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.

Re:On Further Examination

[Anonymous Coward]

You do know you're on Slashdot, right? An article from 10/8 is practically superluminal for these guys.

Re:On Further Examination

[garyebickford]

I recall a study from several years ago (10 years? possibly) that showed the probability of failure increased with the size (budget) of the project. Above about $5 million in then-dollars the probability was near 100%. As I recall failure was defined as either technical failure, or budget overruns going so high the project was cancelled. Of course, I have no citation. That would be too easy. :)

However, I did search for "Probability of Software Project Failure", and got some fascinating results. This is one of them: Statistics over IT projects failure rate - a summary review of several of the most definitive studies over the last 20 years. And this one: Healthcare.gov website 'didn't have a chance in hell' notes that:

The Standish Group, which has a database of some 50,000 development projects, looked at the outcomes of multimillion dollar development projects and ran the numbers for Computerworld.

Of 3,555 projects from 2003 to 2012 that had labor costs of at least $10 million, only 6.4% were successful. The Standish data showed that 52% of the large projects were "challenged," meaning they were over budget, behind schedule or didn't meet user expectations. The remaining 41.4% were failures -- they were either abandoned or started anew from scratch.

And I suppose this: £12bn NHS computer system is scrapped... and it's all YOUR money that Labour poured down the drain fits into this model pretty well. (Regardless of one's opinion about the Daily Mail.)

Here is a thought..

[Anonymous Coward]

Doesn't it strike anyone as odd that the Govt can design and implement a billion+ dollar data storage center for the NSA but can't deploy a website to allow people to sign up for insurance?

Re:Here is a thought..

[ClickOnThis]

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

You must be joking? The VA with high satisfaction ratings? And Medicare is an insurer of LAST RESORT, of course people are going to at least appreciate that aspect of it. It's that or NOTHING.

No, I am not joking:

http://www.defense.gov/News/NewsArticle.aspx?ID=14560
http://www.commonwealthfund.org/News/News-Releases/2009/May/Elderly-Medicare-Beneficiaries-Give-Their-Coverage-Higher-Ratings.aspx

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

What went wrong?

[Chas]

First and worst, politicians were involved. Everything else pretty much is a cascade effect off that.
Second, cronyism.
Third, you had a bunch of non-technical people setting up moving goalposts for the technical people to hit, with regard to the technical specs of the site.
Fourth, distinct lack of firm, single-message communication to the technical teams with regards to whether the project was or was not going forward.

I could go on and on about all the fuckups with regard to this. But I'd just piss off a bunch of people who aren't worth my time.

Re:It's time to kill off the boomers.

[GPierce]

Actually, Social Security is hardly bankrupt. It has about 3.5 trillion dollars invented in special interest drawing T-Bills. Unfortunately, the deadbeats in Congress borrowed the money "invested" by Social Security and spent it on every Congressional wet-dream and war they could come up with.

The "full faith and credit" of the US requires that they pay this money back. This means raise taxes, run the printing press, or weasel their way out of as much of the repayment as they can. Every dollar they actually have to repay is a dollar that can't be spent on future corporate welfare.

Re:It's time to kill off the boomers.

[garyebickford]

I will argue that part of the political problem is the boomers (of which I am one) - we grew up spoiled, filled with neo-socialist propaganda (see "The Closing of the American Mind" by Alan Bloom), and isolated without much chance to learn how to get along with each other or to how to be spouses and parents. For example, never having had to share a bedroom meant we never never really learned the art and necessity of compromise and living with someone else. We're arrogant, self-centered and always convinced we are right about everything. So, now we are running the political system, it is inherently dysfunctional. And that's not even counting those of us who are still lost in the 1960s, and think the hippie utopia was the best of all possible worlds, disregarding the realities of life. Someone once described American liberalism as confusing wishes with facts.

So, politics in the US at least will continue to be dysfunctional until we boomers age out of the power structure. Assuming the next generations aren't even worse... :P

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:Does govt want an insurance website?

[Frobnicator]

Grant me the legal authority to print money anytime I want and make everyone else pay the true cost of it (inflation) and I, too, could pay for anything money can buy. In the Apollo days they at least tried to pretend that debt is important and that there's something deeply wrong with running a government in a way that would bankrupt any business or household.

Hold your horses, partner.

A history lesson is in order. (Then get off my lawn.)

The 1960s had a lot of debt.

There was the Vietnam war and it wasn't cheap. There were some questionable political deals in Cuba that included a rather scary nuclear showdown that led directly into the cold war. Also there was the whole space race that you mentioned.

The US was in debt and facing a deficit. Not as big as today's deficit and debt, but it felt bad at the time.

President Johnson was looking over where the money was sitting, and he noticed a huge pile of cash sitting in an off-budget area. It was called the Social Security Trust Fund. It had billions of dollars just sitting there being invested, not being spent.

The good president looked over the budget, noticed that he could make himself look better (and presumably look better on the world stage) if the US didn't appear to be in debt. So President Johnson decided to move the Social Security Trust Fund into the general budget. There was a bit of a complaint at the time, "you cannot spend that money, it is for retirement". Not a problem they assured us, there would be plenty of money available in 2010 when baby boomers start to retire. We might not even be on a cash society in the future, let's spend it all today! The President made a proposal to Congress, and then all of them started rolling up the Social Security funds into cigars and enjoyed a smoke.

The Apollo program and several other major programs were funded by TODAY'S social security problem. Much of the reason we have so much debt is because the social security fund was robbed to pay for the war and the space race. Government took out a loan from the people and only recently started feeling the pain of paying the loan back. Baby boomers who don't suffer from society's generally short term memory can clearly recall that the focus was divided on the war, the protests, and the space race, and how those few people who noticed the money was missing were quickly written off as being anti-war or pro-war (whichever was a better distraction) and somehow the messenger was blamed and the message quickly forgotten.

Much like groups like WikiLeaks today; we all remember the name but the hundreds of soldiers who were documented committing clear acts of murder somehow escaped the court martial. Back then if you mentioned the social security funds you were branded a hippie or communist and you didn't believe in America. (Anything to make you look like an unpatriotic troublemaker rather than someone who wanted to see where the money went.) Then Johnson lost to Nixon and another scandal followed, most people forgot about Johnson's scandal taking the money and moved on to Nixon's spying scandal that evicted him from office, which is NOTHING compared to today's spying scandal that people don't care about.

Enough rambling, get off my lawn.