Healthcare.gov Official Resigns, Website Still a Disaster

Nerval's Lobster writes "A government official who helped oversee the bug-riddled Healthcare.gov Website has resigned his post. Tony Trenkle, Chief Information Officer (CIO) for Medicare and Medicaid Services, which oversees Healthcare.gov, will reportedly join the private sector after he departs on November 15. A spokesperson for the Medicare agency refused to say whether he had been forced out, telling reporters: 'Tony made a decision that he was going to move to the private sector and that is what our COO announced yesterday.' Because of his supervisory role, Trenkle is considered a significant player in the Website's development; The New York Times indicated that he was one of two federal officials who signed an internal memo suggesting that security protocols for the Website weren't in place as recently as late September, a few days before Healthcare.gov's launch.Following Trenkle's resignation, Health and Human Services secretary Kathleen Sebelius admitted to the Senate Finance Committee that Healthcare.gov would require hundreds of fixes. 'We're not where we need to be,' she said. 'It's a pretty aggressive schedule to get to the entire punch list by the end of November.' Sebelius added that she was ultimately accountable for what she termed the 'excruciatingly awful' rollout. Healthcare.gov has experienced massive problems since its Oct. 1 debut. In addition to repeated crashes and slow performance, the Website's software often prevents people from setting up accounts. President Obama has expressed intense frustration with the situation, but insists the Affordable Care Act (ACA) backing the Website remains strong. 'The essence of the law, the health insurance that's available to people is working just fine,' he told reporters in October. 'The problem has been that the website that's supposed to make it easy to apply for insurance hasn't been working.' While the federal government won't release 'official' enrollment numbers until the end of November, it's clear that the Website's backers are losing the battle of public perception."

Comments

As an outsider.

[goruka]

It seems like a giant project that was hurried, kind of like a Windows Vista. Isn't it getting gradually fixed?

Re:As an outsider.

[FearTheDonut]

While you might well be correct, the issue at hand is the website. It's a bit disingenuous to say the whole law is broken because of the website. That is, unless the same people who made the law are the ones coding.

Re:As an outsider.

[Dunbal]

How much did linux cost you, again? There's a difference there.

Re:As an outsider.

[TheNastyInThePasty]

It's like saying your car is broken because the website you tried to buy your car from crashes a lot.

Re:As an outsider.

[alexander_686]

That is true. But what we can do is divided large sophisticated software packages (OS or applications) into 2 categories.

“Big Bang” packages where the entire packaged is released at once. Vista and Health Care web site are two examples. These have a history of delays, cost overruns, and initial releases performing poorly. This is particularly true for government ones.

“Evolutionary” packages which come about from a lot of small incremental changes. Linux and Windows for Workgroups 3.11 are 2 examples. Issues are know so things are stable. Thing gradually get better. Lots of legacy code that lend itself to lots of legacy “features” (a.k.a. bugs).

By choosing the “big bang” method we know the kind of troubles we are going to run into. As such extra effort should have been put into delivering requirements on time so adequate testing could be done. At times this means rejecting additional features or (in the worst case) functionality.

Re:As an outsider.

[Anonymous Coward]

It seems widely known but little reported that Michelle Obama’s Princeton classmate is an executive at the company (CGI) that built healthcare.gov. Reportedly, only one bid was reviewed... CGI's.

Re:As an outsider.

[Anonymous Coward]

Look, I use Linux and love Linux and am even considering fully switching away from Windows but let me just say that cost is not only measured in money. It's also measured in time. There are certain users for whom Windows (7) will provide all the functionality they need without ever needing an additional driver, or a new window manager (KDE vs Unity vs Gnome), or a custom screensaver (why does Ubuntu not come with a screensaver?), etc, etc. We're doing ourselves a disservice by assuming everyone wants what we want. A lot of people are genuinely comfortable with Windows and our refusal to see that only clouds our vision, not Microsoft's.

Re:As an outsider.

[cdrudge]

I think all parties can agree that it has been a bit of a political embarrassment for the President.

I'm not sure how much of a political embarrassment it really is. Yeah it should be working, but I'm not sure embarrassment is the right word. The right wants to make the website it an embarrassment, but they would want to paint whatever happens as an embarrassment even if the website worked perfectly. The left wishes the website would have worked. But with close to 2 months left before anyone is required to have insurance, there's still time.

Look at previous administrations for more embarrassing things. Bush with his wars in Iraq and Afghanistan, lies about WMD, and everything that resulted in the "War on Terrorism". That's an embarrassment. With Clinton, the affair with Monica Lewinsky and all that came with that was an embarrassment.

If Obama is going to be embarrassed politically, I think it should be more for his domestic and international spying programs.

Re:As an outsider.

[i kan reed]

That $600MM figure is, naturally, a fabrication. That's the total amount of all software contract work by the entire department of health and human services in the time-frame of 2009-2013. Needless to say, if you can't imagine what other outlays that might include, you're crazy. $93MM(the real number) is still a lot, but 9 women can't delivery a baby in a month.

Re:As an outsider.

[SuricouRaven]

"If you're not a US Citizen"

The whole world is aware. We all follow US politics. It's just so entertaining - like professional wrestling, but with slightly less violence. Our own politicians are mostly all very sensible and boring, nowhere near so much fun to watch.

Re:As an outsider.

[meburke]

Actually, I kind of agree with you; The law may be faulty, but sniping at the website problems won't fix the underlying flaws.

Economists know that every attempt at price controls over the last 4500 years (approximately) have resulted in shortages of the goods/services under control, and higher prices for those goods/services. All I needed to know about Obamacare was that it is a form of price control.

I'm 65 years old, and I've been tracking the results of Obamacare among the people I know. (NOT a scientific study.) So far, I'm seeing 8 instances of increased insurance costs (including two people who just qualified for Medicare/Medicaid) for every 1 instance of cost savings. It seems that some States, like NY, are benefitting from the increased competition created by allowing offers across State lines.

It is an Economic Principle that whatever you tax, you will get less of. Obamacare imposes about a 9% additional tax on each employee, and so it is probably going to lead to fewer qualifying jobs in the private sector. The number of part-time and temp jobs seems to be increasing here in Texas, but full-time work is hard to get outside industries such as Medicine and Energy.

Re:As an outsider.

[roccomaglio]

I used mod points in section which are now wasted, but it was worthwhile to correct this post. The Obama Administration only reviewed only a single bid for the Obamacare website http://washingtonexaminer.com/article/2537194. Whether that constitutes a no bid contract can be argued, but that is usually what is meant by that phrase. If you do not consider that a no bid contract then Halliburton was not awarded a no bid contract in Iraq. Calling the statement that this is a no-bid contract a myth is at best disingenuous.

Re:As an outsider.

[geekoid]

False. It comes from bad management, and bad program techniques.
It really seems like a system that no one bothered to break the code out into tiny bits laid out over a good API architecture for data sharing.
There are good software system of more complex code.

"a badly conceived law could be a reason for the poor performance of the site if it puts overly burdensome constraints on the system."
the law is a set of rules to apply. Nothing more. That is no reason for broken code. If you are talking about adding a second or three to a responce, you would be right.

as a side note:
" draconianly complex law " doesn't make sense.
It could be a byzantine law, but draconianly isn't complex..also, I don't think it's an actual word.

Re:As an outsider.

[timeOday]

The point of the law is to remedy under-insurance, so obviously it will raise insurance costs on average. That's the cost. The benefit is that when people later incur health care expenses, they will collect on the new or improved policies they are now paying more for, instead of paying it all out of pocket, or going broke and pushing the costs on to the rest of us.

It's just silly to count the cost of insurance without counting the benefits of the coverage.

Re:As an outsider.

[DaHat]

There is a bit of a difference between getting a letter from your insurance company that says "Due to the ACA we will be upgrading your plan at no cost to you to comply" and what we are seeing... Letters saying "Due to the ACA, we are canceling your policy effective Jan 1. You are welcome to apply for a much more expensive plan though us or the exchange... If you can even login."

Re:As an outsider.

[jeffmflanagan]

Nice job illustrating the ACs point
>We're doing ourselves a disservice by assuming everyone wants what we want

>Ah, you want something that show you ponies, rainbows and stuff? I don't know, never felt the need for it.

Re:As an outsider.

[CQDX]

How so? The law passed when the Democrats controlled both houses. Not a single R voted for it, nor were any needed to pass it, so the D's got what they wanted. In fact, R's were kept out of many of the planning meetings. The reason the law is bad is that it is much too complicated with many facets written as TBD at the HHS Secretary's discretion. The implementation is left to the amorphous bureaucracy. I don't think any of our representatives know what's in the law and none have read it cover-to-cover, at least not before voting it in. It's just too damn long.

Re:As an outsider.

[nbauman]

The reason the law is so complex is that American health policy is made not by a process of examining the options rationally and picking out the best ones, but by a process of political compromise,

If we looked around the world for health care systems that are working (in terms of price, quality and service), we would probably pick something like the Canadian single payer system.

Instead, we had to accommodate every powerful interest group, campaign contributor, and free-market ideologue. Why do we need a private insurance industry? We don't, they just have a good lobby.

The free market health care system doesn't work unless you're willing to let people die when they can't afford health care. http://www.nejm.org/doi/full/10.1056/NEJMp1312793 So how do the right-wingers get out of that? They come up with a system of subsidies (which they call tax refunds). In order to figure out who "deserves" to get what subsidy, they have to examine every applicant's income, expenses, and circumstances and apply arbitrary formulas.

Because it incorporates tax payments and other grants, you have a system which is as complicated as the entire tax system and a welfare application combined.

Then you have to please these economic theorists who believe (despite 40 years of evidence) that if people have to pay co-payments, they'll be wiser medical consumers. So you've just made a simple system complex. Then you have to provide "choice" of silver, gold, platinum and lead policies, so you have to do the same thing four times over.

By the time you've finished compromising with every interest group, you have an enormously complicated health care financing system, which may not even be precisely designed or logically consistent. So when you try to write code, you have to go back and clarify the policy that you're implementing in code.

Compare that to the Canadian system: You hand your Canadian Medicare card to the receptionist, and she swipes it. The government pays for it.

Re:As an outsider.

[_xeno_]

The Government did allow you to keep your plan.

No, no it doesn't. Grandfathered in plans were not allowed to change at all since 2011, and that simply is never going to happen over three years. Change the doctors covered under the plan? Plan changed and can't be grandfathered in. Adjust costs due to inflation? Plan changed and can't be grandfathered in. Increase coverage? Plan changed and can't be grandfathered in.

Obamacare was written in such a way to guarantee these plans would be dropped. Period. Obama knew you weren't going to be able to keep your plans. Period.

You can't blame the insurance companies for this. There was no way they were ever going to be able to actually meet the requirements to grandfather in plans, if for no other reason than simple inflation.

And that's exactly what the individual mandate was--a huge compromise of liberal values to adopt a Republican idea. The fact that no Republican voted for it even then shows how spiteful and divisive they are.

Or that they looked at Massachusetts, saw that Romney's attempt at implementing it didn't work, and didn't want to send the nation down the same path. It's not hard to see that Obamacare doesn't and never will work. The HealthCare.gov debacle is proof enough of that.

Re:As an outsider.

[Straif]

The compromise was between far left Democrats and center left Democrats, the Republicans never entered into it. At no point were the Dems who were pushing for this courting or expecting Republican votes, hence the procedural trickery they did in the Senate to pass it, but they did require the blue dogs and other center left Dems.

As for the Republican alternative, it was not to pass an omnibus bill which almost never leads to good results, but to pass separate bills to correct flaws in the system in a more piecemeal and less painful way; a method that would make it easier to make corrections as they arose as well as ensure a better understanding of each individual bill and it's impacts.

They wanted to remove restrictions on cross border insurance purchases (to allow for more competition), they proposed allowing individuals to claim the same deductions as businesses to try and break the employer based system, there was also support for legislation to remove lifetime limits and help people with preexisting conditions and even for leaving your adult kids on your family plan (under certain conditions). Their main issue was that because these were separate proposal and not a blanket catch all bill, people like you either through ignorance (which could be due to the lack of media coverage of these proposals) or simple denial, continually state they had no alternative.

Re:As an outsider.

[Tanktalus]

You're entertainingly deluded if you think Canada is a single-payer system.

We have a tiered healthcare system, it's just that most people don't seem to acknowledge it.

I have partial coverage from my province. I have partial coverage from my employer. And I cover the rest out of pocket.

My mother-in-law, having turned 65, but is still working, has even more payers: the province, her employer's health care coverage, the provincially-mandated health care coverage (different pocket, not sure if she pays for it or not), and then the rest out of pocket.

There are health-related items that are fully covered by provincial plans, some that are partially covered, and many that are not covered at all. For the last two categories, private health insurance can cover all, some, or none of the extra costs. If you have multiple health insurance providers (e.g., two different employers for a household, usually they cover the employee and their spouse and kids, so you have two insurances covering the household), there is some sort of duking it out for who covers what, but, in the end, you usually end up with the higher percentage of the choices being covered somehow. And then, whatever is left, is your responsibility.

I go to the doctor with a cold. The province pays the doctor for my visit. He wrongly prescribes me some antibiotics. I go to the pharmacy, get the pills. The province doesn't pay for any of that (though they play a role in regulating the drug costs). My employer's health insurance pays some of the drug cost (the percentage widely varies on which drug it is) and none of the pharmacy fees (other insurances do pay for pharmacy fees). I then pay the rest, never less than 10% due to the plan I have with work.

If I then spend more than a certain percentage of my pre-tax income on health expenses, I can submit them against my taxes for a further refund, though I've never hit that amount, personally. I'm sure lower incomes could easily hit that.

If I go to the optometrist's, the province pays nothing for my visit, but all of my children's visits as they're all under 18 years of age. I submit to my employer's health insurance for my visit and any and all prescription eye wear that results, including for my children.

If you cannot get health insurance from your employer, or you cannot afford to get insurance on your own (here in Alberta, there is a cheap provincial-run insurance available for purchase, not sure about other provinces, and no idea what kind of coverage it gets you), you get to pay full costs for chiropractic and vision care. Dental visits are also not covered, or any orthodontic care. If you're poor, you're going to be stuck with bad eyes and bad teeth. Even in Canada. Because you're in the bottom tier of health care. Which itself is because we have tiered healthcare.

Sure, emergency access is paid for. But same in the US - effectively. If you can't afford it in the US, the hospitals eventually absorb the cost, by law. In Canada, the government absorbs it. However, if you can't produce your healthcare card, you're still responsible to pay for it - tourists and out-of-province patients don't get free rides. (However, when I was in Toronto a couple months ago, had I required health care during that time, my home province would have covered the costs same as if I were at home. Which, again, means not everything is covered.)

Re:As an outsider.

[Lumpy]

News flash, ALL insurance is there to screw you when you need it. Blue Cross and Blue Shield tried to DENY coverage of my daughter being born as a "unreported pre existing illness"

Insurance companies have entire departments designed to find ways of screwing the payer.

Re: As an outsider.

[jc42]

The difference is, the fighters are hugely complex and bleeding edge. A website is pretty old hat in 2013.

From what I've read, it's actually sorta the opposite. The healthcare.gov site is generally described as a bureaucratic database horror story. Multiple databases, actually, each with its own API (that's poorly documented), each one elsewhere on the Net, with unrealistic response-time "requirements" written by managers with little distributed-DB experience. And no understanding that messages between sites can't move faster than the speed of light.

Funny thing is that I've also read a number of comments recently about the zillions of cases where new decrees from Congress are handled by thousands of government web sites within a day or two. Thus, the recent "shutdown" was handled gracefully by most departments' web sites, and they were back up within a day or so when the people were called back to work.

So it's not that "the government" can't handle building and revising web sites. Thousands of departments are doing it the job routinely, and nobody notices because it usually goes smoothly.

But healthcare.gov by its very nature has attracted the attention of every politician within reach, most of which qualify as PHBs who want their name attached to the results but are otherwise clueless about this InterWeb stuff. The result is a flood of conflicting orders coming down to the grunts doing the actual web-site development, with radical changes appearing in their inboxes daily.

I'm sure that lots of readers here can identify with this situation. How often have the rest of you seen exactly this sort of mess in a corporate setting? I'm sure we can collect a lot of good horror stories. Or we can just go over to The Daily WTF and read about (or submit them) them there.

Entering the private sector??

[FearTheDonut]

I hear Microsoft is looking for a CEO..

Accountable?

[jamesl]

Sebelius added that she was ultimately accountable for what she termed the 'excruciatingly awful' rollout.

Accountable how? Will she get a black mark on her annual review? She still has her job.

Re:Accountable?

[Guppy06]

She still has her job.

Senate Republicans refuse to allow any Obama appointments to move forward as it is, none of them are as high-profile a target as HHS Secretary right now.

It's either Sebelius or leaving the job vacant until 2017.

Private unemployment?

[Dunbal]

"will reportedly join the private sector"

Is that what unemployed people are called nowadays? No wonder reported unemployment is so low, contrary to all observable evidence. Certainly he won't be going into a "job" straight away - who in their right mind will hire him?

Re:Private unemployment?

[slew]

As with all politically connected people, I'm sure a soft landing "place" was made for him in one of the companies owned/operated by one of the generous political donors to the current overlord administration's party, so he would be comfortable vacating his current cushy post before he became a total embarassment.

This is probably not too dissimilar to how some dictators seem to find themselves living with an annual stipend in some remote area of the world...

Recapping an old post. . .

[Salgak1]

My previous analysis

Simply:

One: Schedule Fail. Compounded by late award of the contracts to develop/influence:

Contracts Awarded Dec 2011

Two: massive requirements base to develop specification for development and implementation: The PPACA was 1800+ pages, and the associated regulations are 10,000+ pages, and are STILL changing. Can't develop without a spec and design, with big parts of requirements still changing.

Three: inadequate testing. The above-referenced link states that security testing BEGAN in August 2013, less than two months before rollout. There's no mention of load testing.
UPDATE: There WAS load testing, Radio reports say it was tested with a 1000-user simultaneous load. EXPECTED was 60K simultaneous users. . .
However, the only CONCRETE numbers I've found say it crashed at several hundred simultaneous users. . . .

Four: Integration issues. The Obamacare Exchange system combines data from numerous agencies and systems, and integrating between them is always a difficult task.

Five: Identity-management. This is in parallel to Integration, somehow all identities need to be federated into a single overarching system.

Twenty-three (now 25) months, even with a top-flight team, would simply not be enough to do this: this is a 5-7 year job. . .

Typical big outsourced project...

[ErichTheRed]

I've been on enough big-bang massive IT projects to know that this is no different from anything we've seen before.
- Ambiguous requirements that aren't settled, and constantly changing (stuff that even "agile" can't account for): This is always a killer. Even an "agile" project can't have the framework ripped down and rebuilt at the last second...some decisions have to be permanent.
- Contractors who just want to collect money : Outsourcing is always more expensive and produces worse results than if you do it in house. The only thing you save is the cost of employees, but you pay more in the long run.
- Entrenched groups who don't want to see it succeed: ERP implementations often fail because the business processes that need to be changed are held up by people or groups that don't want their job changed or automated away, and have powerful friends.
- Massive time pressure: I don't know why software development and IT are so different from engineering projects, but there is still the persistent myth that you can throw bodies at a late project to make it come in on time. You can't do this with a construction project of any reasonable size...there are still dependencies. Yet, there's always pressure to make arbitrary dates.

Seriously, replace "government healthcare insurance marketplace connecting people with thousands of insurers" with "SAP implementation", and you see the same problems.

I can see why they made this guy resign though -- someone has to be the scapegoat. At one of the companies I worked at, the much-loved founder of the company was thrown out by the board (it had grown into a public company) after a massive operations disaster that forced him to go out and publicly apologize. Some of it might have been willful blindness, but executives tend to say "I'm paying millions of dollars, just make this happen and don't bother me with details." Consulting companies love these kind of executives....

Re:project management.

[CanHasDIY]

>

But you tell me, if you are a cook who cooks great 3 min omlets and some smuck comes in
and gives you $1000 for a 1 minute omlete , what do you do ?

I tell you what I wouldn't do - give him a salmonella-inducing, raw fucking egg and call it an omelette. Because I'm not a moral-less piece of shit who values profits over the health and safety of my customers.

If the job can't be done under the criteria set forth, it can't be fucking done under the criteria set forth. You tell the fuckers that, and when they say, "well, we'll pay you extra to make the impossible happen," you politely decline, tip your hat, and be about your fucking business. Because guess what? When shit hits the fan and people start to suffer actual harm, who do you think is going to end up on that cross - the assholes that paid for it, or the idiot who tried to make a quick buck by willfully poisoning his customer base?

Bureaucrats != engineers

[RogueWarrior65]

Here's the root of the problem and would explain why Obama, Sebelius, and other bureaucrats are sticking to their guns. They believe that they are smarter than the software engineers charged with building this monstrosity. From my own experience, I once got into a pissing contest with a senior VP over something I had developed for the department. He had no background in software or computers. None. Even though the guy had a Mac on his desk, he didn't understand the concept of windows and insisted on using a single one to view his files opening hundreds of turn-down triangles. Hundreds. But I digress. The guy only understood image, flash, and how things looked. His precious weekly schedules had to look pretty rather than be functional to the point where the secretaries were spending an entire day putting together a weekly schedule in QuarkXPress. So I built a database system (with the assistance of one of the secretaries) to generate these schedules. But the database engine we had available to us, while it could use fancy fonts, didn't understand variable character widths. So printing schedules using dingbats was a nightmare. During a presentation, some flunky asked if we could make some changes. The secretary said "Well I don't know. We're jumping through a lot of hoops to make it do what you're seeing now. I don't know if it's possible." The VP said "It's possible" without even asking me. I nearly quit that day. As a matter of interest, a few of my coworkers and I had a daily reading from The Dilbert Principle.

Point is that Obama and his minions don't understand that you can't set arbitrary deadlines for technology when they know nothing about it. It's the same as ignorant politicians setting lofty fuel economy standards without talking to automotive engineers to find out if the goal is realistic or even possible. The politicians believe their own hype in that they think they are smarter than the engineers. At the very least. One can also make the case that unrealistic goals aren't set out of ignorance but by design to suit their ideology. E.g. Set a pollution standard bar so high that it either isn't possible or that it's so expensive that nobody will bother and voila, the source of that pollution is gone taking all the benefits (jobs, consumer savings, useful product) with it. To the politician, the ends justify the means because in their mind, the citizenry is too stupid to understand it.