The Billion-Dollar Website

stoborrobots writes: The Government Accountability Office has investigated the cost blowouts associated with how the Centers for Medicare & Medicaid Services (CMS) handled the Healthcare.gov project. It has released a 60-page report entitled Healthcare.gov: Ineffective Planning and Oversight Practices Underscore the Need for Improved Contract Management, with a 5 page summary. The key takeaway messages are:

• CMS undertook the development of Healthcare.gov and its related systems without effective planning or oversight practices...
• [The task] was a complex effort with compressed time frames. To be expedient, CMS issued task orders ... when key technical requirements were unknown...
• CMS identified major performance issues ... but took only limited steps to hold the contractor accountable.
• CMS awarded a new contract to another firm [and the new contract's cost has doubled] due to changes such as new requirements and other enhancements...

Comments

Technical People

[TechyImmigrant]

Non technical people are not competent to commission technical work from technical people.

If you (as a government or large company) don't have your own technical people on staff to oversee the process and comprehend or write the specs, you're doomed. The contractors know well how to milk a cash cow, simply by adhering to the specs written by people who don't understand how to write specs.

Re:Technical People

[Chrisq]

Non technical people are not competent to commission technical work from technical people.

If you (as a government or large company) don't have your own technical people on staff to oversee the process and comprehend or write the specs, you're doomed. The contractors know well how to milk a cash cow, simply by adhering to the specs written by people who don't understand how to write specs.

Sadly this is true, but it shouldn't be. Technical people should have the professionalism to analyse requirements and check that the requirements fit the purpose. Unfortunately the way of the world is that technical people would be quickly shuffled out of the way by sales and marketing if they started to reduce revenue by telling a customer what they really wanted instead of what the spec says.

Re:Technical People

[Anonymous Coward]

Unfortunately the way of the world is that technical people would be quickly shuffled out of the way by sales and marketing if they started to reduce revenue by telling a customer what they really wanted instead of what the spec says.

Truer words have never been said.

I anonymously mod you up +5.

Re:Technical People

[Anonymous Coward]

Technical people should have the professionalism to analyse requirements and check that the requirements fit the purpose.

Typically, they do. However you overlook one key component of this and then dump the blame completely on sales & marketing (not entirely unfair, they are typically huge scumbags). This requirements analysis and design phase costs more money than development. The cost for architecting software is far higher than simply building it. Clients typically do not want to pay for this and assume they know how to do it themselves. This is exactly what happened to healthcare.gov.

I have seen this happen with both state government and private corporation projects alike. I've never done a federal project, so I can't speak first hand about that, but I know people who have and they report the same is true when working for a federal agency.

So yes, part of the blame definitely should go to the sales & marketing bastards, but a very large chunk is on the client for not wanting to fork over the cash up front. This almost always results in spending even more cash later on to fix what people think are bugs but are really design failures which result from poor architecture and design processes.

Re:Technical People

[BringsApples]

Dunno man, I feel what you're saying, and agree. However, a quick look at the site will prove that there's more than just milking a cash-cow going on here. If you check out this page for instance, you'll find that there isn't any information regarding anything at all, just a bunch of random Latin.

Google translate thinks it's English, but it's Latin. Here's what I found it to mean:

Lorem ipsum dolor sit amet pretty easy. Unfortunately, lots of orange gear, but every time a commercial truck.
Gets certain warm-up is a lot of life from which the film's style is. I'd now look at a wide range of law enforcement.
Residents drink
Currently, my, lump in the throat, it's the sauce.
To learn how Warren financing, but the emotional temperature, the element of surprise.
Tomorrow protein recipes. He was smart, maybe he was always in need of a lake in Japan.
No matter who or how inexpensive and easy-to-time only. In order that on Monday, but the laughter of a wide range of airline, travel agency employee is the ugly, and not before or it's just the likelihood of the company. In fact, it has been said it is in the interests of the quiver.
Unfortunately, the keyboard of the United States in the very soft impact.

So it looks like this page, a page that many would go to looking for advice on what to do since no doctors take medicaid now (Many are no longer accepting obamacare at all), is left blank (feeling that perhaps what's there is some default junk included with whatever web-hosting software they use). Seems like someone would have done something to fix this by now.

Re:Technical People

[david.emery]

PLEASE Mod Parent up! I've been working on large government funded systems (defense and commercial) for 35+ years, and in my view programs are screwed from the beginning by overly-aggressive schedules for the up-front work. When the incomplete/absent requirements/architecture/design results in coding, or more often test and integration delays, they'll find more money and time. By then, it's too late.

Back when we had explicit waterfall milestones (requirements review, preliminary design review, etc), we could tell at PDR a program would fail as a result of incomplete or even incorrect requirements & architecture.

Unfortunately, the adoption of "Agile" in these organizations has reinforced the culture of "We don't need no stinking requirements! We can draw an architecture on a whiteboard in an afternoon", resulting in systems where you really can't say anything intelligent about how long it will take to complete them, because you have no fscking idea what "complete" actually is.

And this -should not be a revelation-, at least to anyone who has read "Mythical Man-Month," which will be 40 years old next year. https://en.wikipedia.org/wiki/...

Thank God I'm getting ready to retire.

Re:Technical People

[Anonymous Coward]

Note however there is one very important point missed in all the rhetoric... That of changing specification coupled with muddied/stratified change management. This issue sits squarely on CMSs shoulders and is absolute poison to any IT project of any significance...

Re:Technical People

[Metabolife]

Absolute power corrupts absolutely. Bankers without oversight lie and steal. CEOs without oversight lie and steal. Techs without oversight lie and steal. Not everyone will follow this path, but you will always have a few.

Re:Technical People

[LordLucless]

Sadly this is true, but it shouldn't be. Technical people should have the professionalism to analyse requirements and check that the requirements fit the purpose.

Most I know do. The problem is that they're not sufficiently expert in the domain (in this case, health care) to determine the purpose, and the purpose the client gave them is wrong.

Specs aren't just some bureaucratic hoop that needs to be jumped through to get a developer to sit down and code, and they're not something a developer can just wing, and get right anyway, because they already knew what they were and were just being anal about getting you to write down.

They are important, and if they're not done properly, the dev will likely spend a lot of time doing the wrong thing correctly, and you will be billed for it.

Re:Technical People

[Anonymous Coward]

Unfortunately the way of the world is that technical people would be quickly shuffled out of the way by sales and marketing if they started to reduce revenue by telling a customer what they really wanted instead of what the spec says.

Disclaimer: I'm a software engineering contractor that works on contracts for the federal government.

A solid majority of the contractors (the grunts doing the work) I've worked for/with in my career want to get the job done and do it well. Sales/marketing has a say at contract award and for mods, but during the actual work we rarely, if ever, hear from them or take guidance from them. The people commissioning the work (the government) usually have no clue what they want and, if presented with multiple solutions of varying risk and value, they still have no idea how to make a decision. The most altruistic contractor still, at the end of the day, needs to know loosely what the success criteria are...the government half the time has vehement disagreement about that among themselves and never comes to a unified decision.

The GAO's report is exemplar of what I've experienced...the government has no clue what requirements are or should be, how to execute, how to manage a contract. My contracts have routinely consisted of us contractors drafting requirements and handing them over to the government, only to have them ask us if they were sufficient and would accomplish the (loosely defined) task, then sign them, hand them off to contracts and they appear on our desk weeks down the line modified by contracts to be 1) more generic, or 2) incorrect. The government oversight at the program manager level is almost entirely a rubber stamping process.

Re:Technical People

[oneandoneis2]

"Lorem ipsum" is industry standard "filler" text for incomplete web pages - typically used to show clients what a page will look like when it has some useful content.

Not that it isn't appalling that it's appearing on a page in production, but it isn't "random Latin" - there are even browser extensions to make it easy to C&P for you.

Re: Technical People

[AvitarX]

By obama care do you mean private health plans ?

Re:Technical People

[trout007]

Part of the problem is because of how contracts are awarded. A business is allowed to use their brains and not go with the low bidder because they obviously don't understand the job or have a history of being a pain to work with. The government is not allowed to do this. They have to write a perfect requirements document and put out an open request for bids. If anything in the requirements document is not perfect the contractor is legally allowed to mess it up on purpose and charge for fixing it. This type of behavior doesn't happen as often in the private sector because those firms get a bad reputation and go out of business.

Re:Technical People

[Anonymous Coward]

It isn't just the abuse from consultants and contractors, which don't get me wrong is huge, it is the culture.

In government you have political masters. They issue the orders from on high, and they go down the chain of yes men, that assure everyone above them that everything is fantastic and yes we would love to do whatever their bidding is (no matter how wrong or idiotic it may be). They will promise stupid time lines, based on ??? nothing really other than maybe fiscal timetable. Features? Well we can do everything! You want totally conflicting features, we will find a way! All this slurry of shit eventually slides it's way down to the peons who actually have to do the work, and somehow find a way to put it all together. Then every now and then, change requests will come altering something fundamental without regard for cost or timetable.

Currently working on a project where they want us to assume certain technological features will be available when currently they don't even exist, and may never exist if they fail to create the technology, or it is delayed, or they run out of money, or decide not to do it, etc... Scope is basically nebulous as everything and nothing is in scope. Whole pieces are missing, just assume that it will eventually get done in the future. Details? Oh we have none, we are still figuring that out. Legal authority, oh well we are still waiting for that to be figured out. Policy, or those changes are coming soon... You just finish your automation and we'll figure all the details out later or as we go... If stuff doesn't end up being ready on time for technology or decisions and the like, well we'll just set up a non-automated manual process to handle it in the interim, we must push forward! You know all those fun programming ideas of things like Waterfall, or RAD, or whatever... well throw all that stuff out the window, and lets do everything all at the same time for a huge project and see what happens! What could possibly go wrong? Oh and UAT? Yeah we are going to have to get random project team members to do it over a couple of days because we have to go live by that date...

So no, do not blame the technical people. Their choices are do the above mess, or find employment elsewhere. Trying to explain up the ladder that perhaps it should be done in a different manner is futile, and a good way to brand yourself a negative Nancy and limit your advancement prospects. I have been that guy. You accomplish nothing but get targeted by the ire of management, who will find some new guy who says yes to everything they say.

On top of that (though not relevant to the Obama example), a year or two into a large project, your political masters change, and kill the entire project, or change the requirements enough so that you might as well start over again. While few there are plenty of talented technical people in government, who would love to do good work, they are not always in a good environment to be able to do so however.

Re:Technical People

[Wycliffe]

Sadly this is true, but it shouldn't be. Technical people should have the professionalism to analyse requirements and check that the requirements fit the purpose.

I have a friend who bids government contracts (highways,schools,sewage plants,etc).
He says that there is no advantage to fix the contract before the bid because then all the other bidders get those same cost savings.
Also, you also can't have multiple people bidding and making suggestions on what to change as then you have no way of comparing the resulting bids.
Likewise, after the bid, you can tell them how to fix it but then you're fighting an uphill battle because you're basically trying to change the contract at that point.
So it isn't really about professionalism and taking the higher ground but more an effect of the entire bidding process.

Re:Technical People

[sunking2]

Oh please. It's just another example of fleecing a government contract. This one being a no brainer to do on given it's importance.

Re:Technical People

[The Grassy Knoll]

"Lorem ipsum" is industry standard "filler" text for incomplete web pages

But it never occurred to me to pop it into Google Translate! Many thanks, BringsApples!

Re:Technical People

[JWW]

The GAO's report is exemplar of what I've experienced...the government has no clue what requirements are or should be, how to execute, how to manage a contract. My contracts have routinely consisted of us contractors drafting requirements and handing them over to the government, only to have them ask us if they were sufficient and would accomplish the (loosely defined) task, then sign them, hand them off to contracts and they appear on our desk weeks down the line modified by contracts to be 1) more generic, or 2) incorrect. The government oversight at the program manager level is almost entirely a rubber stamping process.

Exactly. But what I love most about the study is how this ineffective oversight will be solved by ..... MORE oversight!

Re:Technical People

[bitingduck]

Non technical people are not competent to commission technical work from technical people.

If you (as a government or large company) don't have your own technical people on staff to oversee the process and comprehend or write the specs, you're doomed. The contractors know well how to milk a cash cow, simply by adhering to the specs written by people who don't understand how to write specs.

This is a part of why the government created Federally Funded Research and Development Centers (FFRDCs). DOE created them during WWII because they saw a need for an organization that had more flexibility than the government (they're all privately operated) but would act as an expert exclusively on behalf of the gov't. They get their money entirely from a single agency and most do a combination of direct work ("we'll do it in house") to main expertise and procurement ("we'll spread it around"), recognizing that to be good buyers they need to have a good deal of internal expertise. Most of the FFRDCs are run by DOE (they started as the weapons labs and science centers to develop knowledge of elementary physics for weapons research), but many agencies have them. It's probably time to create one for government software development, or assign is as a role to a few existing ones.

Re:Technical People

[I'm New Around Here]

I anonymously mod you up +5.

Wait. How'd you do that?

Re:Technical People

[I'm New Around Here]

Thank God I'm getting ready to retire.

Stock up on essentials now. Or even sell everything and retire to a warm island. It's only getting worse here.

Re:Technical People

[Cludge]

This is a nice way of saying that the governing bodies of many large organizations are staffed by idiots. I recently did technical work in Asia, as a contractor for a well-known company with a global presence. They've been in business for more than 100 years. They have a beautiful website, filled with inspiring photos and pages and pages of uplifting copy, talking about their important altruistic mission. So I naively thought they would be experts at their core work. What I discovered was a company run by greed-driven overlords at the top, and clueless staff at almost every other level. Technical proficiency was clearly not an valued commodity -- it was all about maintaining the facade of being the good guys, saving the world. I was shocked by how much they relied on boiler plate to write nearly every document, and the serious lack of technical skills necessary to do their job. The few technically competent people were marginalized, while the loud, pushy "A" types in charge of daily operations mainly worked at protecting their own status in the company. What was truly sad to see: how the recent graduates, hired to do the core tasks, had their enthusiasm and can-do attitudes suck out of them by the continuous stream of obfuscation, redirection, and soul crushing obliviousness. I guess some things never change.

Re:Technical People

[I'm New Around Here]

Page has been taken down.

Re:Technical People

[Anonymous Coward]

sales & marketing (not entirely unfair, they are typically huge scumbags)

I'm a web developer who works in the marketing department of a large organization. The people in my department are smart professionals who are tasked with keeping the organization on-message and professional in its communications with the outside world. This is an immensely difficult herding-cats kind of job because so many different departments and individuals are communicating with the public every day, and many of them do so in a way that unnecessarily casts the organization in a negative light. Sometimes it's just a matter of professionalism (poor grammar/spelling, rudeness, childishness), and other times it's because they're uninformed and telling people things that simply aren't true, which ends up confusing everyone.

Our department has a broader and deeper understanding of this organization than anyone else here, including the top leadership. We're the ones who have to continuously remind everyone else of the organization's guiding principles and priorities. And every time someone sends out yet another bulk email to 20,000 people in pink Comic Sans containing information that was no longer accurate as of 2007, we're the ones who have to beg them, yet again, to run their communications by us before they send them out. In fact, how about we just start sending your materials out for you? We'd be happy to. No, really, it would be our pleasure.

Contrary to common opinion, that's what a lot of marketing jobs are really like. Maybe some marketing people are scumbags, but not the ones I work with.

Re:Technical People

[Anonymous Coward]

> The cost for architecting software is far higher than simply building it

Say what? This makes no sense. How is nobody else commenting on how backwards this is? Using colorful language "simply building it" to characterize a falsehood, doesn't make it true. Building out a complex system is the only way to find undocumented or unknown conditions and redesign interfaces to deal with that. You don't usually "rearchitect" the whole project because 1 resource has a snag, but investigation and rework NEVER overruns the cost of implementation. It IS the cost of implementation.

Re:Technical People

[Anonymous Coward]

Unfortunately, the adoption of "Agile" in these organizations has reinforced the culture of "We don't need no stinking requirements! We can draw an architecture on a whiteboard in an afternoon", resulting in systems where you really can't say anything intelligent about how long it will take to complete them, because you have no fscking idea what "complete" actually is.

And this -should not be a revelation-, at least to anyone who has read "Mythical Man-Month," which will be 40 years old next year. https://en.wikipedia.org/wiki/...

Thank God I'm getting ready to retire.

You've just described most government contractors business model. If they deliver a piece of software that is bug free and satisfies all the customer's requirements, that is actually frowned upon. If a project delivers on time and under budget, people get fired because leadership considers the project a failure. Finished on time? That means no contract extension. No bugs to fix and the product is user friendly and easy to maintain? No O&M contract opportunity. Satisfied all the requirements? No follow on contract opportunity. Because of the overhead of the army of managers employed, they actually lost money.

Working for a government contractor, it is definitely in your best interest to write shitty code, screw off as much as possible, slip deadlines. It is in your best interests to suck at your job.

Re: Technical People

[Anonymous Coward]

The solution is to take away the power. Keep governance as close to the people as possible.

Re: Technical People

[Anonymous Coward]

They mean government meddling in healthcare.

Re:Technical People

[perpenso]

Not that it isn't appalling that it's appearing on a page in production ...

Well the site is not complete, its still under heavy development. Remember that the only part that got "finished" was the sign-up portion.

Re:Technical People

[poached]

Agile is not about not needing requirements. It's about the fact that any complex project will have requirement changes and the project and the people on the project need to deal with those changes quickly. It's like that saying, "the only constant in the world is change." Rather than avoiding change and try to spec out everything in advance (which cannot be done), embrace it and deal with it so it minimizes disruption.

There are meetings to gather requirements, but those meetings are two-way; you also present and let clients play around with whatever you have and gather feedback and incorporating those feedback into the next iteration. By the time you deliver the product, there shouldn't be any surprises to the client about how the product behaves. Both parties are happy with their experience.

Re:Technical People

[david.emery]

Kool-aid...

Re:Technical People

[Dr. Evil]

Last place I work was run by millenial developers.

They told me "the code is the documentation".

I asked them "ok, what are the requirements?"

They gave me a blank stare.

"How can we write code until we know what we're trying to accomplish?"

"You want to write a 300 page Word doc that nobody's going to read?"

I was at a loss... "no, but a doodle on a napkin might be enough. I need *something*"

Possibly the most educational 6 months of my life. Didn't accomplish much, everything got thrown out for not fulfilling the non-existent requirements. Despite the maddness, the people were nice. It took a long time for me to really understand what was going on. In the end, I was glad to leave the gig. The company was made of three one-man developer shows who didn't understand that the stuff in the heads of three developers were separate and unrelated requirements documents for separate projects. It was impossible to contribute to any project without reading the mind of the developer.

They measured their own success in achiving goals after they were accomplished. Which meant that the stars shone, but contributors rarely had successes.

Re:Technical People

[Anonymous Coward]

In theory, yes, but Agile is very rarely properly implemented. You still need to gather initial requirements. You also need requirements to not be constantly changing on a basis that's impossible to keep up with. And in order to release a production-worthy product, you need them to not change right up to, during, and after product launch.

This is all where shit goes wrong, and where it went drastically wrong with heathcare.gov.

Re:Technical People

[Anonymous Coward]

who has read "Mythical Man-Month," which will be 40 years old next year.

Maybe if we both read it, it'll only be 20 years old.

Re:Technical People

[Bartles]

You do realize that Cynthia McKinney was the Green Party nominee in 2008, right? For me, it would take a lot for them to right that wrong and get my consideration again.

Re:Technical People

[I'm New Around Here]

My proposition isn't about getting what you want, directly. It is about getting the current system of Dem/Rep out of shared power. For that, you need every fringe and near fringe voter to choose against the current system. Take the 20% far left, and the 20% far right, and make them believe they can change Washington politics, and we will see a change in Federal control.

The two groups aren't aligned on many things, but the issues common to both are privacy rights and government spying, our latest wars, and bailing out big business. Don't make issues of social aspects, because that drops half the voting pool you are looking for. Just get in a new system to break the back of current corruption and cronyism (again, from both Dems and Reps) and let America see what they have lost over the last several decades.

Re:Technical People

[TechyImmigrant]

> The cost for architecting software is far higher than simply building it

Say what? This makes no sense. How is nobody else commenting on how backwards this is? Using colorful language "simply building it" to characterize a falsehood, doesn't make it true. Building out a complex system is the only way to find undocumented or unknown conditions and redesign interfaces to deal with that. You don't usually "rearchitect" the whole project because 1 resource has a snag, but investigation and rework NEVER overruns the cost of implementation. It IS the cost of implementation.

Yet it is true.
My single data point is and average of ~3 years of thinking about how to build a system to ~6 months of building. It has never been a mistake to think through the whole thing from as many angles as you can and not commit to build until you know everything fits. I could spend 6 months thinking, 6 months building and 3 years fixing and patching, but no one is happy with that.

Re:Technical People

[Bartles]

Yeah, that's all great. But they nominated Cynthia McKinney. If it had been David Duke would you be saying the same thing? Ultimately, the candidate matters.

Re:Technical People

[TechyImmigrant]

> since no doctors take medicaid now (Many are no longer accepting obamacare at all),

That makes no sense whatsoever. Medicare is not Obamacare (or the Affordable Care Act to name it properly). Medicare predates the ACA by many years. No one goes to the doctor with an obamacare. They go to the doctor with an insurance plan. The doctor has no way to differentiate that plan obtained through an ACA exchange from any other plan obtained through an employer sponsored plan. They look the same to the doctor. You don't get a card that says Obamacare on it. Mine says Bluecross/Blueshield.

Re:Technical People

[TechyImmigrant]

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Re:Technical People

[tomhath]

It depends on what you mean by "specs". Ideally the organization commissioning the work has subject matter experts who know what they want, but don't try to dictate how to do it. They should have enough technical people on staff or on contract to review the proposed implementation.

The real problems start when either non-technical people try to do the technical design, or technical people try to guess what the application should do. In the case of healthcare.gov, nobody really know what they wanted. CMS had no experience running an insurance exchange.

Re: Technical People

[TechyImmigrant]

>They mean government meddling in healthcare.
How does that work? How does a doctor reject an insured patient because 'government meddling'? Do people have special 'government meddling' marks on their insurance cards so they can be singled out? I think not.

In programming this would be called a type mismatch. In the normal world it's called something much more offensive.

Re:Technical People

[I'm New Around Here]

I'd say it unless they nominate Hillary Clinton in 2016. I don't care what the candidate is like personally. I just want to break the deadlock we are living under right now.

Besides, it's not like they are going to be able to do anything anyway. Congress certainly isn't going to change enough in one election allow it. But it will eventually change if my split ticket won in 2016. Basically, long term, it is the only hope I see for the country, and it's only a glimmer at that.

Re:Technical People

[Anonymous Coward]

You seem to have misunderstood my point. I meant the cost in dollars is far higher to do a requirements and design phase first, as architects bill at a much higher rate than developers.

However, you still went on to spew a bunch of bullshit nonsense, and the reason no one has commented about it being backwards is because it's not. Would you build a sky scraper without first having plans drawn up and survey work done? Of course not! There's a massive amount of work that has to be done first before you can even start building. What if the ground is not stable enough to support the weight of the structure? You end up with a leaning tower of Pisa situation. Should we use steel instead of concrete? Glass or stone/concrete exterior? What sort of HVAC needs will this building have?

The same is true with any complex system. The whole "fuck it, let's build it and see what happens" approach is why shit goes downhill so fast, and you end up with massive cost overruns. That might work great for a dinky little iPhone app, but enterprise software is far more complex and the users are a lot touchier about shit not working the way they want. Sure you improve things in subsequent versions. This is how Agile methodologies are supposed to work. That doesn't mean you don't do requirements gathering. It also doesn't mean you eschew all attempts at some upfront design work. A fucking doodle on a napkin is better than nothing, and a well thought out architecture is even better.

Re:Technical People

[Anonymous Coward]

I agree that seeing all of the requirements upfront is very difficult, and that the waterfall model of software development is not always appropriate. Unless, of course, your requirements ARE LITERALLY WRITTEN INTO LAW. Oh wait, that is exactly what happened with this particular project.

If you were ever going to use a waterfall design model, it was now.

Re: Technical People

[AvitarX]

Like preventing me from doing medical work because I don't have training?

Doctors absolutly want government to meddle in healthcare, it allows them to charge more for things we all could do.

Re:Technical People

[luis_a_espinal]

Agile is not about not needing requirements. It's about the fact that any complex project will have requirement changes and the project and the people on the project need to deal with those changes quickly. It's like that saying, "the only constant in the world is change." Rather than avoiding change and try to spec out everything in advance (which cannot be done), embrace it and deal with it so it minimizes disruption.

There are meetings to gather requirements, but those meetings are two-way; you also present and let clients play around with whatever you have and gather feedback and incorporating those feedback into the next iteration. By the time you deliver the product, there shouldn't be any surprises to the client about how the product behaves. Both parties are happy with their experience.

I know that. You know that. A lot of people (specially people in power do not), which is what the OP was referring to.

Re:Technical People

[BlueStrat]

> since no doctors take medicaid now (Many are no longer accepting obamacare at all),

That makes no sense whatsoever. Medicare is not Obamacare (or the Affordable Care Act to name it properly). Medicare predates the ACA by many years. No one goes to the doctor with an obamacare. They go to the doctor with an insurance plan. The doctor has no way to differentiate that plan obtained through an ACA exchange from any other plan obtained through an employer sponsored plan. They look the same to the doctor. You don't get a card that says Obamacare on it. Mine says Bluecross/Blueshield.

That's for people like you who can afford to purchase insurance. Guess what card poor people and the working-poor whose employer has dropped providing health insurance and opts to pay the penalty instead carry under ACA/Obamacare?

That's right, Medicare/Medicaid.

I'll give you three guesses on what type of new patients GP doctors (the ones that haven't yet joined the increasing numbers of doctors who are retiring early to avoid this train wreck) are increasingly refusing to take on.

If you want to see how well health care is going to be run in the US under the ACA, just look at the VA and the recent news stories concerning it.

Strat

Re:Technical People

[Cyberdyne]

Technical people should have the professionalism to analyse requirements and check that the requirements fit the purpose. Unfortunately the way of the world is that technical people would be quickly shuffled out of the way by sales and marketing if they started to reduce revenue by telling a customer what they really wanted instead of what the spec says.

All too true, sadly. Tendering processes seem to exacerbate this: when a government control freak puts out a document announcing that the government is really determined to buy a chocolate teapot, whatever the price, the bidder saying "here's a stainless steel teapot which will do the job for $5" gets dumped, while the one saying "we'll stick bars of premium Swiss chocolate together with chewing gum for $1m" gets handed the million - then another million to patch the chocolate teapot with cement to make it hold hot liquids. Then it turns out they were actually needing a milkshake dispenser in the first place but didn't understand anything about beverages, so they have to start again from scratch, $2m down.

One large government contract I was involved in stipulated in minute detail exactly what error message had to appear when the service was offline. There was no SLA, however, not even an incentive in the contract to improve it! (This was the result of the previous project for that department having been a high-profile failure, with servers overwhelmed by the load. The bureaucrats responded to that with "next time, let's make sure it can show an error when busy!" rather than requiring scalability or load tests.) On the bright side, the winning bidder had the integrity to make sure it didn't fall apart anyway.

Re:Technical People

[ThatAblaze]

Unless the project is R&D or entirely new and unknown architecture should be the larger job. Building without planning really only works when you aren't working with a team.. so it hardly ever works in a corporate or government environment.. as demonstrated by the article.

Re:Technical People

[Anonymous Coward]

I work for the federal Government, and I would just like to say that this is false. We do not go with the lowest bidder on many occasions. In fact, here are some actual documents on the subject:
description of best value process - https://acc.dau.mil/CommunityB...
acquisition regulation mandating best value - https://acc.dau.mil/CommunityB...
Federal Acquisition Regulations indicating best value - http://www.acquisition.gov/far...

Re:Technical People

[TechyImmigrant]

You are continuing to conflate Medicaid with the ACA. Is your problem with Medicaid or the ACA?

> just look at the VA and the recent news stories concerning it.

Unlike you, I've recently had cause to spend a lot of time at a VA hospital. Unlike other hospitals, it doesn't fund itself by employing people to spend all day on the phone with insurance companies. The issues you pretend to understand around Medicaid do not have any relevance to how the VA hospitals are run. Trying to suggest that the VA hospitals are a model for how the ACA will work suggests you are not honest.

Re:Technical People

[Anonymous Coward]

speaking as a code-jockey and machine wrangler of over 35 years in high tech, you lost me at marketing...

Re:Technical People

[BlueStrat]

You are continuing to conflate Medicaid with the ACA

And you seem to be denying that Medicaid is part and parcel of ACA and where those who can't afford the higher costs of ACA insurers end up.

The issues you pretend to understand around Medicaid do not have any relevance to how the VA hospitals are run

They are both ran by government bureaucracies. Government bureaucracies are infamous for waste, fraud, abuse, and corruption. They are no exception and neither is the ACA.

Trying to suggest that the VA hospitals are a model for how the ACA will work suggests you are not honest.

Trying to suggest I am not honest because I see and recognize universal patterns of bad behaviors and poor results from government programs suggests you are defending a political partisan ideology rather than trying to solve real problems.

Strat

Re:Technical People

[Anonymous Coward]

Problem was that those laws were re-written, re-interpreted, and flat out changed right up to minutes before the launch date.

Sure waterfall should, in theory, have been appropriate here, but the fucking law is still changing even now, after the site launched.

Re: Technical People

[etienno5775]

The "adoption of agile" has nothing to do with this failure. On the contrary. The project was absolutly not agile. It was a bad waterfall project, date-driven, with a complete failure in requierements management, and lack of architectural ownership. There's no way a more waterfall approach would have saved this project. It would have killed it earlier. This is non-sense. A fixed date driven project, with a fixed + growing set of requirements is a nightmare to manage. It will necessary lead to much higher cost than planned. The audit report is totally wrong to state that a cost-plus-fixed-fee was a bad deal for CMS. For what I read, it seems like an excellent deal for CMS. A cost-plus-fixed-fee is the cheapest way to build a product while you do not have the final requirements. The real problem I see while reading the audit report, is that CMS was totally incompetent to manage and communicate with their contractors (CGI and Accenture), and totally incompetent in managing the requierement portfolio backlog. A fix-cost contract would have cost a lot more. A more agile approach, a portfolio management structure like in SAFe for instance, continuous integration, continuous delivery and test, would have helped a lot.

Re: Technical People

[I'm New Around Here]

It's called Medicaid and Medicare.

Many doctors no longer accept patients covered by such programs.

Re:Technical People

[Anonymous Coward]

Heh -- all reasonable except the implication implicit within the "Millennials" reference. I had a similar experience coding a DOD weapons control system, using ruggedized Data General minicomputers, in -- gulp! -- 1981

Conclusion: This will not change.

Re:Technical People

[Anonymous Coward]

The upside is that we really have nothing to fear from massive technological control systems from the government since they are fucking incompetent. Let's keep it that way. STOP HELPING THEM with your good ideas.

Re: Technical People

[david.emery]

I don't know if anyone associated with this project adopted anything they called "agile" or not. What I was saying was that I have zero confidence in "agile" as I've seen it either defined or applied, for products that are (a) large, (b) complex and/or (c) have substantial infrastructure (versus user-facing) functionality. This project had at least (a) large, and probably (c) substantial infrastructure requirements (that might have been solvable by judicious selection of the right commercial products.)

It should be a feature that a waterfall project could be seen to fail early, but for the PM whose career is built on continuing the project past his tenure, there's no advantage to her/him to fail quickly.

Re: Technical People

[etienno5775]

You have a good point on your idea of "failing early waterfall". But this is an utopia. Waterfall project will never have the feature to fail early, it is not part of their DNA. With the lack of transparency brought by the tunnel effect, Death March project will always happen in Waterfall.

My two cents.

a) Large: This is were you might have a point. When your project is large - large because of functional design issues, or large because it needs to be large? - collaboration might less effective without a sort of strong portfolio governance (agile or not). All project is difficult when *big teams that never worked together before*. But on the other hand, does Waterfall have greater success on ad-hoc large teams? I would tend to say that we might have the same problem. I would hypothesis that most large projects fail, less because of the chosen methodology, but for cultural problems, requirement managements, lack of purpose that limits the collaboration and effectiveness.

b) Complexity: One great advantage with Agility is the facility to deal with complexe problems. By shorting the length of deliverables, working intensively on collaboration (small and large), and testing value early, agility can address complex and unknown problems. Agility is about "adaptation to change" needed in complex situation. By implementing fast feedback, and optimized transparency in the agile methodology, the Fail Often, Fail Fast, Fail Cheap principles are embedded in Agile.

c) Infrastructure: No project will succeed without its infrastructure, and the capacity for the development teams to deliver, integrate and test their components rapidly. Agility states that you need to test everything (the business value) as soon as possible, iso-production systems, in a cadence way. Waterfall states that you need to plan to have your machines, your testing machine on the right order. I don't see how Agility would create a insurmountable challenge in managing infrastructure.

Re:Technical People

[trout007]

And if you don't go with the low bidder they can sue and drag out the procurement process. Again this doesn't happen in business.

in other words

[ganjadude]

it was a giant clusterfuck like many people on both the left and right were claiming way before launch. the site was NOT ready for prime time (the back end still is not 100%) and it never should have been launched when it was.

also, water is wet

Re:in other words

[ganjadude]

congress tried to delay it before the government shutdown remember? obama would not budge, causing the government shutdown.

after the shutdown the site launched, and as expected obama changed his mind and delayed implementation anyway

so the reason for the shutdown was that the democrats did not want a delay and wouldnt budge. then when the site launches and makes them look bad, the implement the delay anyway... yet they still blame congress for the shutdown. and based on your comment it seems some americans are still dumb enough to believe it

Re:in other words

[Anonymous Coward]

Pull your head out of your ass. Seriously. You've got the president going on record of saying he is not going to negotiate and actually claiming he's going to use executive order to bypass the limitations of power spelled out in the constitution during the state of the union, and you've got congress throwing up road blocks to do everything to basically try to stop Obama. I'm going to throw a shocker at you. You might want to sit down for this. I'm a conservative, and I'm happy with congress. The dems in the first two years when they had full control shot out of control. They did whatever they want with the justification of "well, we're the majority, we can do what we want". I'm sorry, that's not how the world works. If you had a 90% majority, then yes, but you don't. You have a 51% or 52% majority. When that's your majority, you need to consider what the other side wants, you don't get your way all the time.

What the dems pulled in the first two years of Obamas presidency set the stage for what's happening now. I voted in people to put the brakes on you guys, and they're doing exactly what I wanted them to. How about this, how about you sit back and say "hey, conservatives, okay, we need to live in this world together, how about we sit down and try to find a solution we can both tolerate". And please note that tolerate doesn't mean like. Remember, we have both parties right now refusing to negotiate. It's not one side or the other. The presidents own words can be quoted to attest to this.

And also note, I'm not claiming conservatives are blameless here either. But you just threw out a load of tripe putting all blame on one side, when both sides stink so bad they should all be thrown in the garbage.

Re:in other words

[Pascoea]

This whole argument revolves around Obamacare. You can argue its effectiveness till you are blue in the face and never get anywhere. You would be more successful arguing about religion or programming languages.

It boils down to one simple question that you have to get consensus on before you can move forward: Is healthcare a basic human right? I specifically left out words like "affordable" and "quality" because they dilute the conversation. It is simple, if I am sick am I entitled to get better? I would love to hear somebody answer "no" to that question, and offer a reasonable justification without using any terms related to affordability, money, insurance companies, or quality of care.

So, assuming you are all with me on the basic right to healthcare, we dive into the money part of it. Which is what all of the bitching is actually about. Everybody has the right to get well, who pays for it? The current solution is that everybody has to buy health "insurance". If you can't "afford" it the gov't will help you pay for it. This is where the current administration looses me. And since this is Slashdot, why not use a car analogy. The gov't assumes that at some point, everybody in the country is going to have to get from one place to another, so they make it mandatory that everybody must own a vehicle. If you can't afford a car, they will help you buy one. Some people will drive their car every day, some cars will sit in the garage all day every day. Yes, in theory, everybody will be able to get where they need to go when they need to go there. But what about all of the money wasted on the cars sitting around not being driven, where has that gone? You can bet the guys at GM, Ford, Toyota, et al. are happier than pigs in shit. They just broke every sales record they have ever set. That is my frustration with Obamacare, the gov't just handed truck fulls of money to the insurance companies (who have been continuously turning record profits.)

Re:in other words

[Anonymous Coward]

"congress tried to delay it before the government shutdown remember? obama would not budge, causing the government shutdown."

Well, one could say Congress didn't budge (rather than Obama). Also you need to be more specific on what "didn't budge" means. In this case it means providing the necessary support for a new law.

The fact that Obama delayed implementation was merely incidental due to a rushed implementation, not some "proof" that Congress was "correct" (as you imply).

Re:in other words

[ganjadude]

what i mean is that what the republicans were after was a delay to the individual mandate due to the fact that the system was not ready.

obama and the senate dems said too bad we are going to implement it there will be no delay, and thats the end of that.

so in the end the government shut down, obama went out of his way to make it as hard as possible (closing open air memorials like the WW2 memorial for example) and when the government opened back up, the website launched and what does obama do? the exact thing that the republicans asked to happen to avoid the shutdown.

Re:in other words

[Anonymous Coward]

what the truth is, is that what the Republicans were after was canceling Obamacare due to the fact that it's not Republican.

FTFY. You may have meant what you said, but what you meant doesn't reflect reality.

Re:in other words

[Anonymous Coward]

+5, Insightful. What we wanted was health care what we got was health insurance. Not the same thing.

Re:in other words

[Anonymous Coward]

Roads are a better analogy.

Everybody has been granted a road leading to their home. Everybody pays into their costs despite how many car trips they take or how many trips they can afford to take. Sound familiar? Trucks full of money go to construction companies.

Are there minimum standards for roads? You bet. Are there minimum standards for health plans? There are now.

Re:in other words

[ganjadude]

that might be the end goal, but that was not the goal concerning the govt shutdown. try and keep up my statements reflect reality much better than anything the media is pushing

Re: in other words

[Anonymous Coward]

No. Healthcare is not a right. We all will die eventually and making 'unconditional staying alive' into a "right" denies that reality.

A better way of looking at it is: "how much should somebody be allowed to demand from others for the continued opportunity to stay alive."

Why should healthcare workers essentially be enslaved to pander to someone else's delusions of immortality?

It's a complex matter that doesn't lend itself well to bumper sticker slogans.

Re:in other words

[I'm New Around Here]

It boils down to one simple question that you have to get consensus on before you can move forward: Is healthcare a basic human right? I specifically left out words like "affordable" and "quality" because they dilute the conversation. It is simple, if I am sick am I entitled to get better? I would love to hear somebody answer "no" to that question, and offer a reasonable justification without using any terms related to affordability, money, insurance companies, or quality of care.

I'll answer "no" to that question, without using any of the gotcha phrases you are hoping for. I will do so with a thought experiment I entertain myself with when I'm bored. I use variations for different situations, so I'll make one for your 'right to healthcare' scenario.

If you have a small population of people, say 500, and the rest of humanity disappears, what 'rights' do they have? Does one person have the right to live in peace, without one of the other 499 attacking him/her? There is no such right in the natural world where lions attack zebras or hornets attack bears. Do people have that right? Personally I don't believe they do, because that right has to come from something outside of the group of people. Maybe something 'higher than' the people. Yes, religion is basically codified human rights. Without that system, I have no more rights than an antelope or humpback whale. Within that system, I may not have the same rights as others, but most religions cover the fundamental ones of survival. Coincidentally, I am not religious, but I am glad most people are.

So, what rights does a 1-in-500 person have? If they are members of the same US Midwest church (that was saved when the rest of humanity disappeared), they have the rights their religion stipulates. They have no 'Constitutional rights' because the whole government is gone, including enforcement of the Constitution. If they are 500 random people chosen from all the cultures of the world, they will have to decide for themselves what basic rights each person has. And I can guarantee there will not be agreement on even the basics, if they even understand each other enough to argue intelligently, rather than gesticulating and shoving each other.

But for the sake of your question, let's assume the people agree than they have the rights of: not being attacked, non-violent personal belief/religion, privacy, speech, self-defense, healthcare. How are these rights enforced? Most of them are enforced by not attacking someone. Let a person live in peace, let them pray, let them talk, and you've already covered the first four. The fifth is enforced by not punishing someone for fighting off another person who chose to ignore the first right listed.

So that leaves us with the final right the group chose to include. How is 'healthcare' enforced? If there are no doctors/nurses/healers/whatever in the group, they have a real quandary. They have to train someone on healthcare, so that person can then provide it. But how do they train someone in a field none of them know to begin with? They have to have some of the group work towards learning what they know their doctors knew. That's not going to go very well, and will take a long time doing it.

Now let's say that one of the 500 is a general practitioner, and has the knowledge needed to treat common conditions the group will face. What if he doesn't want to do so? If he decides he wants to be alone to contemplate his own beliefs for a while, in light of the disappearance of the rest of humanity, does the rest of the group have the right to force him to be their doctor? If he wants to move away, start a small farm to raise vegetables and forget all his medical knowledge, does the group have the right to force him to train someone as an apprentice/replacement? If he will agree to see some people but not others, for whatever reason, do the others have a right to force him to see them as well? Do they have the right to follow him around begging for his attention? Do they have the right t

Re:in other words

[Anonymous Coward]

+5, Insightful. What we wanted was health care what we got was health insurance. Not the same thing.

We do not have health insurance anymore. Insurance is "in case ya...", like in case your house burns down or in case you crash your car. What we have now is completely disjointed from the traditional insurance model. You can now drop your insurance, pay a small "fine/tax/whateverObamacallsit" and then purchase the health plan when you need it and then drop it when you don't, which will completely screw up the entire industry. That's not insurance.

Re:in other words

[sillybilly]

Obamacare has two sides to it. The yin-yang sides. On the one hand it finally allows low income families, and elderly, to purchase badly needed healthcare, so they don't get bankrupt every time they land in the hospital, or the whole family does not get bankrupt when one of the 10 children gets sick. However, by not doing what the law says, young and healthy people rebelling, and not buying health insurance, they can do OK too. Which is what the whole law was supposed to go after, for the insurance companies. Insurance companies are not interested in the sickly elderly, or huge families who can't afford anything because they are huge families, and somebody inevitably gets sick all the time, because they cannot make money on them, they drag them down from the profit into the loss territory, to bleed red ink and go belly up as an insurance business. What the insurance companies and Obamacare are after is the single, healthy youth, who are profit cash cows, because even if they are sick, they recover fast. The real health issues are with either the very young or very old, as in less than 6 years old, and more than 60 years old, insurance companies want none of those, and even under Obamacare will figure out ways to shed them, or give them the runaround, but they are really interest in earning age, 18+ or 22+ to 35 youth, who even if they get hit by a disease, they bounce back in no time and cost very little. But they have the choice not to buy it anyway, and pay the tax penalty, and if that gets too out of control, don't pay the taxes at all, let alone the tax penalties. The only option then is getting jailed and executed, so what. Give them the finger right before they execute you. Over money.

Re:in other words

[Bartles]

The difference being that the people on the left that recognized it as a giant clusterfuck, still supported it and the politicians that forced it upon us. Authoritarians don't care if their provided services are good or bad.

Re:in other words

[Bartles]

Thanks for destroying them with facts and logic.

Re:in other words

[Anonymous Coward]

If Dems caved, Republicans would have kept doing the same thing, delaying the law until they eventually got the majority and could vote it down. Republicans did not have any special insight into the status of the website, and their interests were not in ensuring a smooth roll out. The worst thing that could happen for Republicans is that the law becomes popular. They didn't want it to launch so they could avoid the risk. Shutting the government down was just one of the many asinine tactics they have used to try to damage ACA. I'm not going to say ACA is perfect, but the party philosophically opposed to universal health care, has been doing everything in their power to make it worse. Such as red states refusing Medicaid expansion.

Re:in other words

[Anonymous Coward]

Exactly. The Democrats that had the supermajority in the Senate, the majority in the House, and the Presidency were not allowed by the Republicans to give us healthcare. Instead, the Republicans forced us to pay corporations or go to prison.

Re:in other words

[ganjadude]

right, when the dems control all 2 seats, you cant blame the otherside, its laughable.

Re:in other words

[Shortguy881]

How about instead of asking us to justify why healthcare isn't a basic human right, why don't you explain your reasoning behind it being a basic human right?

I'd really like to hear a justification for thinking you are entitled to healthcare. I've heard ample people throw out that claim, but none of them have ever made a compelling argument as to why it is a basic human right.

Re:in other words

[ganjadude]

Chambers, not seats

Re:in other words

[ganjadude]

because.....bush!

Re:in other words

[ganjadude]

im not sure which is worse, knowing it was bad but still pushing it through, or actually believing it wasnt bad.

Re:in other words

[Pascoea]

That really is an excellent question. It's tough to answer, beyond the usual "Why SHOULDN'T we have free healthcare, you a heartless asshole."

My initial though is, I am entitled to healthcare because we live in a civilized country, and it is the moral thing to do. And people have a basic right to live out their natural life alive. If someone gets dragged into the hospital dying, your choices are to help him or let him die. Human beings, for the most part, are designed to be compassionate. The "I'd rather just let him die" people are in the definite minority. (Again, leaving the financial argument out of it) Now you just have to figure out how to pay for keeping that person alive.

And to me, it only makes sense, purely from a financial perspective. I pay $XXX per month, my employer pays $YYYY for "Health Insurance". I use quotes because it's not really insurance. I carry car insurance because if something catastrophic happens to my car I will need a new one. If I don't have car insurance I don't get a new car. If I don't get a new car, my life will be significantly inconvenienced, but I'll still be alive. I carry health insurance because if I don't carry it and something catastrophic happens they will still do what is reasonable and necessary to make sure I don't die. Wait, what? Yup, it still gets paid for. They will ruin me financially if I don't have insurance, but they aren't going to lock me out of the hospital, and SOMEONE is going to end up paying for it.

So, now we have the insurance companies. Their job is solely to sit between me and my hospital. And they "earn", collectively, over $13B in profit annually to do so. That's a shit load of money. And that is just the profit. That come's after they have paid their thousands and thousands of employee's salary. I know it's the norm to hate on insurance companies, but holy shit, what value do they add to this equation?

Re:in other words

[NoKaOi]

it was a giant clusterfuck...also, water is wet

Yep. True of any big undertaking when contractors are involved (whether it's government or a large corporation hiring the contractors for a big project). How about this:
-The defense department undertook the development of F-35 and its related systems without effective planning or oversight practices...
-[The task] was a complex effort with compressed time frames. To be expedient, DoD issued task orders ... when key technical requirements were unknown...
-DoD identified major performance issues ... but took only limited steps to hold Lockheed Martin accountable.
-DoD gave a lot more money to Lockheed due to changes such as new requirements and other enhancements...

The difference between healthcare.gov and any other big project is the politicalization of it. On one hand, you have the people who want health insurance so they can get medical care. On the other hand, you have insurance companies that want to keep the old system because they make higher profits. With the F-35 you only have one side...the defense contractors who want to make tons of money.

Re:in other words

[Anonymous Coward]

... I believe you and I have the right to provide for ourselves ...

So you've provided yourself with $500,000 for a liver/heart transplant or for a lifetime of $300/month drugs that may be required for your continued living? The non-obama-care insurance isn't providing an answer: They limit medical care to $200,000, which eliminates all complex surgery. The obama-care law in essential terms is forcing insurance providers to provide a minimum level of service. Does one have a right to a specific level of service? It's an irrelevant question. Should there be standards and minimum results in the endeavours of commerce? That question gets an unreserved 'yes' answer .

... one of the other 499 attacking him/her ...

What about an attack from the neighbour's dog, or from the industrial-waste of a private dam (where there are still no minimum construction requirements in the USA so they all fail, sooner or later), or a disease? This is why welfare exists. So that one is protected from things that cannot be predicted or eliminated: disease and crime.

Re:in other words

[Anonymous Coward]

I believe you and I have the right to provide for ourselves. I don't believe we have the right to force others to provide for us.

I'm not a big believer in rights, per se. But I don't really have a problem with socialized medicine either.

From a pragmatic perspective, an economy can only consume as much as it produces and an educated healthy workforce is more productive. We can all consume more if we cooperate and take care of each other. But there's a prisoner's dilemma where the highest pay-off comes from being a selfish person in a society where everyone else is generous. So if you want everyone to be cooperative and generous then you have to impose enough punish on selfishness to make it unattractive.

And then there's the issue of fairness. You talk about providing for yourself. But did you yourself develop all the science and technology that you rely on? Did you discover all the medical advances that you "provide for yourself"? Or do you at least provide the people who did develop these advances with fair compensation? Do you put some good and services in a time machine and send it back to the guy who developed antibiotics? Or aseptic surgery? What about electricity? Do you send some good and services back in time to early pioneers in that field?

And then there's the issue of scarce resources. Take land, for example. At some point someone came along and said "This is mine". And if they were big enough and strong enough then no one was able to disagree. But it they create the land themselves? When a baby is born into the world, all the resources have already been claimed - by people who didn't create those resources. Is that fair?

If someone were to stock up a houseboat and go live out in the middle of the ocean - not paying taxes but also not relying on any government services - military, police, roads, schools, internet, etc. - then I'd say, sure, I don't really approve but let them do it. But when someone living a life of extreme privilege in a society built by others claims they they don't want to give back and contribute to that society - well, I'm not exactly going to support them in that.

Re:in other words

[Anonymous Coward]

No, the Republicans stole our seats. They have hundreds of them that they stole between the House and the Senate. That is what their kind does. They lie lie lie and steal votes.

Re:in other words

[I'm New Around Here]

... I believe you and I have the right to provide for ourselves ...

So you've provided yourself with $500,000 for a liver/heart transplant or for a lifetime of $300/month drugs that may be required for your continued living? The non-obama-care insurance isn't providing an answer: They limit medical care to $200,000, which eliminates all complex surgery.

So, your assertion is that before obamacare, no complex surgeries were ever done? Or only the rich 1% were able to have transplants? Really?

This is the biggest problem with trying to discuss something substantive. Idiots throw out comments like yours, thinking they made a valid point. When a little reasoning quickly shows they are moronic statements with no connection to reality.

Re:in other words

[I'm New Around Here]

I believe you and I have the right to provide for ourselves. I don't believe we have the right to force others to provide for us.

I'm not a big believer in rights, per se. But I don't really have a problem with socialized medicine either.

Thank you for the reply.

I've said before that I would not oppose basic health care being taken care of by a national health system. Areas like car accident victims, broken bones, heart attacks, allergic reactions. Routine ER situations. But if I am to support that system with my tax dollars, the people who use it have to do their part to try to live healthy lives. Drug addicts and alcoholics get treatment then go into rehab, overweight people are put on a healthy diet and exercise regimen, and so on. But since that would violate people's rights, and I can't force my beliefs onto others, even when they are using my tax dollars, I don't support a public health system.

We have the safety net of welfare/food stamps/medicaid for the poor. We have insurance that is easy to get for the rest, with only a few exceptions that are truly 'uninsurable' due to birth defects or genetic disorders. There are still ways to get them covered by insurance, since large corporations and governments provide comprehensive insurance to all employees and their dependents. I would even be ok with the government 'hiring' the uninsurable just to get them onto the insurance available to federal employees, or making a version of Medicaid specifically for the people with high-cost conditions.

My views aren't as draconian as my hypothetical situation may suggest, since we of course are not the last 500 humans left alive. But given the waste, fraud, and abuse of the current system, I just don't see the benefits of making it even more vast with less control over it.

Re:in other words

[Sabriel]

But if I am to support that system with my tax dollars, the people who use it have to do their part to try to live healthy lives. Drug addicts and alcoholics get treatment then go into rehab, overweight people are put on a healthy diet and exercise regimen, and so on. But since that would violate people's rights, and I can't force my beliefs onto others, even when they are using my tax dollars, I don't support a public health system.

I don't get it. How would that violate rights? When society assumes an obligation to offer help to its members, members who seek out that help to correct their personal failings assume the reciprocal obligation of not "crying wolf" (not quite the phrase I want to use, but I hope it's close enough that you get what I'm trying to convey). "Society, I'm addicted / obese, please treat me." "Our obligation is that we will treat you, but your obligation is that you'll accept our help in avoiding this situation in the future." "Okay." The whole basis of society is the social contract - we help you, you help us!

The technicalities of deciding when any given person is not meeting that reciprocal obligation should only impinge on the general availability of a public health system to the extent that the statistical occurrence of recalcitrant individuals would make the system a net burden or benefit to society. And even then, that is not necessarily an argument to completely reject a public health system instead of the less drastic response of narrowing its scope.

Re:in other words

[Anonymous Coward]

The assertion not that that nobody got any complex surgeries, or even who it was limited to, but that prior to the ACA reform, some people could not have complex surgeries performed due to imposed coverage limits, rather than any other bar to their receiving the treatment. The only resource lacking was an approval of payment, not a lack of medical supplies, not a lack of medical personnel, even transplant organ availability wasn't brought up (though that can be a significant concern to be sure). Just the coverage limit.

I get it, you would rather declare another person to be an an idiot, than actually discuss that situation. But it is a real issue, and you're not even willing to try to discuss it. Strange, because it is one that actually did exist in reality. While your own does not.

Re:in other words

[I'm New Around Here]

So when you said:

The non-obama-care insurance isn't providing an answer: They limit medical care to $200,000, which eliminates all complex surgery.

what you meant was that some people had insurance that only provided the amount of coverage they were willing to pay for.

I don't see how that makes the point you are trying to make. People had choices on what they wanted for insurance. Many people specifically chose jobs based on insurance coverage, willing to take a lower paying job that had higher insurance coverage. The $200,000 amount is something you pulled out of thin air, because there was no such ceiling across the board, either at every insurance company, or on every policy, or from every employer offering benefits.

Were there annual limits and lifetime limits? Yes. If you don't know why then you don't understand insurance. It's that simple.

Has obamacare outlawed annual and lifetime limits? Yes. Which is why nearly everyone is seeing their premiums increasing. If the insurance company has no limit on possible expenditures, they must take in a lot more money to be able to cover those future costs. So now, in that regard, all policies are equivalent to the highest priced plans that corporate executives have had, with the pricetag to match. Everyone now gets the privilege of paying for very expensive insurance, because people like yourself don't understand insurance.

If you want to discuss the issue, I would be more than willing to do so. But when you make idiotic statements like "insurance had a $200,000 cap" which eliminated "complex surgery", I will call you out on them. If you instead want to focus on your own fantasy world, in opposition to the one I laid out, what do you need me for? Go create your own version of history where people had no choice in their own insurance.

By the way, my scenario was not about insurance. It was about human rights. But don't let that fact get in your way.

Re:in other words

[sysrammer]

Sorry, the 'pubs have tried to kill Obamacare dozens of times. When faced with a relentless enemy one has to put up a relentless defense. Yeah, the 'pubs were right; anyone with an IT background would have known the same. But delay was also a political move, defended by another political move.

So, yeah, sucks, but any big IT project has major problems. It had to be rolled out everywhere at once else there would be charges of political favoritism.

Re:in other words

[ganjadude]

so what you are saying, if i understand correctly is fuck the reality of things, we need to keep up the political theater to screw the people

that makes the dems look EVEN worse in my mind when you put it that way.

"sorry folks, we know the website is broken, but we are going to force you to use it so we can save face with the other side"

thats cowardice

Re:in other words

[ganjadude]

i think you need to look at fergison MO, i dont think its republicans out there on the streets rioting....

Re:in other words

[almechist]

+5, Insightful. What we wanted was health care what we got was health insurance. Not the same thing.

We do not have health insurance anymore. Insurance is "in case ya...", like in case your house burns down or in case you crash your car. What we have now is completely disjointed from the traditional insurance model. You can now drop your insurance, pay a small "fine/tax/whateverObamacallsit" and then purchase the health plan when you need it and then drop it when you don't, which will completely screw up the entire industry. That's not insurance.

Except nobody is going to do this, because for one it's just not that easy to do, but mainly (and this may shock you) because most people do want to have insurance in case of an emergency. I'm no fan of Obamacare, despite the fact that it's been enormously helpful to me personally, and in fact has already quite literally saved my life. Regardless, the ACA was a broken piece of legislation from the start, and the only positive thing I have to say about it is that it's marginally better than what we had before. But I don't believe your particular criticism is valid, and the proof is that the big insurance companies are still making big bucks, for the most part they love the ACA. So what you suggest just doesn't seem to be happening in the real world, at least not so far. This is not to say Obamacare isn't deserving of hundreds of other criticisms, but the "people will buy it only when they get sick" thing doesn't seem to be a real worry, so far.

Re:in other words

[sysrammer]

Reality is that any and all methods were and are being used to kill Obamacare. Dems can't trust Pubs with any legislation regarding Obamacare, lest it be a trap. All big systems have problems; they get fixed eventually. It will take a couple of years to fully stabilize. Reality.

Re:in other words

[Anonymous Coward]

The coverage limits that have been imposed are also a human rights issue, due to their express impact on human lives.

And note the modifier, imposed, not chosen. The insurance companies imposed them, individuals didn't have any effective input about those, any more than they do about the costs of medical services. You can speculate about the whys of that if you want, but it's a real condition of the situation in regards the health care system.

But yes, sure you could have fairly asked for more accuracy in regards the expression of those coverage limits, but unfortunately, what you did say was a bit of hyperbole claiming it had no connection to reality.

Except, the thing with the connection to reality was the coverage limits. Not yours.

Re:in other words

[ganjadude]

so eventhough obama did EXACTLY what the republicans asked for to avoid the shutdown...in your eyes the shutdown is still the republicans fault....

this right here, is just one of the many problems with this country these days

Re:in other words

[DRJlaw]

If you have a small population of people, say 500, and the rest of humanity disappears, what 'rights' do they have? Does one person have the right to live in peace, without one of the other 499 attacking him/her? There is no such right in the natural world where lions attack zebras or hornets attack bears. Do people have that right? Personally I don't believe they do...

Now let's say that one of the 500 is a general practitioner, and has the knowledge needed to treat common conditions the group will face. What if he doesn't want to do so? If he decides he wants to be alone to contemplate his own beliefs for a while, in light of the disappearance of the rest of humanity, does the rest of the group have the right to force him to be their doctor? If he wants to move away, start a small farm to raise vegetables and forget all his medical knowledge, does the group have the right to force him to train someone as an apprentice/replacement? If he will agree to see some people but not others, for whatever reason, do the others have a right to force him to see them as well? Do they have the right to follow him around begging for his attention? Do they have the right to force him into their hut to care of their ailing mate? If he refuses to do so, and fights his way free of such an action, is he to be punished for hurting the person accosting him?

In response to all those questions, my answer would be that the person with knowledge that may be essential for the survival of the group does not have the obligation to act on or dispense that knowledge. Or, in terms of rights, the group does not have the right to force the (former) doctor to do something he is not willing to do anymore. They don't have the right to violate his rights of not being attacked, personal beliefs, or privacy.

So, in conclusion, no I don't think people have a 'right to healthcare'.

That's odd. Because based upon the premise of your argument, people do have a right to healthcare (assuming that the doctor does not wish to die).

Yes, if you strip everything back to the law of nature (Locke-world), and create your own positve law, you can eliminate a right to healthcare. Or, you can enact a positive law creating a right to healthcare. That's the thing about positive law - it is whatever you construct it to be.

But don't argue that there is no natural law right to healthcare. The moment you rely purely upon natural law, there's a right to anything that the stongest dictates, because the strongest (the one with the most power at that instant) can attach that to the only right that matters in that system -- the right to exercise force to obtain what one wants.

Consider this an object lesson in a 'philosophy fail.'

Re:in other words

[Shortguy881]

"I'm entitled to it because it exists" is not a valid answer and shows you put zero thought into your stance. Not only is that not even remotely sustainable, but that type of philosophical argument is why our society is in the shitter. Internet exists, so Im entitled to that as well. Cell phones exists so I'm entitled to one of those too. There are people who think that way.

Life, liberty and pursuit of happiness are our basic rights, inalienable rights. This goes well beyond just the US Constitution and into the "Age of Enlightenment" and is the work of several well known philosophers. These rights are things that no man can take away from you or deny you from having. This does not constitute tangible things and to think so is pure ignorance. These are things like speaking ones mind, writing and reading what you want, living your life your way without infringing on others free will. This, of course, is all based on egoism or social contract theory.

Even if we look at this from a utilitarianism point of view, in so much as society as a whole is better if it shares healthcare among all its citizens, you run into larger problems. This is only better for a society were everyone is contributing to society. If someone isn't contributing, they should then be removed. Why waist resources on the non-producers? This is arguably much worse than social contract theory.

And before you burst in with its better for utilitarianism if we keep everyone alive, that's an unarguable point that bypasses reality. Healthcare is a limited resource and must be distributed as such. That being the case, a utilitarian society would need to pick someone to not receive treatment, so that others can.

As for the rest of your dribble on insurance, that had nothing to do with my initial question.

Re:in other words

[genkernel]

That is not what sysrammer is saying. He is saying that the republicrats (not to mention the insurance industry) were stonewalling and attempting to cause delays, and that the demipubs were in danger of having the delay ending up in the same stasis field the patriot act is in.

So what he is saying is that the political theater needed to be disrupted in order for things to progress at all, even if the reality of things wasn't pretty.

Re:in other words

[Anonymous Coward]

It boils down to one simple question that you have to get consensus on before you can move forward: Is healthcare a basic human right? I specifically left out words like "affordable" and "quality" because they dilute the conversation. It is simple, if I am sick am I entitled to get better? I would love to hear somebody answer "no" to that question, and offer a reasonable justification without using any terms related to affordability, money, insurance companies, or quality of care.

I'll give it a shot.

Assuming the word "basic" in "basic human right" is intended to mean a natural right akin to, for example, the set of natural rights listed in the first amendment, then no. If we were talking about the "pursuit of healthcare", then I'd say yes, but nobody ever phrases it that way. As I see it, it cannot be a natural right if fulfilling it requires the resources of someone else. It's important to note that my assertion that it cannot be a natural right is orthogonal to the issue of whether we as a society might decide that it's desirable to provide some level of healthcare to all. To that, I'd say "yes", possibly with reservations depending on the details, but that's not the issue at hand.

For example, the first amendment describes the natural right to free speech, but nobody owes you a megaphone. However, you don't need anything from someone else to exercise your right to free speech. Speak all you want, write all you want; nobody is coerced by the government to listen or read, nor is anyone required to provide you a soapbox or a printing press.

Other easy examples: You have the right to be whatever religion you want, but we don't owe you a church or a Koran. You have the right to keep and bear arms (OK, just for this discussion ignore the controversy), but we don't owe you ammunition, a gun, a sword, or even a big stick. You have the right to pursue happiness; we don't have to help you, and we certainly don't owe you happiness itself.

Of course, we recognize that nobody has the right to suppress your free speech as well (putting aside "fire in a theater" and so on), so you might argue that government coercion is certainly involved. However, I hope you can see that requiring others to not interfere with the exercise of your natural rights is fundamentally different from coercing others to aid you in the exercise of your natural rights.

Any non-trivial healthcare requires resources (time, effort, medicine, and so on) which someone must provide. If everyone were to have a natural right to healthcare, then that implies that others have a "natural responsibility" to provide it. Such an onus is not generally recognized as valid in our culture or legal system (AIUI; IANAL). I vehemently reject such a notion: The idea of a limited government granted specific powers by the people is not intended to include ensuring altruism; ensuring natural rights, absolutely yes, but not ensuring redistribution of resources.

But lets consider some consequences of recognizing such a "natural responsibility", using food. Surely, if you consider healthcare to be a natural right, then food must also be a natural right - one might live quite well for extended periods without healthcare; food, not so long. So, if you have no food, and I have more than enough to feed myself, then you probably see no problem in having the government coerce me into fulfilling my "natural responsibility" to give you some of mine, even if you have nothing to trade in return for it. Now, what if I only have just enough food for myself? Resources, whether food or medicine, are limited, which directly implies rationing, and that implicitly implies force to ensure redistribution of resources.

You certainly have the right to "pursuit of food", but not to snatch it from my plate, nor to have the government do it for you at gunpoint. If you ask nicely, I'll likely share if I can. Furthermore, we might all decide that each of us will give up a small portion of our food

I'm so glad

[sabbede]

I don't work for a company that made the mistake of getting involved in that nightmare.

Re:I'm so glad

[Chrisq]

I don't work for a company that made the mistake of getting involved in that nightmare.

I'm pretty sure that a lot of companies are doing just fine out of it - paid to deliver the wrong thing then paid to deliver what the government should have specified in the first place.

Re:I'm so glad

[StikyPad]

It's actually relatively common for custom software to experience feature and scope creep. The source of creep is split between design by committee and leadership changes. When new leadership comes in, the vision almost always changes, and when new stakeholders are added, they pollute the water with their own special interests.

It's arguably the role of developers (or at least business analysts) to push back against ridiculous requirements, and some do, but they're not properly incentivized, since they work for the contractor. BAs should be working for the government, not the contractors. Ideally, one person with software development design and management experience and a clear vision should be in charge of the project. Unfortunately, it's almost always someone with more generalized management experience who doesn't know the difference between HTML and CSS, and comes up with new "great ideas" on the fly.

At any rate, the problem isn't limited to government software -- I've seen the same thing in commercial business software, especially "customizable" software. I'm looking at you, mortgage and scientific industries. We get a little more upset because we fund government software through taxes -- we feel like it's our money -- but we honestly fund almost all poorly designed software, even if it's rolled into our mortgages. It's just less transparent.

Re:I'm so glad

[Anonymous Coward]

Or, they could have just open sourced it. 100's of developers would have worked on such a project for free, or they could have offered bounties for accepted code. A contractor could have been used to lead the process.

Re:I'm so glad

[Anonymous Coward]

... we fund government software through taxes ...

It's more pervasive than that: Taxes are taken at gun-point so the government can always take more taxes. The supposedly small government has so many policies, employees and unions, it is impossible to hold someone accountable. A corporation has an approximately fixed revenue and is accountable to its shareholders. So the inevitable bad policies, poor management and group-think are more difficult to hide.

Out of Character for Government?

[rmdingler]

A group of master thieves with no conscience,

who are working round the clock to skim money from a project,

are still unable to run up costs like a government project gone off the rails.

Re: Out of Character for Government?

[jd2112]

You are giving them way to much credit. Don't attribute to malice which can be easily explained by incompetence.

CYA

[orlanz]

Somebody had to take the fall, and I guess they found the one group who didn't do the proper amount of CYA. Actually enumerating the failures and irresponsiblities of the various parties involved from the politicians down to the subcontractors... would have been too much work.

I guess they will just fire 1-2 guys and move the rest to other projects like "Heathcare.gov support" and file this report some where the sun never shines.

Let's be absolutely clear

[argStyopa]

The key takeaway from the report is that nobody will be personally held to blame for the incompetence (at best; corruption and nepotism at worst) of the process and end result.

No punishments or consequences, all around!

Re:Let's be absolutely clear

[Anonymous Coward]

Who are you going to hold responsible?

The White House - at the highest level - was pushing an unrealistic time frame. The President rewarded the policy wonks by letting them be in charge of implementing the project. The House refused to provide funding for implementation.

Not saying it would have worked anyway, but the sources of the problems are in positions that are accountable only on election day.

Re:Let's be absolutely clear

[Rockoon]

The House refused to provide funding for implementation.

...besides the hundreds of millions of dollars spent on it?

Re:Let's be absolutely clear

[Anonymous Coward]

The Republican controlled House of Representatives refused to pass any legislation providing funds to implement the ACA. Secretary Sebelius was forced to move the project from her direct supervision to CMS, which was funded but had dozens of other projects to manage.

Not saying things would have turned out any better if this hadn't happened. There are too many other points of failure - ill-defined requirements, politically motivated deadlines, scope creep, having to provide more state exchanges than was anticipated - all contributed to the end result.

However, to return my point - politicians, executive and legislative, are the ones ultimately responsible.

Re:Let's be absolutely clear

[bill_mcgonigle]

No punishments or consequences, all around!

No government worker will be fired, but don't worry, three hundred million people will be collectively punished for it as that billion dollars gets added to the debt and all their cost-of-goods prices go up.

Sadly, that feedback loop never seems to get closed. Results don't matter - as long as there are promises and intentions, that's good enough for most.

what's the difference

[Chadster]

between that and most private sector projects?

Except for technical companies, almost every large project during my 30 year IT career had the same issues and reasons for failing.

Re:what's the difference

[ganjadude]

the difference is that if its a private company doing it, we are not all paying for it. I dont care if a private company wastes a billion dollars, that has nothing to do with me and the rest of america. but when the government does it, it becomes an issue for all of us

Re:what's the difference

[Anonymous Coward]

I dont care if a private company wastes a billion dollars, that has nothing to do with me and the rest of america. but when the government does it, it becomes an issue for all of us

If you buy the private company's products and they have ~10 million customers, then it's cost you ~$100* total in higher prices on purchases you made from them. Multiple that by how many companies you buy from that have billion dollar wastes and you end up with a lot of money wasted on pet projects that you paid for by sheer circumstance and for which you're unlikely to (1) change your purchasing habits over (since most people aren't going to choose one brand over another over a penny or a fraction of a penny) and (2) even know about the sheer amount of waste going on (since so many private companies are guilty of it at all levels that near all prices are inflated).

So, yea, it's none of your business that the business you do business with is in the business of wasting money. Magic free money that doesn't indirectly come from you or anything, no sir. Honestly, both government and business waste concerns me. It's just that it's harder to deal with most business waste since competition is not something you can magically create and regulation is often captured or more costly than the initial waste. But at least calling out companies that do waste gives people a chance to at least attempt to "vote with their wallet". Not that that likely will have a noticeable effect any more than complaining about government waste. But, *shrug*.

*Obviously, companies don't shift 100% of the burden to their customers most the time, your actual purchase history determines whether you're closer to the $10 or the $1000 range, and it's possible that like government rounding error (since tax code doesn't specify a 14.257891230740192374987% tax rate and things get rounded to the nearest dollar) the money ends up coming from a general "slush" fund that results from having their product sold at $4.99 instead of $4.9855547294835 (which carries over multiple purchases) and hence the "optimal" price is always rounded up which is where the waste can effectively go unnoticed on the consumer side.

Re:what's the difference

[ganjadude]

obviously i was referring to the point that i DONT have to do business with them if i dont like what they are doing. Cant get away with that when its the government

better summary

[slashmydots]

Don't hire people who have failed multiple projects in the past just because they were friends of the Obama campaign. At least that's what my finding determined.

Re:better summary

[thrich81]

So we would have been better off hiring the friends of the Bush campaign who did such a bang up job of efficient contracting in Iraq?

Re:better summary

[Anonymous Coward]

Actually, I'm pretty sure we was saying "don't hire somebody who's a friend and instead hire somebody who's competent", but hey, why let the meaning go through when that meaning would stop you from bringing up a president that hasn't been in office for what, almost 6 years now?

Re:better summary

[Anonymous Coward]

If they can't just use their power to give their friends cushy jobs, what's even the point?

Re:better summary

[Anonymous Coward]

I thought that's what he said.

Re:better summary

[Anonymous Coward]

Do you have a source for you claim? Obama has run the most transparent administration in the history of mankind. Backup your claim or admit you're one of those Faux Knews asslickers.

Re:better summary

[slashmydots]

I've never met anyone who's so polarized politically that they can't actually read...until now.

Re:better summary

[Anonymous Coward]

When you looked in a mirror, you mean?

Why dont we

[thaylin]

Put the money for the contract, plus 10% into escrow. Every 10% into the projects completion you get 10% of the money. If you cannot complete it for that price, that is on you, not the tax payers, learn to better account for your work. If you can show that it was due to the government itself then that is what the extra 10% is for, if not and you fail the project we still got that amount of work done and can pass it to the next contractor in the bid to start working on. I am so tired of hearing about these massive cost overruns.

Re:Why dont we

[ka9dgx]

Because 10% of a working system can't be measured. Even a 100% completed to spec system is worthless until it has actually been used for a while... when it will prove to need about 100% more work.

Most software projects fail, unlike construction, etc... engineering can't be applied.

Re:Why dont we

[thaylin]

You can prove that 10% of the feature set is done. when you agree to a contract you agree to a timeline and a feature set.

Re:Why dont we

[Andy Dodd]

That's pretty much how government contracts work.

It fails because:
1) The customer will change their requirements mid-stream, screwing everything up
2) Even if they don't, in some cases it's discovered once everything is complete that the system which meets all of the customer's requirements is utterly fucking useless in the real world. I believe this was a major role in healthcare.gov's failures - many of its issues were discovered post-launch

Re:Why dont we

[kellymcdonald78]

Then I hope you enjoy your "sports car" that sits 8, has 5 square wheels, no brakes and a 14 HP engine. Built exactly how the client asked for it. Most government RFPs are terrible, written by people in procurement who have no clue what they're asking for. Rarely is there any kind of defined feature set, or schedule, mostly its just a laundry list of things people raised in a couple of committee meeting, with a date some politician wants it by (usually tied to a campaign promise, or event), and a budget that someone pulled out of thin air.

Re:Why dont we

[kellymcdonald78]

Said someone who obviously has never worked with government

Re:Why dont we

[bitingduck]

And never worked large projects.

For some projects (not necessarily software, and not even necessarily that large) there aren't more than 2 or 3 companies that can do them, and they're all a pain to deal with.

Did you expect anything else?

[Anonymous Coward]

America hired a man to run the country who never even managed a McDonalds.

Why would they vet their contractors (or contracts) any better?

Re:Did you expect anything else?

[thrich81]

Well, I've got karma to burn and this AC got modded up to +2 insightful, so look, the argument that the current President and VP have never run/managed "anything" and so are unsuitable for the positions would be valid EXCEPT that the previous President and VP had vast private sector and government managerial experience (or at least they were sold to us that way) and they screwed up running the country at least as badly as the current administration. So, from observation of the actual, real world experiences we've gone through in the last 15 years it would seem to be clear that previous managerial experience has no correlation with good administration of the Executive branch of the US government.

Re:Did you expect anything else?

[Bartles]

Actually, just about every metric for measuring the economy is far worse now than it was 8 years ago. So no, both administrations aren't equally bad. The one you voted for and support is far worse.

Million Dollar...

[johnsnails]

Any one else think the article might be about a retina version of:
http://www.milliondollarhomepa...

How many millions....

[zoid.com]

How many millions did this investigation and report cost?

You spend a billion on lorem ipsum? Don't hire you

[raymorris]

> almost every large project during my 30 year IT career had the same issues and reasons for failing

They spent a billion dollars to post lorem ipsum https://www.healthcare.gov/med...

If almost every large project you're involved with is similar, we've learned one thing: Don't hire Chadster!

Don't Forget the State Websites

[Anonymous Coward]

Anyone in software would understand the idea of code reuse. Instead the "billion dollar website" was re-implemented at the state level in many locations. Way to go politicians!

Also: Scope creep is a killer

[Anonymous Coward]

Scope creep/requirements instability are the root cause of nearly every failed contract I've seen.

Whenever a government contract fails, the public always blames the contractor, but if you look a little closer, there's almost always a significant customer role in the failure.

See VH-71: Within days of contract award, the White House pushed the Navy to add a bunch of new requirements. Pretty much, "We can't tell you why these are needed, but trust us, they're needed or THE TERRORISTS WILL WIN!" - This was the Bush-era White House, and that administration pretty much got anything they wanted with the "OR THE TERRORISTS WILL WIN!" argument. Lockheed was on time and within budget for Increment 1 (which was being built to the original contract requirements) but Increment 2 was becoming a massively overpriced flying tank due to scope creep/requirements instability and that killed the entire program.

See JSF: A major cause of issues on that program has been prioritizing the Marine STOVL variant over the others, even though that should be the LAST one due to it being the most complex/highest-risk variant.

Agile? Huh?

[Anonymous Coward]

CMS made many risky decisions in order to meet their goals, such as the use of "cost-plus-fixed-fee" contracts in the bid process and an Agile software development model, which was new to CMS.

As Figure 5 from the study, included below, shows, the Requirements, Analysis and Design stage of the project went from the originally scheduled three months to a year[...]

[... cutting] Operational Readiness Review from seven months to one. Yes, one. They reserved enough testing time to realize just how bad things were, and then they launched anyway.

Let's see...

Big up-front design? Check!

Scope creep driving increased redesign time? Check!

Implementation delays and compresses test phase? Check!

I guess they were using LAFABLE as their process.

Repeat!

[felixrising]

Sounds remarkably like the Myki public transport ticketing system with it's associated blow-out to 1.5 Billion dollars https://en.wikipedia.org/wiki/... Although arguably Myki downgrade from the previous ticketing system. Clearly, planning and careful tendering and contract wording are vital in these big projects to hold the winning contractor to account, no changing contractors half way through or half arsed planning phase. Maybe it's just my thinking as an engineer, but so often these projects take on such a life of their own, what is really needed is a highly skilled and capable small core team of engineers and designers who build a working prototype and are able to make well thought out fast decisions on the move, then once it's been thoroughly tested, the big rollout happens, also with their oversight, you don't need huge numbers of program managers, project managers or project coordinators and nary a MBA should be in sight, you need people with the skills and knowledge to deliver the project, driving it, and only then farm out delegation work to other teams for specific deliverables to realise the bigger project.

Semi-trolling but...

[Anonymous Coward]

Oh look, yet another great idea turned to shit with terrible execution. The hallmark of the Obama administration, and sadly the Bush administration too. I really hope this is not a trend with the new generation of politicians on both sides of the aisle.

Re:Semi-trolling but...

[I'm New Around Here]

It will be. Look ahead to 2016. Who are the front runners? Hillary Clinton and Mitt Romney.

F-35 Joint Strike Fighter

[tekrat]

Really, we want to complain about a website that cost a Billion? This is the United States Government, full of waste, fraud, no-bid contracts, and shit spread out out over every state so that ever senator and congressman has his slice of the taxpayer slush fund.

Witness the F-35 Joint Strike Fighter, an aircraft nobody needs, trying to fill too many roles, and was supposed to save our armed services money by having one plane replace many planes.

Except it's billions over budget, still doesn't work (and might never work), and is expected to cost more than a Trillion dollars before all is said and done.

Meanwhile the aircraft is being usurped by drones, which are cheaper, easier to deploy, and may fill all the roles we'd ever need this crazy ass jet for. And we're trying so hard to make it stealthy, meanwhile as pointed out in a slashot article a few weeks back, long wave radar will find the plane just fine.

And yet the Pentagon continues to shovel more money into the project because -- guess what, there's no "plan B". This is the people we depend upon to strategize for us in times of war, and they have absolutley no fall-back plan. Brilliant.

Re:F-35 Joint Strike Fighter

[david.emery]

...Witness the F-35 Joint Strike Fighter, an aircraft nobody needs, trying to fill too many roles, and was supposed to save our armed services money by having one plane replace many planes...

I'm not defending the F-35 (I'm a huge A-10 fan, and 2 F-35s would fund the whole A-10 fleet), but your comment here is self-contradictory. Either we don't need it, OR it's trying to fill too many missions (that do need to be done.)

I think it's the latter, and that's not just requirements creep, but a different phenomenon that is something like "requirements conbinatorics", where too many requirements get loaded onto a system (health care or weapon) and the result is either (a) not buildable as a violation of math or physics or (b) massively complex and therefore massively expensive.

It's a combination of no discipline on the part of the users/managers who develop the specifications or needs statement, and the problem that the number of major system starts (whether DoD or commercial) is limited, so each user/stakeholder needs to get -His/Her Requirement- in place on this system, because they won't have a chance for another 10 years to get that requirement into their/their user's hands.

dave

Re:F-35 Joint Strike Fighter

[Anonymous Coward]

I'm not defending the F-35 (I'm a huge A-10 fan, and 2 F-35s would fund the whole A-10 fleet), but your comment here is self-contradictory. Either we don't need it, OR it's trying to fill too many missions (that do need to be done.)

Not at all, the roles that the F-35 is putatively intended to fill may be necessary, without it being necessary to have a single aircraft trying to do them.

No contradiction, just a different understanding.

Re:F-35 Joint Strike Fighter

[bill_mcgonigle]

Witness the F-35 Joint Strike Fighter, an aircraft nobody needs

Don't play the game, man. Here's who needs it:

* Politicians, for pork
* Defense contractors, for "Sweet Jesus we're rolling in dough" money
* Lobbyists, for a slice of the dough.
* The Federal Reserve, the monopoly private bank that makes interest on the debt
* Wall Street bankers, who take a commission on the new debt created.

If you look at this as corruption instead of a mysterious boondoggle, it makes perfect sense.

There's absolutely zero chance of defeating an invisible enemy.

Re:F-35 Joint Strike Fighter

[Anonymous Coward]

Actually, the F-35 is a repeat of the F-111 - they designed an aircraft with improbable spec's that was supposed to fulfill every task for every service. What they got was a heavy, expensive aircraft that wasn't all that good at any of its tasks. The big difference is that the Navy was smart enough to back out of the F-111 fiasco.

CMS wow

[Anonymous Coward]

CMS bows to congress who bows to the owner of congress = Big Pharma and more xxx.Inc's
who do you suspect issues the orders to CMS? I am very skeptical, to say the least
Probably this project came off just as planned.......

IBM Accenture et al

[Anonymous Coward]

From the article:

QUOTE

The Accenture contract to take over the FFM development project was a one-year, sole source contract for $91 million for one year, and even that contract has exploded. As of June 5, CMS had obligated more than $175 million to the Accenture FFM contract.

END QUOTE

These contractors are a joke,. IBM has literally billions of failed projects all over America, most of them with some state government, DMVs BMVs etc etc. Look it up. Who is Accenture ? Accenture is Arthur Anderson by another name. Same fucking deregulation seeking, government tit-sucking sociopathic scum , they just changed their fucking name after they blew up America's economy with the Enron debacle in 2000.

http://www.zdnet.com/blog/projectfailures/erp-train-wrecks-failures-and-lawsuits/12055

http://www.businessinsider.com/2009/2/sap-clueless-consultants-from-accenture-and-ibm-giving-us-a-bad-name-sap

http://studentunionofmichigan.wordpress.com/2013/11/20/the-university-of-michigan-accenture-and-shared-servicesast/

These "consulting" companies smell a mega contract with the government and sail into port with slave ships filled with H1Bs with "Learn how To Program in 390 days" tucked into their knapsacks, knowing that the government will be too embarrassed to admit how much it's actually costing as the overruns start piling on. They bill the fuckshit out of the taxpayer and after they have that in their pockets, it all goes to court and the government is left with egg on its face while the filth defend themselves using the government's own money, "settle" the case with non-disparagement clauses everywhere then just roll on to their next "implementation".

http://accentureischeatingonitsclients.blogspot.com/2009/12/three-ways-accenture-is-cheating-on-its.html

http://www.pcworld.idg.com.au/article/445543/microsoft_accenture_joint_venture_avanade_sued_over_alleged_erp_project_failure/

http://spectrum.ieee.org/riskfactor/computing/it/bridgestone-sues-ibm-for-fraud-in-600-million-lawsuit-over-failed-it-implementation

Why does anyone hire these fucks in the first place? IBM et. al. should just be banned by law from any more state, local or national contracts and ditto with Accenture. Look it up i you don't believe me. This is the worst of the worst of sociopathic capitalism, right up there with Wall Street's credit default swap and collateralized debt obligation bullshit. This is the fleecing of America by what amounts to organized bands of thugs.

  http://news.techworld.com/applications/3410597/ibm-faces-lawsuit-over-failed-sap-implementation/

http://itknowledgeexchange.techtarget.com/sap-watch/failed-erp-implementation-watch-ibm-named-in-lawsuit/

http://www.eaconsult.com/2013/12/20/with-friends-like-these-uncovering-responsibility-in-avons-rollout-failure/

http://blogs.wsj.com/cio/2013/08/06/pennsylvania-nixing-ibm-tech-contract-running-60m-over-budget/

Re:You spend a billion on lorem ipsum? Don't hire

[Chadster]

I am just a technical guy, not the one writing business requirements, doing project management or signing off.

My point was, it is a general problem with how large technical projects are done and most "fail" because of the exact same reasons. This is not intended to start a discussion on techniques/methodologies.

I'm not trying to defend, it's just an observation.

Of course governments should be better at spending public money, but how can they be better when most organizations follow the same patterns and practices.

For the record, I don't work with or for any organization involved with that project.

Until there is repentance...

[Anonymous Coward]

Until President Obama repents of the great sins he supports, including abortion and the homosexual agenda, he will never have success at implementing anything! He has to first start with fixing the areas where he is morally wrong personally before he can successfully implement any scheme as grand as health care reform, because sound-mindedness does not come without a desire to obey the very basic precepts that God has layed out as Law first. And sound-mindedness is a prerequisite to knowing how to properly communicate information behind specifications and following-through with semantics refinement.

But don't take my word for it... you can read it in a book, the King James Version of the Bible. And if you disagree with this, you just take your diagreement to God and see where it gets you! But you have already received the message of the Gospel of Jesus Christ and are treading dangerous waters if you don't understand the plain truth that sound-mindedness first requires a desire to obey God out of love.

Technical People

[cshamis]

Normally, in order to solicit a project of any appreciable size, (over 100K) the government is required to produce a detailed SOW (Statement of Work) that defines the scope and goals. As projects get bigger (over 100M) the SOW begins to get more and more generic, but the accompaning Work Breakdown Structure (WBS) gets more detailed, and much much longer (five, six, sometimes as deep as eight or nine sub-sections) Each sub-section may generate dozens of Task Orders (TOs). Task Orders are what get assigned to contractors to work. If the upper document is vauge, or poorly thought out, or poorly defined, then the individual TO may be nonsensical.

Okay... so who is writing this nonsense? Well, the Government can't have the contractors who will be doing the work come up with the work they will do. (That's putting a fox in the henhouse.) So the Government will sometimes turn to a special type of contractor called a SETA (Scientific Engineering Technical Adisor) or FFRDC employee (Federally Funded Resarch Development Center) to develop the approach and SOW, WBS, and sometimes even write the TO. A SETA or FFRDC is specially recognised in that, they (and their respective employer) are expressly forbidden from bidding on or performing work on ANY project for which they have acted as a SETA or FFRDC. It's a classic case of conflict of interest. And, usually these guys are pretty good. There was no SETA or for the Healthcare.gov website. It wasn't considered a "technical" project (like building a moon-lander) so... that was probably the first mistake.

The second mistake is that the people in Government who normally get tasked with writing the RFPs SOWs and evaulating them are usually the same people who aren't um... "smart enough" to figure out how to get out of it. (LIke the jury-duty joke) They's also the same folks who get tasked with evaulating the proposals that come back... again... not the sharpest tools in the shed. So... there's plenty of blame to go round.

The absense of personal accountability in Government encourages irresponsible behavior. But, too much accountability encourages paralysis. (I'm not signing off on that!) So until we figure out how to fix that too... well... this is just going to keep happening.

F-35 Joint Strike Fighter

[Anonymous Coward]

why fall back when you are falling all over cash?

Many people fail. $billion should hire competence

[raymorris]

Sure, many people make the same mistakes. I'd hope that for a BILLION dollars, you could hire a couple of project managers who are actually competent. Plenty of companies have incompetent people, but plenty have lots of competent people who successfully complete projects - Google, eBay, Facebook, and a thousand other companies are competent at large scale IT projects.

If, like most projects, your budget is around $100K, you might end up with some typical incompetents in key positions. For a billion bucks, you should be able to have really, really good people in the key leadership positions making sure the project gets done. Was the person running the healthcare.gov project competent? Nobody was running it! I hope that's not like your typical project, I hope you actually HAVE a project manager at the head of most of your projects.

> Of course governments should be better at spending public money, but how can they be better

#1 Put someone in charge of the project.
#2 Choose someone who has successfully led a large project before.

It was the politicians more than CMS ...

[perpenso]

Note however there is one very important point missed in all the rhetoric... That of changing specification coupled with muddied/stratified change management. This issue sits squarely on CMSs shoulders and is absolute poison to any IT project of any significance...

It was the politicians more than CMS. Not that CMS didn't have its share of problem generation but folks in the administration doing political recalculations on what the user interface and functionality should be like probably made this problem far worse than your normal federal project.

Wasn't there some last minute change ordered by the administration not to show the unsubsidized policy price, so now the site had to integrate with various other agencies and exchange a lot of personal information to calculate an accurate subsidized price? Note that the subsidized price is absolutely unnecessary for comparison shopping. A person's subsidy is a constant, it does not change the price difference between policy A and policy B. If A cost $X more than B before subsidy it will still cost $X more after subsidy. It was purely a politically motivated change to avoid sticker shock on pricing.

useless website

[BradMajors]

The worst part is there is no reason why the Obamacare websites even need to exist.

Obama could have just told everyone to buy their insurance on einsurance.com and to get the subsidies when they filed their 1040.

Fifth Bullet ...

[ilparatzo]

• The government will continue to operate all future, similar projects in the exact same fashion, regardless of this report.

I'm shocked, SHOCKED...

[mi]

I can't be the only one shocked, SHOCKED to discover, the government is inefficient and wastes money. I mean, after the staggering success of everything else it operates — things like US Postal Service or Amtrak — it is certainly most disappointing to encounter a government program, that fails to live-up to our high expectations.

Nay, this may even chill our collective enthusiasm for making food and shelter a government's responsibility too — you can't be healthy without nutrition and a roof above your head, can you, so it only would've seem natural to further expand the government's omniscient and benevolent control into that direction. But not any more... Not quite...

All Hail Maximum Leader Barack

[gelfling]

Another is His infinite string of divine victories. All dissidents are of course racist.

Timeline of events

[acoustix]

It would be nice if someone has a compiled timeline of events starting with extremely uncoordinated writing and passing of the law, to the point where technical specs were released to the contractor, when the actually flow of information and final HHS rules were announced, up through go live and the fixes being implemented after go live.

From what I've read/heard there was little to no work being done from 2010 when the bill was signed into law up through 2012. The administration purposely withheld information about Obamacare from the public and from the contractor due to the election year (2012) and didn't want bad press. Once the election had passed the government released more specs and information to the public and to the contractor on how the website was supposed to function. That's when we found out the dirty little lies and secrets. It's damn near impossible to build a website/service to handle 300M+ people in 6 months, but that's what our government did.

This whole bill/law/implementation has been bungled so badly by:
- the incompetent people who wrote it (bureaucrats with no understanding of health care and did not consult people from the health care industry)
- the incompetent people in Congress who blindly passed it without reading or understanding the devastating effect it would have
- the incompetent administration who continued to lie about how the law affected the citizens, and took no ownership of this massive project

Can anyone imagine a scenario where this could have been handled worse? Every step along the way was screwed up.

Silly rabbit, hypotheticals are for kids.

[Anonymous Coward]

And what if the doctor has sworn an oath to provide medical care? What if they have contract with the surviving entity? What if they've been a member of the AMA and agreed to be bound by its code of ethics? What if they've chosen to live within a society, and be bound by its laws?

Right now, as far as I know, you're not being compelled to become a doctor, and your preposterously constructed hypothetical situation doesn't address that doctors are already bound by these oaths and principles of their own accord.

Is it wrong for a person to be bound by his or her own word? When do they get to break or bend it?

There's a reason why medical ethics classes are part of the curriculum at every medical school I know, and while I don't know if they bring up your specific iteration, they surely do cover ones similar enough. The duty of care covers disasters, and it remains in effect.

And the choice is simple. Don't like it? Don't swear the oath. And probably best if you don't try to act as a doctor, you could get in trouble if your standard of ethics doesn't measure up. Why? Probably at the foundation level, because people who behave in the fashion you suggest, are considered dangerous to be around. They're bad for everybody else in reputation alone.

(And no, physicians aren't the only ones with such obligations, many professionals are under such strictures, however, we need not digress into them.)

Re:Silly rabbit, hypotheticals are for kids.

[ganjadude]

well, we have a president(and have had others) who swore to uphold the constitution and we all see how well that worked out

Re:Silly rabbit, hypotheticals are for kids.

[I'm New Around Here]

Hypotheticals may be for kids, but your response is for mental patients.

Is it wrong for a person to be bound by his or her own word? When do they get to break or bend it?

When the rest of humanity disappears for no known reason.

Or do you expect the 500 people to still pay their taxes and obey all traffic laws as well as oaths given to professional associations that no longer exist?

If doctors all swore an oath to provide medical care, why are they insisting people pay them for that care? Your assertion is they must provide the care whether they get paid or not. Have you just solved the problem of health care? Simply insist doctors all work for no pay because their oaths outlive humanity?

Pascoea asked a particular point, which I responded to. I don't agree with his view on this one issue, but at least he has the integrity to offer a challenge in a fair way. Your response is simply brainless drivel. "Doctor's can't violate their oath, because we learned in kindergarten that's bad." The most ridiculous part of it is that if the doctor violates their oath, they are not allowed to practice medicine anymore. Which is the exact situation that my hypothetical was exploring.

Re:Silly rabbit, hypotheticals are for kids.

[I'm New Around Here]

Oh, you can't go there. The obamabots will get you for sure.

It's sad that they simply don't care that the person elected to uphold the Constitution has said that he doesn't believe in it, and has acted consistently to prove he doesn't believe in it. He actually doesn't believe in the document that created the office that he fills.

Re:Silly rabbit, hypotheticals are for kids.

[Anonymous Coward]

And? What's the problem? I fear that it would be a terrible world where you couldn't hold them to their oath. Much like I fear it would be a terrible world where you couldn't hold the government in general accountable for its duties.

Are you trying to make the accusation that they aren't fulfilling their oath? Well, you can endeavor to persuade the rest of us of the merits of that accusation, but of course, just because you make the accusation, doesn't mean it's true, and the rest of us also recognize that. It is a terrible thing to violate such an oath, which is why we must be careful with any accusations involving it.

That is the peril of living a life with choices.

Amusingly, the captcha is wariness. A good concept.

Re:Silly rabbit, hypotheticals are for kids.

[Anonymous Coward]

Oh you're complaining about fairness? You're the one who decided to use an unrealistic and preposterous hypothetical. Pardon me for recognizing that it's a warped construction deliberately chosen to fulfill your own preferences, a work of fiction as it were. You want to write that? Go join Daniel Defoe, William Golding, Robert A. Heinlein, and whoever else you want and start writing whatever you want. The outcome can be whatever you decide it to be. Even Moe can save the day if you like.

There's not much point to it in this discussion though, as the world we live in is not at all like your hypothetical, and the choices people make as part of the process of becoming doctors, are rather different than you seem to realize. They do have obligations and ethical standards. Some quite extensive. And they have training and exposure to them.

So yes, many doctors do expect to be paid. Their oath is not one of absolute charity and poverty. For that, you want a monastic oath. They do exist, and some may even be medical professionals. But others, don't go quite that far, and demand pay. Fair enough. Even judges and politicians aren't required to eschew all of the material world. But can doctors require payment before any treatment whatsoever? Nope, provisions for emergency life saving care are in the law and they're aware of their ethical duties. They don't get to decide to turn a blind eye, but instead have to spend considerable time preparing it. And in some cases, the doctor may be bound to serve in some form at the behest of another, as a result of their agreements made to attend medical school. Even at the peril of their own life.

And yes, in the world of today, a doctor who fails their oath will most likely be fined and stripped of their position. That's because in most cases, their misconduct warrants no further involvement in the world of medicine. And let's face it, the world isn't entirely devoid of other medical professionals. So most likely there's no shortage that really requires any individual to specifically perform. But actually, they can and have been sentenced to community service when appropriate. Including sometimes speaking to others in order to provide warning and real-life experiences. And that's not just true for doctors, this is true for others when facing judicial punishment as well.

There are even many who think that more of such process would be even better for the judicial system. It actually has a long history, and some people believe that significant elements of the current justice system are an aberration. But no need for me to digress into that, if you want to look it up, you can explore the topic yourself. It is also a real world topic, and much discussed. Don't feel any need to go into any more hypotheticals on that either, though if you insist, there are also some works of fiction I could name.

Re:Silly rabbit, hypotheticals are for kids.

[I'm New Around Here]

Your whole argument is based on a doctor who took an oath. What about someone who has medical knowledge, but never took an oath and became a practicing doctor? Would he or she still be bound by your beliefs in what doctors should do, or could be forced to do? That is a very weak linchpin to base a human right around.

As for whether or not I should use a hypothetical situation to prove my point, isn't that a common way of teaching in college classes? Not simply saying a rote answer, but making people think through a situation and its consequences? I know I'm not the first person to envision an "isolated group of humans" scenario. As for it being "fair", I never claimed it was. I said that Pascoea offered a challenge in a fair way. I answered in a manner I felt appropriate to impart the reasoning behind my simple answer of "No".

Good day, sir.

Re:Silly rabbit, hypotheticals are for kids.

[Anonymous Coward]

No, my counterargument to your presented hypothetical is based on the fact that the real world, the one we live in, already has rules and obligations for doctors (and other medical professionals, as well as other professionals in general), as a part of medical ethics. They've already gone through this discussion and come to some strictures for their conduct in order to become doctors. It's already part of the system. If you wanted to understand and examine the principles which it was built around, you could have asked. But from your choice of hypothetical situations, it seems obvious you wouldn't actually want to do that. You want to walk away from it, with a wave of your hand.

Which is the problem. Because, no, it's not whether you should offer hypothetical situations at all, it's that yours, in particular, is rather preposterous, constructed just for you to repeat what notions you've already decided upon. You weren't trying to think through a situation in the real world and its consequences, but instead using a particular narrative to tell your own story. You made your own world, with your own conditions, and came to your own conclusion. Yeah, people have written that kind of book before. Yours is one variation, others have their own stories.

People can do that, when it comes to works of fiction. But it's not really meaningful. Such fictions don't even have to follow the laws of physics, let alone reflect real human behavior on the individual and societal level.

Had you wanted to discuss some cases of medical ethics, there are plenty of real world ones that could be useful for a discussion. Some that aren't so divorced from reality. Examining them would provide something useful in a discussion of the real world. Yours? Not so much.

Re:Silly rabbit, hypotheticals are for kids.

[I'm New Around Here]

Sir, I said good day.

Re:Silly rabbit, hypotheticals are for kids.

[Anonymous Coward]

And? Was there some reason that little pettiness should be given any more weight than say, your own preposterous hypothetical? Not really, no more than whenever somebody tries to end an internet discussion by such an act.

All it does is show you're having a snit fit.

But I knew that already.

Re:Silly rabbit, hypotheticals are for kids.

[Anonymous Coward]

While a certain New Jersey police officer may have made that justification for his own misconduct, it doesn't actually make it true.

You'd have a better case against John Adams or Woodrow Wilson.

Re:Silly rabbit, hypotheticals are for kids.

[I'm New Around Here]

It was true long before that incident. Your blind partisanship is showing.

Re:Silly rabbit, hypotheticals are for kids.

[I'm New Around Here]

Wow. That's a fair amount of over-reacting to a common punchline, given when one is tired of suffering a fool. Also, it is not my fault you cannot fathom the reason people use manufactured scenarios to explore or explain human nature. You are the one who has consistently been showing your lack of mental abilities, insisting that an oath precludes a person from acting in their own interest, rather than in the interest of others, simply because you say so. Especially since I pointed out that the person may have never given such an oath.

If there was no oath, your argument is simply a lot of hot air. You can't accept that fact. You keep blustering on about my hypothetical, as if your own point is anything but partisan ravings against a point you don't agree with.

That is why I said good day.

Re:Silly rabbit, hypotheticals are for kids.

[Anonymous Coward]

And yet from my perspective, you're the one who is over-reacting and having a snit fit. Really, every accusation you've made against me? I'm more inclined to say they're on your end. Though I don't know whose fault it is that you can't understand how your preposterous constructed scenario doesn't help explain or explore human nature, because of how it doesn't serve to address the world we're in today. Perhaps it was your parents, perhaps your teachers, perhaps it's entirely your own fault. I really don't know you well enough to say where your refusal to apprehend the world we actually live in came from, and there's so many potential originations.

But we're in the real world, where yes, an oath does demonstrate a commitment to taking certain actions, even to the point of acting against your own interest. That's the whole intention of such measures, and they are a fundamental underpinning of our society. It seems to me you don't want to accept that fact. Or were you just unaware of how the human interaction works? I know, you chose to bluster on about me with your pointless attacks, and I know you don't want to admit that your own point is based on hand-waving away the real world and retreating into a warped narrative that has nothing to do with the real world. Though I don't know why. As I said, I don't know you. It could come from a lot of places.

Unless you want to describe your life in more detail, it's really not addressable as to causes.

I can, however, point it out.

Re:Silly rabbit, hypotheticals are for kids.

[Anonymous Coward]

Oh, I agree such complaints about Obama predate that incident, it's just that your own words echo that recent bit.

But no, actually, it's your partisan bias that has come across resoundingly clearly. Along with a bunch of other things.

You're only a few monkeys in your barrel short of Michelle Bachmann.

Re:Silly rabbit, hypotheticals are for kids.

[I'm New Around Here]

Wow. That's the best you can do? That's the most pathetic insult I've received all year.

As for my 'partisan bias', I've stated on this forum and others that I voted for Mr. Obama back in 2008, and for Jill Stein of the Green Party in 2012. I don't regret either vote.

So go stuff your preconceived notions of my political and social bias right back up from where you pulled them.

Re:Silly rabbit, hypotheticals are for kids.

[I'm New Around Here]

This is almost getting amusing, if only you weren't such a broken record. You think I am at fault because you cannot understand any system other then your own. You are still talking about an assumed doctor's oath, when I have shown there is not need to assume an oath. Yet you still hang your argument on it, and then say I am the one who can't handle reality.

Yes, we live in the real world, not the mental exercise I used as a mere explanation of my views on a particular point in a large debate about human rights. However, you are saying that my views are only valid in that mental exercise, not the real world. My views are my own, and I have the right to them the same as you have the right to your views. The real difference here, is that I acknowledge you have the right to your own views, even though they are in opposition to my own.

You are trying to deny my right to my own views, and using the 'oath' and 'hypothetical' arguments to force me to change my views so that they match your own. I have seen many people like you, over the 20 years I have been having these sorts of discussions, both online and in real life. You are so convinced of your own superiority and rightness, you can't even comprehend someone else's viewpoint enough to intelligently argue about it.

You have to focus on one or two insignificant (and incorrect) points, and keep bullying your way through until your opponents either give in and leave the discussion, or you push them to lash out at your intransigence, and then you can declare the moral high ground over some 'mere unenlightened savage'.

Re:Silly rabbit, hypotheticals are for kids.

[Anonymous Coward]

If it's a pathetic insult to point out somebody's partisan bias, then why did you do it? Are you that pathetic then? Or did you mean saying you weren't quite as crazy as Michelle Bachmann? Well, I can't speak as to the quality of insults you have received over the course of this year, but I do expect you've received quite a few.

But no, here's your own words:

Oh, you can't go there. The obamabots will get you for sure.

It's sad that they simply don't care that the person elected to uphold the Constitution has said that he doesn't believe in it, and has acted consistently to prove he doesn't believe in it. He actually doesn't believe in the document that created the office that he fills.

Too late to protest with defensiveness. Because my reaction to you? It's not preconceived. It's directly attributed to your own words in this thread.

Especially, now that you say you did vote for Obama , but don't regret it? That's even worse. Because then you are saying you don't regret that you voted for somebody that you described in the way you did, which reflects poorly on your assessments of your actions. I could understand not blaming yourself for being fooled, you could attribute it to being deceived by a slick con-artist, but no regret? That shows a lacking in integrity.

Re:Silly rabbit, hypotheticals are for kids.

[Anonymous Coward]

Well, of course, this discussion is repetitive. Any discussion involving somebody as oblivious to their failings as you seem to be will ultimately hit a wall where there's no progression. You are still trying to act as if the real world, where there are such oaths and obligations on medical professionals, is one that doesn't matter, because you would rather continue to act as if your own preposterous situation was meaningful or addressed anything important.

It's not doing anything though. It's just you writing a story. You can do that all day. It'll come out however you want it. Some people may even eat it up, and think you're saying something profound. It's not like there aren't people who want to agree what you're saying. I've also seen many people like you as well. Ones who happen to be making a self-righteous argument of your own superior views, while disdaining anybody who dares to disagree with them, or points out the nature of their preposterous fantasies, or even just suggests you are being hyperbolic.

Really, your attacks mirror your own conduct rather than mine. You should really try to see how they reflect upon you. Work hard at it.

They called it "agile", but was it?

[emmerson.steven]

From the full report:

The four reviews shown in figure 5—architecture, project baseline, final detailed design, and operational readiness— are among those required under the exchange life cycle framework, the governance model CMS specifically designed to meet the need to quickly develop the FFM and data hub using the Agile development approach.

Sounds like "waterfall" to me.

*COUGH*

[hurfy]

Mine says, "Lifewise"

It also says, "Essential Silver 2500 HSA" which defines it as one selected from the website. The network name probably identifies it also. Not to mention the 4 other id numbers on the card.

Not sure why a doctor would care as they seem to be rather normal insurance plans but they could tell if they wish.

Medicare/Medicaid are a whole other story. Often patients don't have the copay and that is profit for many procedures/items due to low payments on SOME things. (and some are still overpaid) Often the additional paperwork and the threat of an audit put many off accepting those. Or, as in my case, All of the above plus the fact I can't afford the bookkeeper JUST for 3rd party billings.

I currently sell medical supplies and did the books for a medical supplier for almost 20 years.
Survived a Medicare audit and a Sales Tax audit with no penalties ...don't try this at home!

Former construction/contract manager.

[technosaurus]

I used to work for NAVFAC, the U. S. Navy version of contract management for construction projects.  Though there was a lot of bureaucracy involved, the planning and design phase always had plenty of experts to ensure the specifications were above most commercial standards (LEED certifications, military requirements, utmost safety requirements, etc...)  Though many aspects of the process used archaic technology (lots of paper forms, area expert controlled word documents as best practices,...), the end result was that most projects ended up being completed on time and on budget (though the start sometimes got shifted so the review could be thorough ... unless October 1 was coming, but that is a different subject - or maybe not, this project had similar time deadlines).  A lot of this success was due to savvy construction managers doing appropriate "horse-trading" with contractors to avoid the lengthy change processes (which could delay anywhere from a day to 12 months).  When you have (non-technical) contract managers who don't know the reasoning behind the requirements, they have little recourse but to go through the official processes to resolve complex issues... _This_ is where you get your delays.  For the most part, a good hour spent in design/planning will yield ~10 in production, but it is important for the project manager to be intimately involved so this wisdom can actually be _useful_.  I can attest to my own anecdotal experience and my observation of others, that coming into a project at production phase is more than just a steep learning curve; some things just have weird historical issues.  Here are a few that I ran into after another CM was transferred elsewhere:
- endangered species in the area
- abandoned toxic waste in the soil
- asbestos
- this site used to be a WW2 bombing range and guess what?...We found a bunch of unexploded ordinance.
- hurricane damage
- tornado damage

Given the complexity of the project

[ToddInSF]

...and I don't just mean the technical aspects, what I'm talking about is how the technical information to make the project work being spread across multiple organizations that do not necessarily share information much less have systems and methods in place for inter-agency cooperation. You can't come up with an adequate analogy between this project and any others, because there haven't been any similarly complex projects.

Yes, it feels good to bitch about how incompetent "the government" is, but THAT dialogue is always about a political agenda, and not a factually descriptive language.

When you rush a project and dump money into it your results are as expected. No political agenda and deceptions necessary.

And if they can't?

[eric_harris_76]

And if the federal government can't improve its processes for such things, perhaps it will quit attempting them. After all, screw up enough things badly enough, and it'll run out of money, and go away. Such is the nature of failed institutions.

Oh, wait. That won't happen. Two reasons: IRS and Federal Reserve.

Of course, it could go away without running out of money. Two examples: Weimar Germany and Zimbabwe. The places were still there, but they had dramatic changes in management.

Such is the nature of failed institutions.