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Jeffrey Zients Appointed To Fix Healthcare.gov
An anonymous reader writes with news that the Obama administration has appointed Jeffrey Zients to lead the effort to revamp Healthcare.gov after its trouble rollout earlier this month. Zients said, "By the end of November, healthcare.gov will work smoothly for the vast majority of users." Obama created a position for Zients within the government in 2009, when he was made the OMB's Chief Performance Officer. The purpose of his position was to analyze and streamline the government's budget concerns. "Healthcare.gov covers people in the 36 states that declined to run their own health-insurance exchanges. About 700,000 applications have been begun nationwide, and half of them have come in through the website. The White House aims to have 7M uninsured Americans covered by the scheme by the end of March." Zients's appointment came after a contentious House Committee hearing about the healthcare website, in which many were blamed and few took responsibility. The government also said that contractor Quality Software Services Inc., a subsidiary of UnitedHealth group, would "oversee the entire operation" of Healthcare.gov. QSSI has already done work on the website, building the pipeline that transfers data between the insurance exchanges and the federal agencies.
From the soaring triumph of the Apollo Project, to the sub-Hades goat-ropery Healthcare.gov in just half a century.
I, for one, am willing to confess that the U.S. won the Cold War, and is losing the sequel.
Get thee glass eyes, and, like a scurvy politician, seem to see things thou dost not.--King Lear
Sounds like a lot of mythical man-months to me.
All my liberal friends think I'm a conservative, all my conservative friends think I'm a liberal.
There are more lines of code in Healthcare.gov (500m!) than Google Chrome, the Linux kernel, XP, Facebook, Mac OS, and the Debian 5 packages combined:
http://www.alexmarchant.com/blog/2013/10/22/healthcare-dot-gov-lines-of-code-comparison.html
Windows 8 supposed has 80m lines of code:
http://money.cnn.com/2013/10/23/technology/obamacare-website-fix/
It would take a miracle of computing programming and program management that no governmental program has ever accomplished to get this epic cluster f*ck fixed in 2-3 months.
If they actually want it to work, it should be taken out behind the shed, shot in the head, hung, drawn, quartered, burned, and the ashes scattered to the four winds. And then everyone starts over. And then take 2 years (minimum) to recode it again with an almost entirely new team. But that's not going to happen. They're going to try and band-aid it, and it won't work.
So things are going to get interesting. It's unfixable in a politically acceptable way for the Democrats and the Obama administration.
Zients said, "By the end of November, healthcare.gov will work smoothly for the vast majority of users."
Yeah,November of which year?
At some point they will have spent enough time and money to fix the nice shiny bauble of a web site..... and they will trumpet their success...... but this will be used to distract from the fact that they will NOT undo:
1. The fact that hundreds of thousands of people have already been thrown off their insurance (so much for "If you like your insurance, you can keep your insurance, PERIOD." - Barack Obama).
2. The fact that millions will have lost their doctors both by losing their insurance and also by having the new plans exercise very tight controls on their "providers" (so much for "If you like your doctor, you can keep your doctor, PERIOD" - Barack Obama).
3. Nor will it fix the most-basic contradictions of the scheme which always meant it was unworkable: [1] it's "insurance" but you can wait to buy-in until you have had the failure it "insures" against (the pre-existing condition clause; it's like only placing your bet in Vegas after you win) and [2] it requires all the young-and-healthy to buy policies at high prices with high deductibles and high co-pays (in other words, policies they will get nothing from) in order to function but it lets all the young people stay on their parents' policies until age 26 in order to not piss-off Obama's young supporters.
The lesson here: No amount of IT (no matter the quality or expense) can make-up-for, or sufficiently hide from intelligent users, serious flaws in the underlying policies, business principles, economics, claims of the sales force and marketing dept, etc. But a bad launch of a shiny bauble can have a serious impact on reputation and imply incompetence. This lesson applies to business, non-profits, and governments alike.
Oh, and there's another lesson here for the young urban hipsters: The internet is not universally available, and many people do not even have/care to use it. My personal favorite anecdote thus far was from the farmer being helped to sign-up who responded to the navigator with "what's an e-mail address?" In the real world where systems are constructed to serve everyone equally, there must be good non-internet options that work - people who do not get this need to unplug for a month and get out into the real-world where this big bright thing called "the sun" rises and sets every day, something called "the wind" blows, people swim, fish, ski, fix fences, ride horses/motorcycles/etc, turn wrenches, use saws, dig holes, play with their kids, milk the cows, etc.
Good luck to Zients. He's a good guy and I don't doubt the code can be repaired with enough effort. A lot of effort, maybe, but it can be done.
But it might not matter. The Los Angeles Times had a story about how the real code running the show (the legalese in the ACA law) may have a fatal flaw in it. The federal government may not be able to grant subsidies to low income people in the states that did not set up their own exchanges. The law specifically says the states must do it in order for the money to flow. So 36 of the 50 may not be able to get the money. But they are still subject to the penalty for not signing up. This means the people least able to afford insurance get hammered. And since they are treated differently than people in the other 14 states that do have exchanges, you can bet an Equal Protection lawsuit will be quick in coming.
Federal judge is due to issue the initial ruling soon.
Behold, this dreamer cometh. Come now, and let us slay him... and we shall see what will become of his dreams.
In reality, it is also delivering a subjective opinion about the plan by calling it a scheme.
Unless Zients's plan is to sprinkle parentheses liberally on the project.
Half of the people in the federal government are actively trying to sabotage the ACA.
Is that the half that wants to repeal it or the half that voted for it without knowing what was in the bill?
It's early days yet.
After doing software development in the healthcare field for over a decade, I finally made the wise decision to never work in that industry again. Government is even worse, because the rules the software have to follow change on the whim of elections and the rug is constantly being pulled out from under you. Now this mess? Well it's healthcare taken to the bureaucratic power (h^b). Sounds like a good way to shave 10 years off your life in stress.
Better known as 318230.
It was debated for 8 months.
What was debated and what was in the final draft are two different things.
Everyone knew what was in it, regardless of what Rush Limbaugh told you.
Lame attempt at character assignation, you've lost the debate. I'm neither a Republican nor a Limbaugh listener. I am however someone who was paying attention during the debate and drafting of the ACA, it was quite the bipartisan cluster**k.
"Everyone knew what was in it, regardless of what Rush Limbaugh told you." Strange, what I recall during the run-up to the passing of this piece of art was the Democratic Speaker of the House saying "We need to pass it to find out what's in it." And we are finding out.
The thing you have to keep in mind about the US Health System is that it's a series of kludges. Active Federal employees on the civilian side use a version of the Dutch system. There's a bunch of Federally owned hospitals (aka: the British system) for military retirees. To insure retirees in the 60s we stole Canada's system, even keeping the name "Medicare," and simply added the words "over 65" to the bill. Which means we have three entire countries worth of health regulations simply for retirees and Federal employees. Most people are insured by their employers , which is a fourth country worth of regulations. Roughly 10% of the country buys on the individual market, which is regulated at the state-level by 50 different regulators, for a fifth country. Medicaid for the poor is a federal/state mixture, which makes it sixth. The uninsured pay their bills a variety of ways, from charity care to sticker price. So we don't really have a health system, we have seven health payment systems.
If we were Canada or the UK, and we didn't have significant Checks and Balances in the policy-making arms of the government, we could do what any smart engineer would do in this situation and start a massive project to replace these seven systems with one system. But we aren't that country. Every American is convinced that his health insurance is great, therefore he will simply not believe your new system will be better for him, therefore he will bitch at his Senator if you try to (for example) let poor people formerly on Medicaid visit his VA Hospital. And getting 51 Senators (or 50 and the VP), and 218 House members to agree to do anything like that has proven to be damn near impossible. You can get them to agree to pour money into one section of the system or another, but they don't change people's health care very often.
So what Obama did was take the least popular one of those systems (the uninsured), and send half of them to Medicaid and half to the Individual Market in a manner reminiscent of the Dutch. He changed the individual market so it is more affordable. In other words the Affordable Care Act had to have the same amount of regulations in it as the entirety of Dutch law relating to Dutch health insurance. Since it kept five of the other six system it also had to include a lot of language/code to insure compatibility with those systems. For example a student whose dad (with custody) is on Medicare, Step-mom is eligible for insurance through her job and the VA, and Mom-mom (no custody) has a policy on the Exchange. Is the kid eligible for the Exchange policy, the VA policy, or does stepmom have to switch over to her job's insurance?
It possible that in China the technocrats who run the Communist party could all have learned a proposal this complicated in a year or so's debate without majorly neglecting their other duties. But we aren't China. We aren't led by nameless suits whose entire role is to exude policy confidence. We are led by us. And it turns out we aren't smart enough to learn a half-dozen slightly different versions of the Dutch system in eight months. Frankly I don't blame us.
What we are smart enough to do is learn the outlines of the ideas, to a surprisingly high level of detail in many areas; and then muddle through the rest the best we can. This is what happens in a democracy with Checks and Balances, entrenched interests (ie: people calling their Congressman in panic when their insurance changes), and an independent legislature whenever anyone tries to fix any major problem.
There was ***NOTHING*** bipartisan about the Affordable Care Act. It was passed without a single Republican vote and lots of dirty parliamentary tricks.
The Democrats and the Obama administration own this.
http://dailycaller.com/2013/10/25/michelle-obamas-princeton-classmate-is-executive-at-company-that-built-obamacare-website/
Link says it all.
Life is not for the lazy.
Michelle Malkin is a conservative blogger and TV "personality" with a bachelors degree in English, while Paul Krugman is a nobel laureate in Economics. While both may have their biases, I would most certainly give the analyses put forth by the latter infinitely more weight than those of the former.
I'd just like to point out that Obama has presented all the required proposed budgets to Congress. Of course the Presidents budget is just a wish list and it's up to Congress to actually develop and pass one.
There are two things I want to point out. First, you are claiming that the Democrats passed the ACA even though they knew what a mess it was. Second, there is indeed a "death panel" in the ACA. Oh, it is not called that. It is called the Independent Payment Advisory Board, but it gets to decide what care will be paid for and what care won't be paid for, regardless of what your doctor may think is the best treatment for you. That means that it will decide that lifesaving care will not be paid for some people because of their age, or other health issues, or some other, as yet undetermined, criteria.
The truth is that all men having power ought to be mistrusted. James Madison
Actually, the "advise and consent" provision is for every government job that the Constitution does not specifically specify how it is assigned, unless Congress has specifically invested some other entity with the power to appoint someone to the role without their involvement. Basically, whenever the Administration creates a new category of job, they either need to get the "advice and consent" of the Senate, or they need to get Congress to pass a law saying that they do not need such advice and consent for this particular job (the further down the chain of command the job is, the more likely that a law that can be read to give such permission already exists).
The truth is that all men having power ought to be mistrusted. James Madison
I am claiming that the Democrats knew what was in the bill, yes. The bit about it being a mess is your opinion - as someone who lived in a single-payer country for a number of years and who knows what healthcare can be, I think that this bill is a desperately needed step in the right direction. I only wish it had gone further.
As for your hyperbolic nonsense about the Independent Payment Advisory Board: someone has to decide what should and should not be covered, and that person can not and never has been your doctor. Right now it's your health insurance company, seeking to maximize its profits. In the future it will be a panel appointed by the president and subject to senate confirmation. This is an improvement.
Pass single-payer, as we should have done in the first place, and send everyone to medicare.gov.
"debate" Isn't that kind of the point? Bipartisanship I mean.
Except it didn't really happen in a bipartisan manner. For example one night I watched CSPAN and republicans were suggesting quite reasonable amendments and the democratic controlled committee voted each proposal down immediately without debate or further consideration. It seemed that the democratic party leadership had negotiated something in the back rooms between themselves and their lobbyists and no changes were permitted.
This demonstrated the most fundamental problem with the health reform legislation. The President had promised open, transparent and bipartisan debate and drafting during the campaign and then once in office turned control over to the Democratic party leadership in the House. Who then adopted a very partisan attitude and also went behind closed doors with their lobbyists to do the drafting. If there had been any opportunity for bipartisanship or peeling off moderate Republicans it had been discarded. The House, and the White House to a degree, adopted a "screw the Republicans we won the election and have control of the House and Senate. Rahm Emanual, the President's Chief of Staff publicly said something like that. Pretty much the opposite of what the President promised on the campaign trail, and poisoning the well of bipartisanship and setting the stage for the extreme partisanship of the last 5 years. This was all in the first couple of weeks of the new administration, long before the tea party had any significant presence in the House. Sure there would have been Republicans that would oppose anything, but there would also have been some that would have cooperated. There were a couple at times in spite of the highly partisan atmosphere the Democratic leadership created, if things had truly been done in a bipartisan manner its a pretty safe bet there would have been a number of moderate Republicans who could have been peeled off. Both parties are responsible for the extreme partisanship that exists today.
Its the mandatory coverage levels that will sway most Americans to abandon this. Retirees don't need birth control. Most people don't need psychiatric care. Most people won't be seeking gender reassignment surgery. But now everyone has to pay for it and it isn't cheap.
Central planning sucks, no matter who is at the top.