HealthCare.gov: What Went Wrong?

New submitter codeusirae writes "An initial round of criticism focused on how many files the browser was being forced to download just to access the site, per an article at Reuters. A thread at Reddit appeared and was filled with analyses of the code. But closer looks by others have teased out deeper, more systematic issues."

Comments

On Further Examination

[dale.furno]

This article is dated oct 8. I had assumed it would be more recent.

Systemic

[ErnoWindt]

Not "systematic."

Re:Here is a thought..

[fahrbot-bot]

George W. Bush was — a fairly successful — governor (Executive) of a major State.

Well... it's Texas. From Wikipedia:

Compared to the governors of other U.S. states, the governorship of Texas is a fairly weak office. The Lieutenant Governor of Texas, who presides over the state Senate, is considered a more powerful political figure, being able to exercise greater personal prerogatives.

And, according to this reference, the Texas legislature only meets every two years for 140 days, so how fucking busy could the Governor actually be, except for executing people and fund raising.

And, as far as Texas itself goes, according to The Texas Observer, The Texas Legislative Group produced a study saying:

How’s Texas doing? Not so great: The state ranks 50th in high school graduation rate, first in amount of carbon emissions, first in hazardous waste produced, last in voter turnout, first in percentage of people without health insurance, and second in percentage of uninsured kids.

So, even ignoring their tendency to push Creationism over Science in their school curriculum, Texas is certainly a big state, but "major" is questionable - unless you mean major failure... But, if that's what the people want... you can't argue with stupid.

Government

[Maudib]

What went wrong? Government.

The ACA has some great theory behind it. Assuming that the federal government will be able to operate and maintain a system like this in a cost effective fashion is lunacy. It as bound to fail.

Also don't tell me it was Republican "starve the beast" strategy. The ACA was fully funded and largely untouchable. By any reasonable standard the roughly $400m spent on implementing this was incredibly excessive. If a private company had wanted to build this system for profit, it would have been done for under $100m. The big mistake of the ACA was that it did not allow for the creation of privately run and owned exchanges.

Re:Here is a thought..

[gtall]

That's not a valid argument for this. The main problem is the complexity of getting all the insurance companies coordinated. Kneecap those bozos and the problem becomes much easier.

Yes, yes, I know the argument. Government Death Panels. In the insurance industry, they are called Actuaries. See what a change in name can do even if they do the same job?

Re:bitch and moan

[sumdumass]

The SEC under Bush. They decimated it, and helped bring on the Great Recession.

You are completely wrong on this.

http://www.businessinsider.com/2009/1/enough-of-this-nonsense-george-bush-grew-the-sec

The SEC grew in size and scope under Bush. What you probably meant was the repeal of Glassâ"Steagall. But this was under Clinton with the Grammâ"Leachâ"Bliley Act. I cannot say for sure if this was what you meant because with you being factually incorrect in your statement, I can only assume based on facts that are true within it. But rest assured, of all the things that caused the "Great Recession" failing to fund the SEC or shrinking it was not one of them.

Re:Here is a thought..

[ClickOnThis]

The real question is, if they so badly mismanage something so common and widely implemented elsewhere as one Web site, why should they be trusted with anything more complex?

You mean like Medicare (single-payer) or the VA (government-run?) Both have high satisfaction ratings.

Re:Here is a thought..

[Frobnicator]

Jumping on the first flimsy excuse to dismiss the argument is never going to convince anyone who didn't already agree with you. I for one was hoping you would explain why Obama's plan was similar (or maybe, effectively identical) to Romney's. The calmer, more rational person at least provided something to read that I can critically analyze regardless of who's name is on it.

Not sure about BMO's response, but I'll give mine.

When I compare Romney's plans and Obama's plans, I'd say most of the theory is the same. The intention and the general guidelines have a huge overlap, just a small amount of difference. I'll go over the differences I saw between them down below. When I talk calmly and rationally with people about the actual details (not the hyperbole) of the law, they also tend to agree with almost everything. My frustration is that when people start saying "I hate Obamacare", when pressed for what SPECIFICALLY they don't like, they tend to not have answers.

Really, look at the major points. With a little calm and careful debate we can see why these are mostly good ideas, and even if you don't agree with a specific point we can likely debate it to the point where you can at least understand why it is good at a societal level if not an individual level.

• *Drug patents expire quicker, only 12 years until generics in many cases
• *Guaranteed medical insurance coverage for minors and young adults starting on their own
• *Additional guarantees for the elderly, terminally ill, and chronically ill who currently struggle to receive health care under the earlier policy
• *Additional accountability for medical facilities with high re-admittance or other significant documented problems
• *Minimum standards of insurance policies to avoid the near-worthless insurance some companies were providing
• *Requirements that plans include a wide range of options, including non-profit plans and plans that deny abortions, to help people with both religious concerns and with profit-motive concerns.
• *Caps on the profit margins of insurance and also certain other medical companies (20% or 15% depending on factors)
• *Insurers cannot discriminate based on on gender or pre-existing conditions
• *Chronic conditions must be covered under insurance; (it is wrong to punish people just because they had a bad roll on life's dice, it is bad enough they need to live with the chronic condition, be it anything from a mental illness to cancer or Alzheimer's or whatever. Someday you may get your own bad roll of the dice.)
• *Congress and government workers must shift to insurance plans on the exchanges rather than the high-end plan they were enjoying
• *Restaurant chains required to post calorie counts (When this came into effect hundreds of restaurants modified their recipes.)
• *An individual mandate coupled with guaranteed issuance requirements and subsidies for those who make up to 4x the poverty line. (Both Romney's plan and Obama's plan included this, most experts agree is a good thing, it is similar in nature to requirements in most other nations, in the short term it has a cost but in the long term everyone benefits. It is a rather surprising talking point that it comes up so much in the news.)

The devil is in the details of course, but when arguing any specific point it is easy to get consensus that we should do SOMETHING even if there is some disagreement of the specifics.

The biggest difference between the two is that Romney's plan was building a framework for others to implement rather than the federal government doing everything and forcing it on others. Romney's plan had an individual mandate for catastrophic coverage only, not for general insurance. Romney's plan had a cost that was initially nearly budget-neutral (estimated at $100M which is fairly small relative to the size of a budget) with a long term reduction in cost, compared to the federal plan that has a roughly $500B init

Re:bitch and moan

[SlaveToTheGrind]

Sorry, but this is just plain wrong (and sadly reflective of the level of journalistic integrity I've grown to expect from Kevin Drum).

Read for yourself the actual regulations, published in mid-2010, for grandfathering of existing plans. Less than 35 pages of single-spaced small print, so not too hard of a slog as these things go. A few recommended highlights:

• Table 1 on page 34542, listing several ways in which "grandfathered" plans still must conform to the ACA (e.g., no lifetime limits on benefits; no canceling the plan when someone submits bills for a pre-existing condition that they "forgot" to fill in on their application; perhaps most importantly, must refund "excess" premiums in years where payouts were less than [generally 80]% of premiums) -- in short, the ACA materially alters the actuarial assumptions under which the "grandfathered" policies were issued
• Subsection F on pages 34543-45 (and corresponding summary in subsection 3 on page 34547), explaining in detail the extremely limited ways in which an insurer can respond to the above intrusion on the actuarial assumptions of the plan (e.g., can't materially increase copays; group plans can't materially increase cost-shares of premiums)
• Page 34549, explaining that the above hypersensitive triggers for a plan to lose grandfathered status are necessary to prevent adverse selection in grandfathered plans--i.e., lower-premium, healthier-population plans staying grandfathered, and higher-premium, sicker-population plans converting, and that they realize in setting the above constraints, most plans will not succeed in staying grandfathered for long
• Table 3 on page 34553 (summarizing several prior pages), showing that, in 2010, HHS's mid-range estimate was that the above changes and restrictions would cause a cumulative total of 51% of all grandfathered group health plans to lose grandfathered status by 2013
• Subsection F immediately below Table 3, discussing HHS's estimate that the above changes and restrictions would cause 40-67% of grandfathered individual plans per year to lose grandfathered status

In short, it seems clear from HHS's own pen that the concept of "grandfathered" plans under the ACA is (1) highly Orwellian; and (2) was deliberately set up for failure. It's disappointing that the latest distracting meme is blaming the insurance companies for doing what, as shown above in black and white, HHS fully intended to force them to do from the beginning.

Re: Cheapest bidder?

[RoccamOccam]

Correct. It was a no-bid contract. Interestingly, Toni Townes-Whitley, a senior vice president at CGI Federal, is a Princeton classmate of Michelle Obama. In addition to being college classmates, both Obama and Townes-Whitley are members of the Association of Black Princeton Alumni.