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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.'"
Just ask Pelosi: they had to launch the website so they could find out what would crash it.
In the end they will lay their freedom at our feet and say to us, Make us your slaves, but feed us. - Fyodor Dostoyevsky
While there is plenty of blame to go around, I am still left wondering where the investigative journalism was regarding the true progress of ACA implementation as the 3 years progressed up to this point.
So, while the press is justifiably having a field day with the sheer incompetence displayed here, where were they while all this was developing?
"If you want to improve, be content to be thought foolish and stupid." - Epictetus
So the *signature* piece of Obama's second term agenda -- the legislation he's harped on loudly and constantly -- launches with an epic fail. The contractors working the site were sounding alarms well in advance of the launch. And yet Obama is somehow utterly unaware that the launch could be anything but a total success? I call bullshit. Either Obama is the most disconnected president in recent history when it comes to the success of his *core legislative agenda* or he's just bullshitting about not knowing there were issues on launch day.
In the end they will lay their freedom at our feet and say to us, Make us your slaves, but feed us. - Fyodor Dostoyevsky
I think the most interesting thought in the article was about the author's observation of contempt between modern managers (in the example in the publishing business) and the engineers who actually create and manage systems. I'm also drawn to how articles written with sources inside the Administration refer to the technical people as 'Technicians' instead of what they probably were 'Senior Software Engineers' or appropriate equivalent title. I certainly don't think of myself as a technician, and I find the term somewhat demeaning somehow.
CGI was selected in part because they were one of only a handful of companies that got on the task order from DHHS that covered this and many other big CMS contracts. This system is designed to make it extremely difficult to just start a business and put out a bid. The justifications for it are very flimsy and center around things like making sure that some fly-by-night company doesn't get the contract/screening out junk bids. Poblem is, they don't actually work. In many cases, they just let the "primes" that win the slots act as funnels for the actual work done by subcontracts which just adds to the cost of the contract.
Another thing, if the reddit thread on this was correct, CMS needs to do what the DoD increasingly does with overtime which is to scrutinize or reject invoices with more than 80 hours per two weeks per employee unless the overtime was either authorized or can be explained in reasonable terms. Overworked government contractors don't get rich; their employers do at the expense of the employee and government. One thing often left unappreciated by the general public is that unpaid overtime is literally stealing employment from the employee because a salaried employee is only authorized to bill so many hours to a contract during a period of performance.
If only there was this much scrutiny and post-mortem analysis over other government failures such as, oh, I don't know, the multi-BILLION dollar failure joint strike force fighter that nobody wants (other than private contractors who are making billions).
Thank gawd, however, that we have this eagle eyed scrutiny over a website that's a few months over deadline and a few million over budget.
I think that the Members of the House who were newly elected in 2010 after the ACA, resulting in the GOP retaking the House, and re-elected in 2012 are rightfully following what the people in their districts want them to do: oppose the ACA. There are a handful of districts which voted for both Obama and a Republican Member of Congress, but there aren't many, and those few are pretty squishy about what to do. My own Congressman came back into Congress in 2010 (he had been unseated in 2008) and then defeated in 2012 by a Democrat; he wasn't following the will of the voters who showed up on election day 2012, other places, the story is different.
when non-engineers that dont understand technology but make engineering decisions, shit like this happens.
shocker.
Anons need not reply. Questions end with a question mark.
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 worst fears of the GOP will be realized - people will be getting better healthcare at lower cost.
The GOP by and large isnt bothered if your costs get lower (though, in reality, it is not actually possible for the majority's costs to get lower when we are now covering higher risk people); the concern is that we are going down a path of surrendering every area of life to government control. The idea that the government has the right to tell you to buy X product in order to live in this country is problematic; and its problematic that the government is OK with saying "it doesnt matter what bad choices you make in life, we (that is America at large) has your back".
Theres a term called "enablement" when dealing with someone who has an addiction / other problem; it refers to feeding their bad choices by taking away all consequences. What do you suppose happens when everyone is paying into insurance to cover the terrible choices others make? Or, I suppose, we could fix that by legislating exactly how people can live everyday life, but Im not seeing that as much better.
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.
Bureaucrats are comfortable generating reality. To a large extent this becomes their job; if you are in charge of an environmental clean up you will move the goalposts around to match what you can do, and if you can't even meet these mutable goals you figure out a way to measure it so that the result are met. Plus you take any reports that indicate failure and "massage" them until they look good; and if the underlings who create these horrible truths won't shut up you punish them or just get rid of them.
This works well when the facts are a bit fuzzy and you are able to control the flow of information to your superiors and ideally the public. The problem is that the skillset that enables these people to survive and thrive in a bureaucracy aren't the skills required to deliver a functioning and realistic test passing product. So you have a product such as healthcare.gov which is going to be wildly exposed to the public and the scrutiny of people you can't control (the press and political opposition) and oddly enough it blows up.
People look at the hard numbers and say this is a pile of crap that doesn't work. Yet I am willing to bet two key things are happening:
One is that there are reports flowing up to the top people (who don't understand technology) that are a combination of saying that it works far better than the "detractors" are claiming while simultaniously blaming some other party with lesser abilities to communicate with said superiors.
And two that the company that won this contract is awesome at participating in this reality distorting circlejerk. I bet that the reports and other paperwork was Washington gold; the product of top-of-the-class-MBAs. People for whom facts are not only to be ignored but to be looked at with suspicion and hostility.
So the question of which development style should have been used or which technology was best are nearly moot; in that every choice would have been made based upon the criteria of "It must look good in a report"
I suspect that the only lesson learned from this in Washington is that if you love your career that you should not get involved in a project that involves a measurable end product that is delivered to the public.
The various opposition groups will probably try to score various points based upon actual facts such as cronyism and poor testing but the reality is that 5 minutes into getting power they would hand a similar project over to their insider friends and primarily demand good paperwork over an actual product.
So to prevent this type of disaster you can't look at say agile practices in software but maybe agile type practices within government itself.
According to the Washington Post:
"A final 'pre-flight checklist' before the Web site’s Oct. 1 opening, compiled a week before by CMS, shows that 41 of 91 separate functions that CGI was responsible for finishing by the launch were still not working. And a spreadsheet produced by CGI, dated the day of the launch, shows that the company acknowledged about 30 defects on features scheduled to have been working already, including five that it classified as 'critical'".
The question is, what did the President know, and when did he know it? We know the responsible White House staff knew the system would not work because it simply wasn't finished. And that's only for the parts that were to go live on October 1st. As we heard last week from the existing CTO on the project, there is still 30-40% of the backend system that hasn't even been written yet.
I don't think it is reasonable that no one told the President about this. I think the President knew, but decided to push it through anyway. Why? Personally, I think it's because he believed that the glitches would be forgiven, and because the press was behind him, he could always blame the other side, and they would go along as the usually do.
"We receive as friendly that which agrees with, we resist with dislike that which opposes us" - Faraday
Way to take that line out of context. "Failure is not an option." wasn't about general day to day stuff, it was about saving the lives of 3 astronauts during an emergency situation. In fact, the mission (LANDING ON THE FREEKIN MOON) was indeed a failure.... They DIDN'T do it!
The whole "failure is not an option" thing is fine when you have lives in danger and the whole world is watching, but you don't get to use it about your website, no matter how many jobs are at stake. The message to take away here is "Even a million jobs are not worth 1 human life." If you understand and live by that, you will be a better person. Otherwise, you're just another scumbag millionaire who doesn't care about people.
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.
Check out my lame java blog at www.javachopshop.com
In my group there is a person with that specific responsibility. They communicate the possibility of not meeting a deadline and make contingency plans to get the best result given the circumstances.
That person should be fired, and IIRC they have already resigned.
Now find senior advisors who weren't responsible for communicating the risks but knew about them anyways. Ask them why they didn't communicate the risks to the President and based on their answer either fire them or reprimand them.
Send the message that there will be accountability. Why is that important? Unfortunately, be it in Government or the private sector, there is a culture of "that wasn't my job". Everyone knows the project will fail, every single fucking person from the junior engineer to the senior project director know. But everyone winks at each other across the table at meetings and agrees that "failure is not an option, it will be done on time". And inside their heads and within their small groups everyone is saying "well it's not my job to sound the alarm". There is no incentive to take that political hit and say "Boss, we might have told you several times that everything is OK but honestly there are some severe risks to launching by the deadline and we need to start planning for a delay or reduction in features". Instead, when shit hits the fan it's like a mexican gunfight, everyone points a finger at someone else and says "well he knew too" or "that wasn't my job to bring up that this would never work."
Engineering is hard, failure happens. It really shouldn't be punished (except where people just failed to do their jobs), instead it should be learned from so that the same mistakes are not made again.
One day, when software engineering management is a real discipline, they will pound it into the heads of MBAs and PMPs that failure is not only an option, its the most common result so make sure the lines of communication are open, that people feel comfortable communicating risks and saying no, and that all the stakeholders know that the engineers cannot travel through time, so if you start a 1 year project 9 months before you want it to launch then you are SOL and have to pick what features are most important.
I hate "you have more than one number one priority" more than "failure is not an option" and I feel people who say one usually say the other.
The more you hear about how he supposedly didn't know this or that, the more you have to wonder if he isn't a simple community organizer.
When Fascism comes to America, it will call itself Anti-Fascism, and tell you to give up your guns.
Wait, so you're blaming bi-partisanship on the fact that the DHHS mismanaged a project. A project which: A) They had more than sufficient funds available. B) A Mandate in terms of legislative action. C) An executive branch lead by the guy who pushed this shit through?
I'm sorry but if somebody gave me over $300 million to develop a website with the requirements that these guys had, it would be done and our contract would have had penalties for failure to deliver. None of these contractors who put this mess together have yet to be held accountable for their own mismanagement and that is at the heart of why government projects like this fail, the contractors always have weasel clauses that the government allows, ultimately releasing them from blame when things go Tango Uniform. There's ample fees and revenue to be made for change orders which do nothing but encourage the project management team to encourage them to the stakeholders, causing delays and increasing the overall cost of the project. Healthcare.gov has had over $300 million spent on it and it's still doesn't work. Now they've extended dates and shifted delays and I'll bet you within 3 to 6 months they'll try to scrap it and start over. In the meantime you'll get a friendly letter from the IRS saying you owe a penalty because you haven't signed up because now there's thousands of new public servants at that vaunted institution just looking to fuck you over because the T wasn't crossed or some other problem that the government created but now it's your problem. "Oh you couldn't sign up? not our problem, we're the IRS and we're always right and you're wrong."
This whole piece of shit legislation was thrown together by a bunch of morons who wanted to look good. I won't quote that retard Pelosi but the fact that nobody read the legislation. It was over 2000 pages long and more than anything else, shows how truly fucked we are in this country because at that point when legislation gets railroaded through like this because "Teddy is dying and we need to show we still lick the Kennedy's nutsacks in DC" Is no reason the rest of us have to take it up the ass. So while you blame gridlock let's not forget that for two years the Democrats pushed all this shit down our throats, not reading the legislation and trusting that it would all work out; Glinda the Witch of the North will wave her wand and make it all better.
Don't believe me? In 2009 after the ARRA was passed I had the privilege of flying from DC to Raleigh Durham, sitting behind two Congressmen heading back home, one newly elected on Obama's coattails. They were high fiveing the crew when they came on-board "We passed it!" one exclaimed. During the brief flight they kept handing pieces of the ARRA legislation back and forth with one saying "I didn't know that was in there!?" The other being so myopic that even with glasses he held the pages about 2 inches from his nose to read them.
Harrison's Postulate - "For every action there is an equal and opposite criticism"
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.
Yet Obama's response was not "By executive order, if the website is not fully functional by December 1st, all executive departments are hereby forbidden to award future contracts to CGI or its successor entities."
What a putz.
Guess you're not the CEO of the Fortune 500 I used to work for. I see this frequently the time in corporate structure as well - the bigger the structure, the worse it is.
Underling: "That's impossible. We might get it done in N days, and C isn't actually possible without a complete rewrite."
Low-Boss: "Great. The time frame is tight but we can do it with some extra elbow grease! Let's meet about the specs."
Mid-Boss: "Timeline is great and we'll iron out the details."
Upper-Boss: "It's all on track."
BIG Boss: "Great job."
The developer has to do the work, and is the most accurate about time constraints and difficulty of the project. At each level of reporting, though, the prognosis get's a little better because nobody wants to deliver bad news. Low management says it will be tough and there are some problems. Middle management says things are looking good and they're working out the kinks. Upper management says everything is great. The Boss has no idea. The more levels there are, the more dilute the bad news becomes.
Your
And, do you really think a President who spent 4 years convincing people he's actually American is going to blow off a major website snafu and hope to ride his middling approval rates through it all?
Yes. Look at it politically from his point of view. What was the alternative? Admit failure? Delay for a year -- after just winning the sequester against the hated Republicans who ran on exactly that proposition?
The thought that this is another conspiracy and that you'd equate it to Watergate is ludicrous.
Whatever gave you the idea I said this was a conspiracy? The question about what the President knew does comes from the Watergate era, but that is incidental. It's just a very pertinent question.
"We receive as friendly that which agrees with, we resist with dislike that which opposes us" - Faraday
>> a culture that prefers deluding the boss over delivering bad news
I'm pretty sure the guy at the top was in on the ruse too.
>> no one who understood the problems was able to tell the President
Isn't there a petition system for that? :)
OK, so the guy at the very top, the guy who's trying to talk 535 overblown egos into co-operating and getting things done, (which, by the way, haven't been co-operating one damned bit in 5 years) carrying on secret talks with a government who hasn't talked with us in like 30 years to try to defuse some of those 535 overblown ego's dreams of American imperialism and military adventurism, putting up with a childish ally in the region of said 'black sheep' government that wants nothing else but to turn said black sheep's country into a fucking parking lot, trying to keep yet more American boots off the ground in yet another country in the same damned region while aforesaid childish ally insists turning that country into a golf course, and trying to run his department of the government while being chronically shorthanded due to some of 100 idiots as a subset of the 535 overblown egos who are determined to ratfuck him at every instance possible, having to deal with multiple manufactured scandals (in particular, one created by a subset of those 535 idiots defunding a program that would have mitigated the damage done to an American embassy with concurrent loss of life in an attempt to create a Pearl Harbor-type incident as a precurser to demand American military intervention in yet another country the 535 don't particularly like) designed to boost support for their ideology, this guy supposedly has detailed information on the planning, design and implementation of a fucking website designed and built on a cost-plus government contract? When'd he have TIME to deal with that?
Understanding the scope of the problem is the first step on the path to true panic.
There is a common myth that the high cost of health care is due to uncompensated obligatory emergency room care.
The high cost of health care - as seen for by those without insurance - is the inability of the common man to receive services at the negotiated rate of insurers. An X-ray for a major insurer is $27. Double it and add a zero if I walk into the emergency room without insurance. Pills for your condition? $4 co-pay at the in-network provider for the insured. $40 a pill if you're on your own. Don't pretend the insurer is paying $40 a pill, that's just the price the uninsured pay.
If I could pay the negotiated rates for day-to-day services, I'd have the highest deductible plan someone would sell me - saving my insurance for something actually worth insuring against - catastrophe. Unfortunately, that's not an option.
When did he NOT have the time to pay attention to the most important legislative agenda of his entire Presidency? Personally, I think historians will be writing books about the answer to that question for decades to come. Here's the problem: either it really is his key agenda item, or it isn't. If it is, then why did he let it go live on October 1st? If you say, "someone else made that decision", then it can't be his key agenda item, can it? Who concedes decision-making power of the most important item on one's list?
It's more than a conundrum, it's a full-blown mystery.
"We receive as friendly that which agrees with, we resist with dislike that which opposes us" - Faraday
Dude, if I can get 300 mil for a website, how much more can I get to maintain the sucker?
Understanding the scope of the problem is the first step on the path to true panic.
Who concedes decision-making power of the most important item on one's list? It's more than a conundrum, it's a full-blown mystery.
It baffles me, but the President surrendered leadership on his signature legislation at the beginning. One of his first moves was to let partisan Nancy Pelosi take the lead and also take the process into the back rooms with lobbyists in tow. He surrendered his promises of an open and transparent legislative process with seats at the table for all.
blame the republicans, again
And this folks, is how you can recognize people who are hopelessly partisan. "It couldn't possibly be my guys, we must blame the other team even though not one of them voted for it."
You need to take your blinders off, man.
"First they came for the slanderers and i said nothing."
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.
Thank you!
Mr Obama knows exactly what is going on and has known this was coming for years.
[citation needed]
Yes. Look at it politically from his point of view. What was the alternative? Admit failure?
I don't know why he has to take responsibility for healthcare.gov's failure -- it was obviously a result of Bush's poorly thought-out and eventually doomed policies.
False. 26 Republican States refused to create their own website by the December 31st 2012 deadline, forcing the Federal government to create 26 websites in less than a year.
So you are arguing that some big social programs are best handled at the state level, that they should not be done at the federal level? That they can not be done right at the federal level?
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"
Im the CEO of a Fortune 500 company and I can't get answers from my subordinates regarding the failures of my flagship project. What happens to me? *I am fired.*
Save it. Recent history suggests that you'd either get a board-approved raise and/or leave with a HUGE Golden Parachute severance.
It must have been something you assimilated. . . .
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.........