Slashdot Mirror
Healthcare.gov and the Gulf Between Planning and Reality
An anonymous reader writes in with this excerpt from Shirky.com. "The idea that 'failure is not an option' is a fantasy version of how non-engineers should motivate engineers. That sentiment was invented by a screenwriter, riffing on an after-the-fact observation about Apollo 13; no one said it at the time. (If you ever say it, wash your mouth out with soap. If anyone ever says it to you, run.) Even NASA's vaunted moonshot, so often referred to as the best of government innovation, tested with dozens of unmanned missions first, several of which failed outright. Failure is always an option. Engineers work as hard as they do because they understand the risk of failure. And for anything it might have meant in its screenplay version, here that sentiment means the opposite; the unnamed executives were saying 'Addressing the possibility of failure is not an option.' ... Healthcare.gov was unable to complete even a thousand enrollments a day at launch, and for weeks afterwards. As we now know, programmers, stakeholders, and testers all expressed reservations about Healthcare.gov's ability to do what it was supposed to do. Yet no one who understood the problems was able to tell the President. Worse, every senior political figure—every one—who could have bridged the gap between knowledgeable employees and the President decided not to. And so it was that, even on launch day, the President was allowed to make things worse for himself and his signature program by bragging about the already-failing site and inviting people to log in and use something that mostly wouldn't work. Whatever happens to government procurement or hiring (and we should all hope those things get better) a culture that prefers deluding the boss over delivering bad news isn't well equipped to try new things.'"
The press covers what the administration instructs them to cover and they don't have time for investigative journalism, when there's tweets to twitter.
we can't even launch a damn website.
The Republicans in Congress had exactly ZERO involvement with the implementation of the website. Once approved by Congress, and then upheld by the SCOTUS, it was on the Executive branch to hire the firms to build the website. This is 110% on the Executive Branch of the government.
....The idea that the government has the right to tell you to buy X product in order to live in this country is problematic...
There's more than one way of looking at it, and I'll try to explain it in a way that even the most neo-liberal, free-market capitalist would understand. Before Obama Care, back when Barack Obama was probably the name of somebody living in a cave in Afghanistan, the government was requiring those who sold a "product" (medical care) to give it away for free to those who could not or would not pay for it (the uninsured). Forcing "retailers" (hospitals) to give away their "product" (medical care) for free is not a sustainable business model, especially when in some "markets" (states), such as Texas, 20% of the population "cannot pay for the product" (is uninsured). But rather than go out of business, the "retailers" (hospitals) divided the cost of giving away their "product" (medical care) to "unpaying customers" (uninsured patients) and added it to the overhead payed by their paying customers (insured patients). The insurance companies turned around and increased the "price" (insurance premiums) they charged for "X product" (health insurance); thus making "product X" (health insurance) more expensive; thus resulting in more "unpaying customers" (uninsured patients) demanding "free products" (health care) from "retailers" (hospitals), thus further increasing the "price" (insurance premiums) charged for "X product" (health insurance) etc. etc. etc.
But comparing an inelastic market to a normal consumer product with elastic demand, is really as nonsensical as my post.
I think what Richard Feynman said at then end of the appendix to the report on the Space Shuttle Challenger failure may also apply in this situation.
For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled. --Richard Feynman
Having watched more than a couple failed IT projects, the person with the purse strings was told exactly what they wanted to hear. This is what happens when you give someone financial incentive to sugar coat the truth. They end up blowing so much smoke that no one knows which way is up. The real problem is the people who write contracts that do not have any real penalties for failure to meet the over arching goals. As long as the company providing the service gets to write the proposal there are not going to be enough penalties for substandard products. This is why I have become completely disillusioned with the whole RFP bidding process.
If you want investigative journalism, there is always Al Jazeera, who has their own bias, but in places that they don't have an axe to grind, it is surprisingly good.
I forgot the name, but there is a German news organization who is also quite good, provided it isn't an article about German interests or political parties.
There is also a Russian paper (whose name I forgot as well... and it is not Pravda) that also have some good articles on what is going on.
In the US, you have to go elsewhere to seek actual news. If you want propaganda, Fox, CNN, and MSNBC will hand you all you can swallow.
There is a common myth that the high cost of health care is due to uncompensated obligatory emergency room care. Like many myths, it provides comfort to the general public, who are always looking for easy explanations for the complex problems of the world. But like all myths, it has the downside of being false.
In particular, the percentage of a hospital's expenses spent on uncompensated care is about 6% (in 2011, 5.9%)
http://www.aha.org/content/13/1-2013-uncompensated-care-fs.pdf
The mandate to provide emergency care to all those that show up in the ER was part of the Emergency Medical Treatment and Active Labor Act of 1986.
http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act
Turning back to the first link: what was the percentage of uncompensated care in 1985, before the Act? 5.8% So as a result of the treatment mandate, the percentage of hospital's uncompensated care went up all of 0.1%. (From then to today; there was a spike up to 6.4% the year after the Act was passed).
Undoubtedly, uncompensated care is a problem. It's just a rather small problem. Far bigger is the lack of market forces that removes any incentives to inefficiency.
As a side matter; I'm very sorry to hear that about your wife -- there is definitely a significant need for improvement in the system for helping people with pre-existing conditions.
I'm not blaming the GOP, the exact same thing happens in gerrymandered blue districts.
You should. It is a stated goal of GOP leadership to destroy government and then claim it doesn't work. It is a deeply cynical move. The source is a senior 30 year GOP insider who started during the Reagan years.
Like all pain, suffering is a signal that something isn't right
The Gallup poll for this week gives President Obama a job approval of 39% against the entire polled population, amongst self-identified liberals (which I'm going to assume is a synonym for progressive when it comes to American politics) his job approval is a pretty good 70%, amongst 'liberal Democrats' it's 82%.
All this sturm and drang over the website is total BS anyway.
If the website isn't working, just fall back to pen, paper, stamps, and envelopes, like it would have been in the ancient past of say... 20 years ago before everybody expected regular consumers to have web access.
Or perhaps the RWNJ noise makers can point out to me where in the Constitution it says laws MUST be accompanied by functioning websites? All those strict interpretation original intent founding fathers conservative boneheads can stuff that in their john birch ayn rand free market asses. Let's not forget it was private contractors that failed to deliver the product.
According to Wikipedia, "In left-right politics, right-wing describes an outlook or specific position that accepts or supports social hierarchy or social inequality."
Rand Paul is all about small government--which pretty much by definition means right-wing according to the definition above.
Rand Paul calls himself a "constitutional conservative" and a "libertarian conservative." He opposes federal government involvement in health care, thinks it should be entirely privatized. He thinks the 14th Amendment shouldn't apply to kids of illegal immigrants. He shares some of the views of the religious right--he is against abortion even in cases of rape or incest, and he is opposed to same sex marriage.
Even the dates codified in this law have been changed by executive action. This president does not appear to think he is bound by the law or required to faithfully execute it.
Read some news from that time WMD were found just not the quanties the intelligence offices from almost the countries of the world said there were, Cuba and North Korea being some of the that said there were none.