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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.'"
I am from Canada so I am not very familiar with the ACA.
I find it weird that so much attention is given to the website though. Why is it so important for the ACA to work?
At the end day, wouldn't people end up buying health care from a private company? Why is the government in the business of providing a website so that people can buy health care from a private company? Isn't that weird? Even if the website is a good thing because it allows people to compare the different plans, since the private companies are the ones who will profit from selling these plans, they are the ones who should have footed the bill and developed their own solution, no?
When a country, that has received the (temporary) blessings of a goodly portion of the world banks, is lifting off in a multi-decade experiment in keyesianism, and combine that with the residual WW2, "get her done" and "risks be damned" attitude, that kept bureaucracy and regulation in check, and add in a new blossoming impetus in the cold war ....and what you have is a perfect storm, to result in our rocket program.
Fast forward.
1. The cold war ended, and it broke the russians, and it put us in a pretty big hole as well, the blowback of which, we're still seeing.
2. The central banks still find us useful, but the original deal-with-the-devil (or devils) is now approaching 60 years old, and the central banks are now playing defense, positioning themselves within the transition to China.
3. The "get her done" and "risks be damned" attitude that kept bureaucracy-hell in check, are now fully replaced with idiocracy, which is very easily seen in corporations, but is far worse in the biggest corporation of all, The United States Federal Government, which has 4 million dependents, and another 12 million unofficial dependents, the weight of which is not merely creating a sag, but bellies are dragging. The warfare/welfare state and endless push for centralization, because a little bit helped us win a war or two, so multiplying centralization by a million times, will make this country a million times better, has been championed by democrats and republicans, taking turns providing warfare benefits to the banks, and welfare benefits to individuals, corporations, and anyone with hat in hand....
So in conclusion, I find your statement moronic, and perfectly symptomatic of the stage we have reached.
you make it sound simple.
this not a matter of 'read(a); print(a);'
the amount of crap in the law and all the rules and exceptions (not to mention per-state stuff) makes this nearly unimplementable.
its no surprise that when you have thousands of pages of rules to implement, you will have issues and bugs.
blame the republicans, again; they littered the law with so many porkbarrel exceptions for their own people that we could not get a clean law in place. benefits for the insurance companies cluttered up the works much more than they should have.
a single payer system would have been simpler and better for us but the republicans kept sayins "but, but, but, SOCIALISM!" and so they got what they wanted: a piece of shit law that just barely delivers anything to The People (for who it was all intended, btw).
amazon as fought against paying state taxes due to complexity for years and years and they are a well-known software company with a mostly can-do attitude and even they were afraid of all the work involved in the tax system. the healthcare system is as bad or even worse, in its implementation.
its no wonder it failed. it failed because it was designed and voted on by committees who, half wanted to help people and half wanted to sabotage anything to do with obama.
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"It is now safe to switch off your computer."
As soon as we decided that hospitals were legally required to give you health care if you walked into the emergency room we decided that health care is a human right. That debate is over. So now what do we do about it? You can either have the blood suckers feed off a system they're not paying into, or you can require they pay into it like every responsible adult has been doing for generations. The government is not requiring me to do ANYTHING really. They've created a new income tax (you're exempt if you have no income) and a corresponding tax break if you happen to buy health insurance. While it may be slimey it's perfectly within the normal business of government to enact income taxes and tax breaks. IMHO single payer or Medicare-for-all would've been a preferable option, but it wasn't politically viable, so we got this. It's not great, it's basically a big handout to the insurance companies. Have you watched their stock prices? They've shot up over the last few years. But at least the bums who were living off me in the form of higher premiums I was having to pay each year will now be paying in. And if someone was really sick and was unable to get health insurance at any price before now gets health coverage.. isn't that GOOD? My ex-wife couldn't get private health insurance. I know, because we tried. She had a clotting disorder but was generally a healthy and able-bodied person. But nope, can't buy health insurance. So unless her provider got her on a group plan, she was completely SOL. If more people like her, and even people who are not able-bodied can get some insurance now then that's awesome.
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Boehner cannot be Speaker without the Tea Party (libertarian) members of his caucus. How exactly do you expect him to make them vote for policies which would rightfully get them primaried in the next election? The ACA has something like 87% disapproval amongst registered Republicans, and the other 13% probably don't recognize that ACA means ObamaCare. There are lots of things that the parties can negotiate upon, and the ACA has already been modified several times, but the ongoing existence of the ACA is not one of them.
Boehner apparently wants to do something bipartisan with immigration reform, but that's a hard needle to thread given the Democrats mainly support it to add dependent dependable voters and the Republican base don't like the idea of becoming more like Mexico.
would rightfully get them primaried in the next election?
And therein lies the problem. Primary elections are the "true" election in most Congressional districts (Democrat and Republican), thanks to gerrymandering. Primary elections are universally low turnout affairs that are dominated by the true believers, the types that get all of their news from MSNBC or Fox, who are least inclined to seek accommodation with the other side. The consequence of this is that we end up with hyper-partisan hacks that don't even represent the mainstream of their gerrymandered district, much less the country as a whole.
I'm not blaming the GOP, the exact same thing happens in gerrymandered blue districts. Nancy Pelosi doesn't represent the mainstream of the Democratic party, much less the United States, yet she is the voice of the Democrats in the house.
I don't know what the solution is. Some will argue that we need a third party, but that's no guarantee of a different result. Indeed, it makes it possible for the same hyper-partisan hacks to win as before, only now they'll have won with 40% of the vote instead of 50.1%. My hometown (Binghamton, NY) ended up with a left-wing asshole as Mayor, who won two three-way elections, and pushed his asinine left-wing agenda despite 60% of the city voting against him. (Hint for Matthew Ryan if your egotistical self finds this post with a Google search: People don't vote for Mayor to make statements about the Iraq War, they vote for him to fix the fucking potholes, keep the parks clean, and to try and attract employers to the area)
I want peace on earth and goodwill toward man.
We are the United States Government! We don't do that sort of thing.
Had people all worked into a frenzy that power plants and other equipment wouldn't work on 1/1/00.
Things wouldn't have worked if they didn't fix them. That's like saying there's all this frenzy about vaccines. [sarcam] I mean polio and measles aren't that bad since no one I know is affected by them. [/sarcasm]. The problem is that when something works well and avoids a disaster some people think it wasn't necessary. For many years, FEMA did a good job at disaster recovery until Katrina hit. Then the country saw the effects of a poorly run government agency and why putting someone competent in charge matters.
Well, there's spam egg sausage and spam, that's not got much spam in it.
Things wouldn't have worked if they didn't fix them.
The OP didn't say that Y2K was a non-event. But one of the reasons it was a non-event was because of the attention it got in the news. That encouraged people not to ignore the issue.
Healthcare.gov did NOT get that sort of news coverage, and the result was a non-functional service with a tax penalty associated with not using the service...
And yes, I think that if the media had been reporting on Healthcare.gov the way they reported on Y2K, we'd probably have a working system in place, instead of what we have....
"I do not agree with what you say, but I will defend to the death your right to say it"
The Boss has no idea.
At least for big public projects, there is a solution: prediction markets. If plenty of low level people know a project is seriously off track, the prediction market will reflect that fact. All public spending proposals should have explicit goals and be tested in prediction markets before they are funded, and if the market consensus is that the proposal will fail, then it should be either modified or abandoned.
Managers want to look at us - programmers, software engineers - as totally fungible, mere factory robots.
They have the same attitude towards accountants, secretaries, anyone who works on an assembly line, salespeople, HR reps, etc. There's fundamental contempt in the business world for people who actually produce stuff, like they're somehow deficient or inferior to those who go around reprioritizing action items to create synergies in the digital marketplace. That contempt can even spread towards relatively high-status people who produce stuff e.g. how big media companies treat musicians or actors.
From what I've seen so far, the cause of this is that management typically has gone to business school, and what they learn in business school is precisely to treat employees as replaceable components of a system. It's even in the language they use: "Personnel" became "Human Resources", making it clear that instead of flesh-and-blood humans like the managers themselves, rank-and-file employees were tools to be used up and then discarded.
I'd consider loading these folks up on a "B" Ark ship, except that I'm reasonably certain that if we removed one set of parasites another set would take over just as assuredly.
I am officially gone from
Mr. Slippery has it right. The US doesn't have much of a left these days. It has a right (D) and a more extreme right (R). To wit, who do I vote for if I want the law upheld, no one above the law, none of this Too Big To Fail or Too Big To Jail, and those Wall Street thieves and destroyers of our prosperity brought to justice? And who do I vote for if I want sanity, facts, and truth on unpleasant matters, not propaganda? Maybe healthcare can help increase the sanity level. But on the whole, not Obama, and definitely not Romney. Maybe Elizabeth Warren?
If you want peace, prepare for war. If you want to avoid Climate Change, prepare for it. But no, we can't even arrive at a consensus that Climate Change is real and not liberal scientist propaganda, and that if we make no changes it will get very bad for everyone. Many aren't hard changes to make, and are good to do even if there is no climate change problem. Like, with electric cars. I don't know about you, but I don't like breathing exhaust fumes. Maybe we should work on batteries more before making the big switch, that's a valid debate to have. But as to the motors themselves, there is no question that electric motors are far, far superior to internal combustion engines. Then there are traffic lights. Who could possibly not want traffic lights to get some brains and cut the amount of time we all spend sitting at the red light? But people fight such ideas anyway. It's almost like we're deliberately making life harder for ourselves because we're bored or something.
Intellectual Property is a monopolistic, selfish, and defective concept. It is "tyranny over the mind of man"
Well for the developers, they had a time line that Was an Act of Congress.
For your company, you will probably be able to delay the product release if there is a serious glitch going on. However the problem was there was a Legal Act of Congress saying this is when the website will need to be up and running.
Also there is a difference between government work and For Profit work. Government is Risk Adverse while For Profit is innovation driven.
So working for the government for any President, your job is to not screw up so you will get fired or have to go threw some scandal, you can have a million of successes and one failure, and that failure will bring you down. In most good For Profit companies it focuses on your success. You screw up a few times, even some big ones, that is Ok (You may not be happy about it), you learned from your mistake, however under your belt you have a lot of solid successes that will drive you forward.
If something is so important that you feel the need to post it on the internet... It probably isn't that important.
We already had a Rube Goldberg solution in place. It is called the private insurance industry, and Big Pharma. That conglomerate has made profit off of not serving the public and fulfilling its purpose, but by screwing the most vulnerable. No one is more vulnerable than those in need of health care. It was a dumb idea from the start, as the founders should have realized. People who need health care are not in a good position to hunt for bargains or fight back when denied coverage. The injured and the ill can't devote themselves to that. Can't. They're trying to stay alive, they can't haggle over what that's worth. Have to trust that the doctors won't screw you over too hard, knowing full well that they are seriously conflicted and pushed hard to do just that so drug companies and related parasites can profit more. Even when well enough, most of us are not experts in medicine and lack the knowledge and training to evaluate medical propositions. We do a fair job of judging these using other means like reading about others' experiences with specific procedures, organizations, and doctors, but it's not enough. Markets cannot function properly when half the participants aren't in a position to evaluate deals and turn down bad ones.
Another area of denial and dishonesty is death. Medical practitioners make money from providing care, not from making people well. No one needs more care than the terminally ill. It is in medical practitioners' interest to help the dying cling to life as long as possible. Many don't scruple to play upon our guilt and horror. You wouldn't deny that heart bypass operation to your parents who are dying of cancer, would you? You wouldn't say no to a therapy that is hideously expensive but has a 20% chance of holding off the inevitable for another 2 years, would you? You're a heartless, murderering, low life, ungrateful scum if you so much as suggest it. Death panels! Death panels!
Intellectual Property is a monopolistic, selfish, and defective concept. It is "tyranny over the mind of man"
And you know what else was in the law? The timeline for the individual and the employer mandate.
I'm still wondering how Obama has been able to put those off legally, even with executive order?? That doesn't seem right and I wonder why no one has sued for this...I would think anyone planning for this law to be in full effect according to the dates of the law would have standing on this.
I think this would be a good time to test the boundaries and maybe define more what exact powers the President has with Executive Order. It needs to be seriously reigned in IMHO in general.
Light travels faster than sound. This is why some people appear bright until you hear them speak.........