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Obamacare and Middle-Wheel-Wheelbarrows
davecb writes "The Obamacare sign-up site was a classic example of managers saying 'not invented here' and doing everything wrong, as described in Poul-Henning Kamp's Center Wheel for Success, at ACM Queue."
It's not just a knock on the health-care finance site, though:
"We are quick to dismiss these types of failures as politicians asking for the wrong systems and incompetent and/or greedy companies being happy to oblige. While that may be part of the explanation, it is hardly sufficient. ... [New technologies] allow us to make much bigger projects, but the actual success/failure rate seems to be pretty much the same."
developers developers developers!
Actual rational commentary unencumbered by raving political partisanship.
How is this legal?
To many middle man get in the way of the people doing doing the tech work and it's like that part is being worked on by team X and you need to wait for them to do there part and no you can't talk directly to them.
...The website "roll-out" was an utter failure, plain and simple. There are so many websites out there that do far more complex operation, and they seem to have very little problem. I wasn't involved in the "roll-out" of the government's healthcare website, so I know jack-diddly about the problems that they faced. But from what I know about websites, especially ones like that one, is that it's a simple matter of input from the user, and then a matter of storage of that input, and maybe some calculations along the way - all very basic stuff for today's world. I went to the website and the damn thing had major problems that made me think that it was trying to do a lot of on-the-fly operations behind the scene that wasn't syncing up correctly, maybe I'm wrong, but that was my feeling.
However, that being said, I cannot see why the website "failure" had such an impact on the "unrolling" of the actual healthcare change. They had a toll-free number to call and operators that would do everything over the phone, very nice people I might add. Why the site didn't simply display the toll-free number is a good question. Hell, maybe they could have simply had an online-chat window pop up. Again, I wasn't a part of the staff that was tasked with this website, so there are things that I don't know.
Politics; n. : A religion whereby man is god.
"The Obamacare sign-up site was a classic example of managers saying 'not invented here' and doing everything wrong, as described in Poul-Henning Kamp's Center Wheel for Success, at ACM Queue."
I mean, you folks at Slashdot should have called it the Affordable Care Act website then reminded us that it's also known as Obamacare. But to call it what it isn't in the first sentence of introduction is [very] unfortunate!
Disclaimer: I am neiter Democrat nor Republican.
/.
news to someone, stuff you don't care about.
Most articles linked to on slash dot aren't very interesting or are pushing something, but this article was interesting and a good use of my time . +1
A problem with business, that is, not a problem of business. All too often I see business requirements for software that specify how things must be done, rather than specifying what is to be done. The problem is that the business requirements are being written by businessmen who have no training or experience in writing software, so they no more know how things should be done when writing software than (according to those self-same businessmen) the software developers know how things should be done when running a business. The solution is always the same: let the business people lay out what they want done, and let the software developers figure out how to do it.
This isn't the only place we've seen this. The Pentagon and FEMA have been up to their necks in it for years. The process of getting government contracts is so bizarre and complicated that companies have evolved with "getting government contracts" as their only business model. So the companies that actually get the contracts are the companies that are good at getting government contracts (because they focus so much of their resources on the process), NOT companies that are good at delivering what the contracts specify. This is a natural by-product of bureaucracy.
Kemp is being unfair. I understand what this section is about, and he doesn't. A patient decision aid could just be a well-written article or web page. The UK NHS has patient information pages that would satisfy these requirements. There's no requirement for artificial intelligence.
"(1) PATIENT DECISION AID—The term patient decision aid' means an educational tool that helps patients, caregivers, or authorized representatives understand and communicate their beliefs and preferences related to their treatment options, and to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences."
"(2) REQUIREMENTS FOR PATIENT DECISION AIDS—Patient decision aids developed and produced pursuant to a grant or contract under paragraph (1)—
"(A) shall be designed to engage patients, caregivers, and authorized representatives in informed decision making with health care providers;
"(B) shall present up-to-date clinical evidence about the risks and benefits of treatment options in a form and manner that is age-appropriate and can be adapted for patients, caregivers, and authorized representatives from a variety of cultural and educational backgrounds to reflect the varying needs of consumers and diverse levels of health literacy;
"(C) shall, where appropriate, explain why there is a lack of evidence to support one treatment option over another; and
"(D) shall address health care decisions across the age span, including those affecting vulnerable populations including children."
http://townhall.com/tipsheet/christinerousselle/2013/10/21/obamacare-call-center-down-as-president-encourages-phone-registration-n1728960
The toll free number was also down a lot of time.
Charmingly naive, but naive.
The author of that article asks, several times in several ways, why the government always gets it wrong and the lasting solutions always come from the little guys.
The answer has less to do with the size of the organization than the number of organizations all pitching competitive solutions. Yes, a thousand 10-person companies are probably going to do a better job in the long run than a single 10,000-person company or government entity, on problems in the right scale. But you'll never hear about 9997 of those solutions because half of them are dumb and the other half, while not obviously dumb, are inferior in some critical way.
(Then why do we have big companies and governments? Because some projects are simply too large for a ten-person outfit. That, the author got right.)
It's called capitalism. It's not profitable to solve these complex software problems correctly the first time around because then the software companies would be out of the job of maintaining the deployed solutions.
"After stumbling out of the gate in early October, the nation’s new health-insurance exchanges are picking up steam. On the eve of the December 23 deadline for securing coverage that starts January 1, more than a million Americans have completed the enrollment process, according to the Commonwealth Fund. Just over half of the new enrollees (621,000) have joined Medicaid programs, and 525,000 have purchased private plans through the marketplaces.
The current tally for marketplace plans is a small fraction of the 7 million the government expects to chalk up by March 31, when the open-enrollment period ends. But as this chart shows, the total has quintupled in the past seven weeks, and has more than doubled in the past four, thanks mainly to brisk uptake in the state-run marketplaces. If these trends continue, the projection for March 31 is still well within reach. "
--MSNBC
As interesting as it is to guess why another waterfall government IT project failed, I'd rather know why we aren't using wheelbarrows with wheels closer to the center. As a guy who has mostly used wheelbarrows for moving concrete, having the wheel support the majority of the load instead of half (or whatever) sounds like a huge advantage.
The Wikipedia article on wheelbarrows suggests "However, the lower carrying surface made the European wheelbarrow clearly more useful for short-haul work." Does that reason really pan out? Can anyone think of any other reasons?
But I think we all know that a car analogy is needed to explain the healthcare.gov mis steps. Namely, the Democrats drove the law through all obstacles, but then after the elections, they ran out of gas. The Democrats wanted to buy more gas, but the Republicans said the engine is broken and should be replaced. The Democrats asked what engine to buy, but the Republicans had no idea except not from Solyndra. While they were arguing about it, Obama said that the midnight train of 2014 was approaching. The Democrats asked the Republicans to help push the car because it at least helps some people get healthy, but the Republicans said it would be faster if they spilled oil on the road and got rid of taxes on oil. Then the wheels came off the healthcare.gov website.
1. As it was, the US healthcare system was a joke to the rest of the world. The democrats looked at the (gawdawful) mess, and tried to fix it. The republicans took what was reasonable, then chopped the best parts of it, and then what was left was passed (pressed with protests galore) into law. Then the Republicans tried to kill it (at least 49 times, I lost count).
2. As implemented, this watered-down, weak-kneed, still a joke of a health system is being implemented very badly. I've seen and used public health care. The one I used is massively better than Obamacare is trying to be. I've seen complex implementations of online real-time systems. I've seen large companies run by MBA's who schmooze politicians and try to implement 'IT Stuff'; Computer website something. Its like mall security trying to be seal team 6. The takeaway would be that business schools would take it as a lesson to let people who know lead. But that will never happen.
There are already lots of US laws and regulations that mandate how IT is supposed to be procured and implemented by the US Government (see, e.g., the Clinger-Cohen Act.)
Each of these mandates came about because Congress became tired of funding IT projects where the money just vanished and no IT system was stood-up.
The botched implementation of the ACA website raises questions not of "wheelbarrows," but how and why EOP/DHHS managed to bypass or ignore existing mandates.
Regardless of the politics, if Amazon had been selected through a sole-source justification the web site would have been created using a design pattern and it would have worked and scaled from day one. This approach is obvious for those who have worked in government for years. One has to ask why this simple and effective approach was ignored. The competence and agenda of those in charge needs to be questioned from the top down!
True, the code for that ill-fated website was really out-of-this-world in term of lousiness, but in the whole scheme of things the developers play but a very minor role in that disaster.
The ones who should shoulder the most blame are the people who awarded the entire project (without proper bidding process) to a totally incompetent company due to political reason ( read: cronyism )
The ones who should shoulder the second largest portion of the blame are those who, despite receiving untold millions in funding, they hired totally incompetent people to be in charge of that project.
Muchas Gracias, Señor Edward Snowden !
I'm sympathetic to PHK, but I could never have written this piece myself without commenting on a single disadvantage of the Chinese wheelbarrow.
You seem to be stuck with one of three problems:
* using a small wheel that won't easily roll over path obstructions
* having the wheel intrude into the barrow, obstructing tending or shifting the load
* having a large wheel under the barrow with a high center of gravity (what could possibly go wrong?)
The large carts at my nearby Costco are set up so that they won't pivot at the front (only at the middle). This is fine if you can find space to make a 90 degree turn on the spot. It's not at all good for creeping around a tight bend. Moreover, you've got both the front and back end swinging at the same time—which is the number of places you can visually attend plus one—so your chances of taking down some rickety display item are fairly decent if try to wing it.
Furthermore, nothing prevents two people from grabbing different handles on the European wheelbarrow. Also, PHK is wrong about the weight distribution. With a heavy load, it's customary to pile as much as possible up against the lip that protrudes over the front wheel in many front-wheel designs. I'd guess an European wheelbarrow front-loaded with wet clay has about a 4:1 lever arm in vertical displacement of the handle compared to vertical displacement of the load.
Wouldn't a Chinese wheelbarrow be something like a small unicycle with saddlebags and a trailer hitch? If you need to clear some brush (where only your wheel fits the path), you've got no way to jack the suspension under the load, either.
And wouldn't it be much harder for short and tall people to share the Chinese design unless equipped with some sort of adjustable handle. Somehow I'm just positive that the Chinese design from 1000 [BC|AD] comes replete with ergonomic dongles for the comfort of whatever schlep needs it next.
But then, with a billion identical people growing rice on ten million identically manicured terraces, I'm sure the Chinese design is a total win.
or at least permit states to set up their own single payer systems. Problem solved.
True, the code for that ill-fated website was really out-of-this-world in term of lousiness, but in the whole scheme of things the developers play but a very minor role in that disaster.
The ones who should shoulder the most blame are the people who awarded the entire project (without proper bidding process) to a totally incompetent company due to political reason ( read: cronyism )
The ones who should shoulder the second largest portion of the blame are those who, despite receiving untold millions in funding, they hired totally incompetent people to be in charge of that project.
It was awarded to a company that specialized in landing government contracts. To the person in the bidding process, it would appear to be awarded to a company with a proven track record.
Now that it's all over, we know that that company over-promises and under-delivers. What is new? Not much, except that now you have yet another excuse to bitch about your country, making you seem even more "American" as it is viewed from the eyes of the world.
I'll bet there's 20 posts already about how the real crime is the nationalized health care, something that is laughable that a country with your spending on healthcare and your resources can't provide to it's citizens. America is starting to not look like the land of the free, but the land of the feeble-minded and petty.
There was no "wiggle room" for incremental development, prototyping, or staged roll outs. Congress is a perfect example of rule by a committee of unqualified managers. And the public officials in charge? Many were in over their heads as well. The few who may have had a clue were constrained by the law. As public employees, in fact Federal Officers, they took an oath of office to uphold the laws of the U.S. The good ones did the best they could but they had little choice. The law said it would go live on a certain date, and if not the law was violated.
Something to remember.
putting the 'B' in LGBTQ+
I mean, you folks at Slashdot should have called it the Affordable Care Act website then reminded us that it's also known as Obamacare. But to call it what it isn't in the first sentence of introduction is [very] unfortunate!
How about we call it National Romneycare?
> It was awarded to a company that specialized in landing government contracts. To the person in the bidding process, it would appear to be awarded to a company with a proven track record.
In other words, the entire system is corrupt just as the OP implied.
A Pirate and a Puritan look the same on a balance sheet.
I see this phenomenon a lot. Corporate executives tend to be unimaginative when they envision new technology, they look at a job someone is doing and try to imagine ways technology can replace the person. Sometimes they do it backwards, the take a new technology and ask "what existing product can we replace with this or add this to?"
Then you get idiotic products like driverless cars. Most of the design decisions that went into cars had a lot to do with the fact they were going to have a human driver, could you imagine if they'd just said "we have buggies and carriages that work well, so we'll keep them and just automate the horse?" Or with google glass: "we've got a way of putting a screen on someone's head, maybe we can replace the screen on the iPhone with it?" No, the iPhone works much better the way it is, you can't just shoe-horn a new tech into an existing device because it sounds cool. That's putting the carriage before the horse.
On top of that, a lot of executives and politicians are so out of touch with the actual details technology development, they end up proposing things right out of The Jetsons because that's all the more they could bother with doing research before they decide to spend millions or billions of dollars on some project.
The medical insurance program for people 65 and older has been working for 50 years. There are glitches that could use improvement, but in the grand scheme of things, it works rather well and has an established track record. Using it as a foundation to develop a framework for adults between 21 and 65 is a no brainer. If that's O'care, my bad for not reading the tome of legalese.
And show a little professionalism. Use a functional title, such as: (American or U.S.) Medical Security (Insurance); anything but some misdirecting new-speak or some guy's name.
The version of the wheelbarrow with the axle directly under the load normally has 2 fairly large wheels on either side of the bed. This allows for most of the weight to be put on the wheels, while having a better turning radius and better stability.
The main disadvantage is that the wheelbarrow is bigger and wider which makes it hard to maneuver in crowded spaces.
For the money they have spent on the web sites it would have been cheaper and faster by a factor of 10x to hire an army of people to do the applications on paper. We already have the people: Literally the army or you could have the census people do it. No need to waste hundreds of millions to billions of dollars on web sites like this.
Not only that, it was awarded to a company with a proven track record of miserable failure. On no less than TWO large "registration system" projects. But as you say they were masters of greasing skids, paying bribes, and probably bought the finest meals and best looking hookers in town.
This is why the entire Utopian "Progressive" idea of high minded super intelligent people making informed decisions for the masses is flawed from the start. There are no such people. People are greedy, and act in their own self interest FIRST, the interests of power for their "group" second, and the needs of the people last (if it all).
Personally, I am faced with a FORTY PERCENT increase in premiums, HIGHER DEDUCTIBLES, HIGHER CO-PAYS - and for what? The same exact pool of Doctors I had before. I'd pay that forty percent if the ranks of the uninsured were going to decline - I am a compassionate person - but in fact, they have gone up - by some two to three million already, with more coming next year.
Murphy was an optimist
But most companies in the field have poor track records also. It's a field that's hard to get right.
And I bet your new coverage covers more categories, even though it's more money.
Table-ized A.I.
But most companies in the field have poor track records also. It's a field that's hard to get right.
In what field would that be? Sucking at the government teat? An insurance companies web site - funny thing - does exactly what Healthcare.gov does. Had any of the major insurers committed the architectural, design, programming, security, and implementation crimes this project did, there would be hell to pay, Congress would be screaming for an investigation, and we would be hearing for months how those evil, greedy, horrible, nasty insurance companies were only interested in greed, and didn't care about our welfare.
However, since it's the government, I predict the whole system will get a massive taxpayer "bailout" no doubt to "save jobs".
And I bet your new coverage covers more categories, even though it's more money.
You would lose that bet. My post menopausal wife has birth control coverage. What kind of idiot government bureaucrat doesn't know what menopause is? That's the only difference we can find after an exhaustive examination of the policy. Bear in mind this is a small group policy, not individual catastrophic coverage, and that all of the employees of the company are facing a forty percent premium increase. These folks have families, small children, and not a lot of extra cash lying around because times are tight, prices for basic necessities are higher, especially energy, thanks to the war on energy producers. They are all, without exception, asking the same questions:
Why is Obama waging war on the Middle Class? Why is our government doing this to us?
So I'd be very careful running around defending this crap, you might get punched in the nose.
Murphy was an optimist
Like Bush's Medicare D program system screwups? (Which Republicans conveniently forgot about.)
I'm sure there are things that don't apply to any given individual per anatomy or life style, but by pooling them, then risk is spread. And I bet your old plan had some significant and important gaps that you are not sharing with us. I'd bet money on it.
Because naked capitalism failed to adequately cover people, going for only the profitable low-hanging fruit. And polls have consistently shown that only roughly 35% to 40% of people were happy with the existing system.
Table-ized A.I.
Like Bush's Medicare D program system screwups? (Which Republicans conveniently forgot about.)
My example was referring to private industry .vs. government. You've proven my point. Under either "party" the administration and execution of large social programs is terribly inefficient and wasteful. I also notice that you are trying to brand me an evil heartless rethugnican because I disagree with your views. Did I say what my affiliation was? Will you call me a racist next? So predictable. Can't prove you point? Start changing the subject, and then hurl insults.
There was absolutely nothing wrong with the insurance we had. Nothing. No gaps. All the employees were very happy with it. Everyone had input during the plan selection process, and employees had lots of options to choose from. What we have now is "thou shalt take the plan Uncle Sam has chosen for you" like it or not.
Because naked capitalism failed to adequately cover people, going for only the profitable low-hanging fruit. And polls have consistently shown that only roughly 35% to 40% of people were happy with the existing system.
Please cite this poll. Polls "consistently show" very little.
Because naked capitalism failed to adequately cover people,
At the moment, more people are uninsured as a result of ObamaCare than before. If the Administration would be honest about the actual numbers, we'd know how many. The lack of honesty about the numbers is proof that they are very bad.
.vs. actual real life experience. Have you sat in a room and informed employees that their insurance cost is going up 40% and they are getting less coverage? I doubt it. That's what's happening in the real world with this program, in small businesses (also known as job creators) all over the country.
Have you shopped for group insurance coverage? That's the most likely explanation for your ideological argument
As I have explained in other posts, I would pay more to cover the less fortunate - I am a compassionate person. What's happening with this program is I am paying more for less coverage, and more people are uninsured. EPIC FAIL from start to finish, and the Democrats own this thing, due to their stubborn and childish inability to work together with people and get things done. "My way or the highway" is not how one accomplishes anything in life except failure.
Murphy was an optimist