated

Unless the "private sector" in question is the financial sector.

Re:Should not be a federal program

[headhot]

Your right, and that was in the Bill. There are states like Kentucky and Washington that have their own sites running. The Feds were only going to run the exchanges for the states that didn't want to do it themselves

Re:Ineptitude? what did you expect?

[headhot]

Nice trolling.
1. The site was put together by Bi-partisan beltway bandits. No cronies needed to be brought in.
2. Healthcare will still be run by private insures, so the hand sitting beureacrats will be those of the private sector, that have been hand sitting for every one else who already has insurance.
3. Your a moron.

Not unlike a big-bang private sector project...

[ErichTheRed]

I'm sure there's tons of people salivating at the chance to jump all over this topic and say things like "classic government inefficiency at work." But the reality is that these kinds of projects happen every day in private sector companies. You only hear about them when they make the news. I've seen many companies throw out millions in sunk costs because they couldn't get an ERP system massaged enough to fit their business processes. Often, the companies realize too late that they're getting bled dry by outsourcing "partners" and getting nothing in return, then make the hard decision to just dump everything and try again.

Some of it may be leadership incompetence (analogous to CIOs getting swindled by consulting salesmen over copious rounds of golf and strippers) but HHS doesn't have hundreds of web developers on staff, and there would be a monster backlash if they actually did go out and hire them as permanent employees. IN the real world, they're forced to outsource to be "good stewards of the taxpayer's dollar" and end up getting crap. I can't believe that no one over the last 30 years has come to the realization that outsourcing always costs more, and results are not guaranteed no matter how much money gets flushed. What probably happened is that the project got awarded to the lowest bidder of the big consultancy firms, who promptly replaced all the super-geniuses they promised with new grads, and just kept collecting money.

A lot of private firms get fed up and just insource the whole thing, but I don't think the government has that option right now. Given the political climate, I'm sure every paper clip purchased is tracked by certain right-wing groups, and hiring hundreds of Federal employees certainly won't go over well. So, we'll just see the same consultancies who screwed up get rewarded to "fix" the problem. Just like in the private sector...

Re:Not unlike a big-bang private sector project...

[DoofusOfDeath]

As a former government software developer, I can honestly say that it's just not a worthwhile place to work, hiring caps or not.

Well, let me correct that. If you're willing to have that be the last place you work in your career, and you're willing to find job satisfaction outside of work, and you can handle both the intense frustration of being prevented from doing your job properly, with being badmouthed by politicians for not doing your job properly, then it can actually be an okay place to work.

Re:Not unlike a big-bang private sector project...

[Mr D from 63]

I'm sure there's tons of people salivating at the chance to jump all over this topic and say things like "classic government inefficiency at work." But the reality is that these kinds of projects happen every day in private sector companies.

Large companies with anything close to the resources of the US government and with a product that has so much at stake rarely, if ever, roll out anything as broken as this. They may undertake projects that result in a poor product, but they don't roll those products out to the world. They fix them first. Minor glitches are a different story.

I agree with the them of your other points, though. The right wing is going to keep overtly pushing the negatives whilst the president and left wing will overtly stretch the positive. Reality will be in between.

Re:Not unlike a big-bang private sector project...

[cs668]

The problem isn't that it was the lowest bidder. The problem was that it was probably the company that gave the most $$ in backroom deals to secure the contract with no sanity check on whether or not they could actually deliver!!

Here is the scenario. You go talk to a lobbyist about getting access to XYZ congress critter because you want to pitch your company for a federal contract. Next thing you know you are told that if you donate X hundred thousand here and Y hundred thousand there and show up to these 3 parties the contract is yours. You don't know the Washington ropes so you bow out and some company that does know the ropes gets the contract, but they don't have the tech chops to pull it off because they are better at backroom dealing than getting the job done.

Re:Not unlike a big-bang private sector project...

[hawkfish]

I'm sure there's tons of people salivating at the chance to jump all over this topic and say things like "classic government inefficiency at work." But the reality is that these kinds of projects happen every day in private sector companies. You only hear about them when they make the news. I've seen many companies throw out millions in sunk costs because they couldn't get an ERP system massaged enough to fit their business processes. Often, the companies realize too late that they're getting bled dry by outsourcing "partners" and getting nothing in return, then make the hard decision to just dump everything and try again.

For a somewhat terrifying read on how private sector incompetence took out a brokerage firm, have a look at this.

really?

[Chirs]

Single-payer seems to work just fine for other countries...

Re:really?

[drfred79]

Yeah, Because their GDP is #1? Part of the reason our economy is double that of other countries is because of the 50 years we did not have a single-payer system while other countries did. During that time we invented CAT Scans, artifical hearts, DNA sequencing. Single-Payer systems have so much cost overruns they have to ration healthcare while we invest more in medical research. Our medical research would stagnate if the government would nationalize medicine. Our military? That'd have to go too to shoulder the new cost of a single payer system. Why do you think all our allies count on us for military defense and research?

Re:really?

[Salgak1]

It does ? Why do Canadians often come to the States for treatment ? Why does the Elderly death rate in Britain start climbing, late in the summer, and start going down again after the new Fiscal Year starts ??

For that matter, why are so many doctors from Single-payer countries practicing in the States, instead ???

Re:really?

[jnials]

Like the Pay to Slay of the Liverpool pathway? http://www.telegraph.co.uk/health/healthnews/9644287/NHS-millions-for-controversial-care-pathway.html. Or perhaps this: http://www.telegraph.co.uk/health/nhs/10387187/NHS-faces-bankruptcy-over-ageing-population.html

Re:really?

[Idarubicin]

Why do Canadians often come to the States for treatment?

The number of Canadians who receive any health care in the United States for care is vanishingly small. In a country of 30 million people, it is relatively easy to find a few who do so, and who can offer a sound bite for a newscast or an anecdote for a blogger. The fraction of Canadians who receive medical care in U.S. hospitals and clinics appears to be around the 0.5% mark.--of whom roughly 4 out of 5 do so because they happened to fall ill while visiting the United States, and not because they travelled there to receive medical services.

For certain urgent care services, communities close to the Canada-U.S. border can and do make arrangements to share facilities. (If someone has an urgent need for specialized cardiac or neurological care, you want to go to the nearest major hospital, not just the nearest one on your side of the border. Patients flow in both directions under these agreements; there are regular transfers from northern Washington state to Vancouver hospitals.)

Why does the Elderly death rate in Britain start climbing, late in the summer, and start going down again after the new Fiscal Year starts ??

Because high temperatures combined with substantial swings in temperature - typical late-summer weather, and likely exacerbated by climate change - are physically stressful. The same pattern is observed in the United States.

For that matter, why are so many doctors from Single-payer countries practicing in the States, instead ???

I don't have all the data at my fingertips, but in every year since 2004, there has been a small net migration of doctors out of the United States and in to Canada. Further, doctors practicing in Canada (and in the UK) report being significantly more satisfied in their jobs that their colleagues in the United States.

Re:really?

[dcollins]

That smells like horseshit. Put some numbers on those extraordinary claims, and [Citation needed].

Re:really?

[dave420]

Nonsense. Other countries spend less money on comparable healthcare. Many medical treatments were pioneered in other countries, and have since come to the US. Spouting this nonsense is only hurting you and your country. Why do you do it? Because it's easier than admitting your country has serious flaws? That makes more sense than an obviously-intelligent person being so woefully (and wilfully) ignorant.

Site is VERY frustrating

[GodfatherofSoul]

It was smart to build in the 3 month cushion, but that site is driving me nuts. First I dealt with 2 weeks of not even being able to log in (getting dropped to blank screens). Then I had registrations blow up over and over forcing me to repeat the process. Then, when I finally got my account set up, I had deal with Experian's validation blowing up, then being told to wait 24 hours for the fix, then calling back and finding out there was nothing Experian really could do and just call healthcare.gov help, then being told to just email a scanned driver's license for validation, then finding out that the online app is broken and thinks every image is over 10MB, then being told I can just mail in a photocopy or wait another week.

This IMO is an argument for doing thing's in-house. Maybe that wasn't practical or cost-effective, but most of their problems appear to be at the seams right now. And, that Solara dynamic marketplace browsing web app is TERRIBLE!

Re:par for the course

[Salgak1]

Otherwise known as the "get 9 women pregnant to deliver a baby in one month" method.

And it works about as well in systems development and engineering as it does in obstetrics. . .

Government is moving digital

[EMG at MU]

I think this might be the first goverment case of a large organization trying to execute a publicly facing software project and failing. For decades the goverment didn't do public facing benefit projects. If this all happened in the 90s you would have to sign up using paper forms and although it may have been slow and inconvenient by today's standards that's what the goverment had experience in doing, it probably would have worked just fine.

I think software/web centric failures like this are going to keep happening. Few organizations, especially those whose primary business isn't software, are good at implementing huge software projects. Most management doesn't know how to run software projects, budget departments dont know how to account for software projects. If the Social Security administration has a huge backlog of applications they just add more people to the workforce until they work through it. Now everything is different, it doesn't matter how many people and how much money you throw at it, it's going to talk a while to fix. Very few people in goverment, and very few members of the electorate understand how a software project is run, hence a "surge" to fix the problem. People understand that concept, they imagine tons of nerdy looking guys flowing into some building and typing furiously at a keyboard until the problems go away. Good imagery, not really accurate.

I'm actually really amused by all this, it's my job playing out on a national stage. Terrible software estimates, contractors failing to live up to contracts, unrealistic timelines, poorly understood requirements, angry management demanding all hands on deck, and unhappy users. Maybe now software management will become an academic subject and mandatory study for MBAs and such.

Re:Government is moving digital

[DerekLyons]

I think this might be the first goverment case of a large organization trying to execute a publicly facing software project and failing.

Between this and other large scale government software rollouts... I think the problem is less one of the government (as the oft repeated bromides here keep insisting) than it is that there simply no way to roll out a system this big in one go and not have it buggy as hell. (Or at least if there is one, we haven't found it yet.)

Re:Government is moving digital

[EMG at MU]

Yeah totally, that's why I never blamed the problems on the project being "government run" and instead said this is the first (in my memory) case in the government of a large organization failing at rolling out a software solution.

What I was trying to say is that the government is now experiencing the same challenges a lot of companies and other large organizations deal with. The government is just doing it on a national stage, while also forcing millions of people to use the site.

Re:Government is moving digital

[CrimsonAvenger]

What I was trying to say is that the government is now experiencing the same challenges a lot of companies and other large organizations deal with. The government is just doing it on a national stage, while also forcing millions of people to use the site.

The fundamental difference between a government project and a private project is the "required by law" part - you can't be forced to use a private website, but the gov's website has tax penalties associated with it.

Re:Government is moving digital

[gingerfire]

SSA's online application for disability is actually quite good -- I pleasantly surprised at how well the system was implemented. I have no idea who developed it and it is no where near as complex as healthcare.gov though.

Re:Should not be a federal program

[Anonymous Coward]

50 of the 50 states are sovereign states, that's why they are called Sovereign States.

You could argue that healthcare is the responsibility of states, not the Fed, but that's a completely different argument than the one you're apparently trying to make.

Yeah, that might be why the subject line is "Should not be a federal program.
 
It's nothing like a county government forcing a city to do anything. It's a giant, massive organization going outside the bounds of what they were create for. Kind of like, I don't know, the UN trying to force a law on member country that they don't want.

no content

[rewindustry]

just a lot of balloon juice - scrub in, aggressively monitor, and the real kicker - prioritize. they don't have a clue, do they?

Re:benchwarmers

[Salgak1]

Honestly ? Probably. Federal Contractors have a salary ceiling, and unless brought in specially as consultants, pay tops off in the mid-150s or so. Which in DC Metro, isn't all that much.

Private star-quality talent, there's a much higher earning capability when NOT working for Club Fed. . .

Just now getting around to it?

[superdave80]

'We're also putting in place tools and processes to aggressively monitor and identify parts of HealthCare.gov where individuals are encountering errors or having difficulty using the site, so we can prioritize and fix them

You weren't doing this already? On a brand new massive website that you just rolled out to millions of people? To quote Gene Kranz from Apollo 13: "Tell me this isn't a government operation..."

deconstructing Healthcare.gov

[Presto Vivace]

Lambert Strether has a tremendous post-by-post analysis of what when wrong.

Re:deconstructing Healthcare.gov

[Bite The Pillow]

I see subjective opinion, with a few facts scattered about. Was there something specific that was informative there?

A screenshot of missing security questions, which probably failed to load via Ajax, and two pages of complaining about the same income and identify checks that the private sector does, and between the IRS and ssa, the government already knows about you. Low numbers, not surprising, and bad data, surprising because identity checks should have captured good info.

What did I miss, because that is not what you described.

Re:It's a lost cause

[Unordained]

Healthcare is already more expensive and less comprehensive every year, without the ACA. That's a result of a bunch of individuals with insufficient buying power to actually drive down prices, yet stuck in situations (healthcare isn't a luxury when you're sick -- people would always rather go bankrupt than not get care) they have varying control over (you can control your food intake, but the way diseases spread, or your genetic makeup, or the way society has dealt with toxins and mutagens are beyond your practical control) ... trying to get help. I'm sorry that the free market didn't automatically adjust to provide us all with cheap good healthcare. There are niches within the marketplace that the Invisible Hand can't always fix, because the right pressures and options just don't exist. And we already help the poor -- the ACA just makes it more efficient to do what we're already doing.

Re:Should not be a federal program

[SJHillman]

"Sovereign state" refers to a country/nation... I've never seen it used to mean one state of the United States. The United States as a whole is a sovereign state, the individual states are not. I couldn't find a Google search query that returned any results calling them sovereign states either. There are some definitions of sovereignty that sort of fits states rights, but none of them declare the 50 states absolutely sovereign (which is something the Civil War largely solved).

Re:benchwarmers

[bobbied]

No, Just the low bidder..

Re:Should not be a federal program

[msauve]

I guess you never thought about what "United States" means. We have a federal government, not a national one. (don't argue the semantics, I'm using the terms a bit imprecisely to draw a distinction) We are a country of United States, not a country divided into states.

"The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States", "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." - US Constitution. Don't be concerned if you haven't heard that last bit, not even the Supreme Court is aware of it.

The Articles of Confederation made this even more clear: "Each state retains its sovereignty, freedom, and independence, and every power, jurisdiction, and right, which is not by this Confederation expressly delegated to the United States, in Congress assembled."

Re:Should not be a federal program

[Unordained]

A product (healthcare) which they may not want to plan to pay the eventual cost of at the moment, no, but which by law we are required to provide if ever asked for, even if they can't pay? And it's been that way (legally) since 1986, under Reagan. Single-payer would have removed the "buy a product" argument, but hey, we didn't get what we wanted. You already buy a product you don't want, all the time, with taxes. I buy more military than I really want. You probably buy more road projects than you really want. That's life in society.

But as to your original point: states' rights? Sigh. By making employment and healthcare laws a federal thing, we make the market for housing and employment far more fluid. You can move from one state to another looking for a job, with fewer impediments. Employers can attract talent from out of state, without having quite so many per-state issues to overcome. Increased market fluidity reduces localized market irregularities, and makes the overall system more efficient. Living in Oklahoma, I can tell you, I do *not* want more issues to be handled at the State level. But maybe, rather than all working together to come up with a good solution, we should balkanize further: I think all employment and healthcare laws should be handled at the county level, you know, for greater flexibility (people in my county clearly have different healthcare needs and expectations than elsewhere). Maybe even at the city-block level?

I'm a US citizen. I really don't give a crap what State I live in. It's all about being near family, near a job, near good entertainment, with good services. I don't have time to further filter my choices based on some local politician's "bright idea".

The 50 states are not cauldrons of experimentation, centers of innovation. They're just a good excuse for conservatives to shield themselves from changes they don't like. But those same conservatives will be quick to attempt federal legislation (DOMA) to prevent the rest of the country from changing without them. States' rights only come in to play when you lose at the federal level -- but everyone plays that game.

Hells Bells......

[sgt_doom]

....if they can do Stuxnet right, they should certainly have been able to do this correctly?

Re:Two weeks to two months?

[HornWumpus]

Applying my rule of thumb (double the number and go to the next higher unit). It will be between 4 months and 4 years.

Re:They should fix privacy issues as well.

[bobbied]

Nope, It won't. It's going to take four times as long and cost ten times as much.

Re:Big guns?

[bobbied]

Lowest bidder won the contract..

Re:Ineptitude? what did you expect?

[Unordained]

Hold on one partisan moment: now lowest-bid is a bad thing? Suddenly, the Obama administration isn't spending enough money?

Re:Brooks -- not just the mythical man-month...

[bfwebster]

..but also Brooks's Law:

"Adding manpower to a late project makes it later." ..bruce..

Re:Two weeks to two months?

[bobbied]

10 times as long, so we are looking at 2 years or so..

But the *real* question is how much will it cost?

Re:Should not be a federal program

[SJHillman]

The Articles of Confederation have not been in use since 1789... so I think we can safely discard them in any discussion about modern states. One of my professors pointed out an interested change in linguistics after the Civil War. Prior to the war, "United States" was almost always a plural ("The United States are...") but after the war, it became a singular noun ("The United States is..."). The Civil War was basically the end of the question of state sovereignty in the US. It's also one of the reasons the Confederate States were a confederation (and not a federation)... confederate states are independently sovereign and can freely secede from the confederation, but in a federal government, they have shared sovereignty with the federal government at best.

The White House has become a help desk

[Andover Chick]

So it appears that Obama and the White House have become a help desk. So if anyone has any problems with Excel 2007, FireFox or Outlook then please call the White House. You'll get a ticket and they'll investigate the problems. Eventually, to save costs, we'll outsource the Executive Branch to India.

I can see this now... NOP

[swschrad]

an army of ants adding spurious comments into the code base. helpful comments like /* this section queries the SQL get on every character typed */

Re:Should not be a federal program

[azadrozny]

The Constitution limits the sovereignty of the states, but does not take it away completely. A state may not enter into a treaty with a foreign power, but they have complete autonomy with how they issue a building permit, or prosecute a murder case. So they may not be sovereign states from the perspective of the UN, but they have a great deal of sovereign power independent of the US Federal Government. If you look at it from a States' rights perspective, the Civil War was fought over how much autonomy the States had, specifically with respect to slavery.

should expand one of the working state sites

[peter303]

I am in a state with a local excahnge, Colorado. And it worked fine on the first day.

Re:Should not be a federal program

[TheSpoom]

Oh yeah, I remember when the UN decided that it was a country too! *facepalm*

even under a open price list system ER price must

[Joe_Dragon]

even under a open price list system the ER prices must be fixed / have price caps

Victory lap?

[RoccamOccam]

Posted by Guy Benson at townhall.com: "Triumphant President Takes Victory Lap Over Huge Obamacare Success"

He goes on to write
"Yes, really. As you read this morning, I was expecting a some perfunctory contrition and token acceptance of responsibility from President Bystander during his Obamacare remarks in the Rose Garden today. I was wrong. The appearance was more of a pep rally, replete with upbeat promises and applauding supporters. Aides might as well have hung a large "mission accomplished" banner over Obama's head."

"The fact that the Obamacare websites -- a core element of the law functioning -- are in total shambles and won't be fixed for many weeks or even months were all but shrugged off as an afterthought. Be sure to stick with this clip through the very end, when one of Obama's human props actually faints right behind him. There's a metaphor in there somewhere. In short, I thought I had gotten past being shocked by this president's arrogance and dishonesty. Wrong again."

Double-edged sword.

[SeaFox]

"Our team is bringing in some of the best and brightest from both inside and outside government to scrub in with the [HHS] team and help improve HealthCare.gov"

Shouldn't the "best and the brightest" been on this job to start with?
Or are they admitting they hired mediocre people to make a website that will run an entire country's heathcare system?

This x1000

[tacokill]

A thousand time this. Price discovery is almost unheard of in the medical industry. If patients were told prices and actually paid for service themselves (to be later reimbursed by insurance) you would see an immediate change in behavior as people shop the marketplace and prices rationalize. These are basic Free Market principles.

Do this experiment: next time you go to the Doctor, ask them the cost as if you were going to write them a check. Seems simple, right? What is the cost of "x", where x is my medical service? In many/most cases they will not be able to tell you a number. If they do, many times it will be the net cost (after insurance, discount, etc) instead of the total cost as if you were writing a check then and there.

Translation...

[LostMyBeaver]

Some manager type is trying to solve the problem by throwing people at the job. As if it were and assembly line.

The problem is pretty damn obvious. They threw too many people at it to begin with using a government contractor with a long established history of always late, always over-budget.

This is especially why a national system is required. The fed will throw money at it until it works. What would poor states like Mississippi do if they had to build their own system?

Ooh, I love nothing more

[dudeman2]

than having an intelligent discussion of the U.S. healthcare system with a bunch of 25 year old single Libertarians who, by and large, have never faced a personal or family health crisis in their lives.

Seriously, the amount of GOP + Cato institute propaganda I see in this thread is mind boggling. WTF people?

Re:benchwarmers

[Unordained]

Is that a bad thing? Do you enjoy over-paying for services?

Re:benchwarmers

[bobbied]

Depends on your perspective. Sometimes you can be penny wise and pound foolish by not paying enough up front.

In this case, I think we will over pay in general, but that's not what this was about.

ROFLMAO

[samantha]

Two weeks to two months to fix that much of a mess of that huge a size with brand new people brought onto the team? No hacker of even modest experience would believe such a fantasy. It will take nearly two months to bring people up to speed on the existing codebase and its requirements. At least.

Numbers signed up vs numbers with cancelled insur.

[daninaustin]

If you look at the projected numbers of people that have signed up vs the numbers that have received notices that their health care plans have been cancelled you might find that more people are losing insurance than are getting obamacare.

Re:Should not be a federal program

[TheSpoom]

As a sibling mentioned, your analogy is flawed to the point of being ridiculous. The UN is an international body of cooperation between sovereign countries, not a country with states who by definition are not sovereign since they are part of their parent country.

Don't make me bring out Picard.

Tech Surge vs. Brooks's Law

[dcollins]

Other people have mentioned the Mythical Man Month by Fred Brooks (1975), the single most important book in software management. But to be perhaps a little more clear, when someone says "Tech Surge", this is what someone with a clue needs to scream in their face until they get it, Brooks's Law:

"Adding manpower to a late software project makes it later."

http://en.wikipedia.org/wiki/Brooks%27s_law

Ooh! I Wonder How It Will Go!

[Greyfox]

Maybe they should bring EDS in to fix everything with Citrix!

No wait, that's retarded. I wouldn't have been off my medication so long if my fucking health insurance web site was working!

Surge/Coke

[uvajed_ekil]

Can we please force Coke to bring back Surge? So much talk about surges, and I just want Surge! The attempt to placate us with Vault failed - we want Surge!

Easy way to fix:

[Tablizer]

The prez should tell developers whoever fixes it gets a free ride in Air Force One with 3 buddies.

Re:benchwarmers

[kwbauer]

that was located in some other country. The guy who said his opponent was the devil incarnate for having outsourced a few jobs here and there decides to outsource the implementation of his political legacy. And his worshippers eat it up as so innovative.

Mod Parent +Admirable

[handy_vandal]

More like this, please.

Re:Should not be a federal program

[dave420]

So they're sovereign within the realms of the country of which they are part. Wonderful.

The phone number

[fulldecent]

How about this open issue: The official healthcare.gov phone number spells FUCK-YO when you dial it.

Re: Should not be a federal program

[dave420]

If we are playing that game, then the US also killed countless people when it destroyed the Indians. Or we could grow up and actually stick to the present day, with the present incarnations of institutions which might have shared a common name or two in history.

Re:Should not be a federal program

[azadrozny]

Aren't all states/countries sovereign only in their borders? In the US, the people of the states decided that they would cede some of their sovereign powers to a central government. This avoids some of the problems seen in the European Union, where individual states retained more (almost all) sovereignty. I will admit that it is a subtle point, but an important one if you wish to understand the inner workings of our federal system, and why people can get excited over states rights when you discuss topics such as gay marriage.

How about a competent team

[rhalstead]

How about a competent team led by a competent project manager. Say what its going to do, and then do it, with no additions or deletions once the design is settled on, before they write one line of code. It sounds like it'd be faster to start from scratch than to fix the mess.

Why does this feel like Y2K scam deja vu

[DFCollet]

Too much code. Too many coders. Bean counters in charge of the design and feature set.

Sounds like a scam to make as much money as possible without delivering any noticeable results.

I love American Enterprise. The leaders of the Tea Party should write a song.

Interesting post!

[dennisecarter]

Yes, you are obviously right. It's nice to hear you will prioritize and fix the health care of society. Visit here