Recommend
 
 Thumb up
 Hide
57 Posts
1 , 2 , 3  Next »   | 

BoardGameGeek» Forums » Everything Else » Religion, Sex, and Politics

Subject: Healthcare.gov Implementation - Whose responsible this? rss

Your Tags: Add tags
Popular Tags: [View All]
Professor of Pain
United States
St. Joseph
Minnesota
flag msg tools
badge
Avatar
mbmbmbmbmb
The healthcare.gov website is having some serious technical problems. A couple points before discussing why.

1) This is a technical, IT related problem rather than a problem with the exchanges themselves* or the regulatory requirements of the ACA (such as children can stay on parents insurance up to age 26, no pre-existing conditions exclusions, no lifetime coverage cap, etc.). *Sort of, see below

2) Healthcare.gov is simply a public portal to a range of all-private insurance options. See this opinion piece from Fox News.com for one person's experience shopping on the exchange.

3) For the most part, the 20 or so state-run exchanges are working well and some are quite smooth, particularly Kentucky, California, Oregon and others.

So, why the fuck-up with the federal level exchange website and what does it reveal about this sort of program/process? Mike Konczal from the Roosevelt Institute has a fantastic article discussing this very question. Please read the article, it's relatively short.

What Konczal illustrates so well is that the problem with Healthcare.gov (and the ACA in general) is that this is a neolilberal solution to health insurance grounded in public-private partnership. Rather than utilizing the efficiencies, leverage and bargaining power of a government run system, the government here is acting simply as an enabler to market activities. Rather than demonstrating the problems with a "big government takeover" of healthcare insurance, what this is really demonstrating is the need for a single-payer system.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
J
United States
Lexington
Kentucky
flag msg tools
admin
Avatar
mbmbmbmbmb
Elfbane wrote:
3) For the most part, the 20 or so state-run exchanges are working well and some are quite smooth, particularly Kentucky, California, Oregon and others.

The Kentucky one is working very well, but Oregon doesn't yet have their online signup process available.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Professor of Pain
United States
St. Joseph
Minnesota
flag msg tools
badge
Avatar
mbmbmbmbmb
jmilum wrote:
Elfbane wrote:
3) For the most part, the 20 or so state-run exchanges are working well and some are quite smooth, particularly Kentucky, California, Oregon and others.

The Kentucky one is working very well, but Oregon doesn't yet have their online signup process available.

Oops! Going from memory, which is increasingly unreliable. I meant Washington - hard to tell the difference sometimes... What about the substance, though?
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Rich Shipley
United States
Baltimore
Maryland
flag msg tools
badge
the liberal unsavory type
Avatar
mbmbmbmbmb
This is a procurement system issue and oversight failure.

To fix it, I would set up clones of a state system that is working well (maybe KY or CA).
1 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
J
United States
Lexington
Kentucky
flag msg tools
admin
Avatar
mbmbmbmbmb
I would have preferred single-payer, but it didn't pass. I think there would have been problems even if it was single-payer though. The government's process for choosing contractors is byzantine and doesn't always result in the best people being 'qualified' to do the job.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Michael Carter
United States
Marion
Iowa
flag msg tools
Avatar
mbmbmbmbmb
What I love is that they paid their contractor millions of dollars and yet the contractor couldn't implement common security features and left the service vulnerable to textbook hacks that are taught in college courses.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
United States
Texas
flag msg tools
badge
"that's a smith and wesson, and you've had your six"
Avatar
mbmbmbmbmb
mlcarter815 wrote:
What I love is that they paid their contractor millions of dollars and yet the contractor couldn't implement common security features and left the service vulnerable to textbook hacks that are taught in college courses.


The problem is that there are very few software companies out there that can get past the government contracting paperwork. People were asking why big name companies didn't get this contract, and the simple answer was, it is just too hard to navigate, and is quite political in nature. No one else puts in bids.

The government needs to fix it's own procurement processes first so they don't rely on these sub-par companies.
4 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
J
United States
Lexington
Kentucky
flag msg tools
admin
Avatar
mbmbmbmbmb
bjlillo wrote:
The Federal government has proven themselves to be too incompetent to run a portal which multiple private entities have already done and, rather than seeing this incompetence as a warning, you'd prefer to just hand them even more responsibility? That doesn't seem particularly wise.

medicare works pretty well and a majority of people love that program
1 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Ken
United States
Crystal Lake
Illinois
flag msg tools
badge
Avatar
mbmbmbmbmb
Elfbane wrote:
So, why the fuck-up with the federal level exchange website


Failure to test at scale - it may not be easy to simulate millions of simultaneous connections, but it is possible.

Failure to create traffic control mechanisms that "throttled" connection attempts more intelligently (e.g. redirect people away from overloaded servers to information pages with messages like 'We're sorry, but if we tried letting you login right now, the system might crash.').

Different vendors responsible for different parts of the code with little overall architectural oversight to make sure things worked well together.

Trying to do too much too quickly in a single system. Let people shop for policies in one system and check eligibility for subsidies in another system in the interest of stability rather than trying to get it all done in one go.

Quote:
...what this is really demonstrating is the need for a single-payer system.


While I might be a supporter of such a policy, the issues above could arguably be much, much worse if everyone in the country was being handled by a single system.

Don't get me wrong, I see tons of advantages to the structure, but this isn't an argument for it. This is a reiteration of the fact that the government generally sucks at technology because it's usually design-by-committee. There's a saying in the development world I've heard a number of times - "A camel is a horse designed by committee."

Too many cooks, too many dishes, too little space in the oven to make sure it all cooked properly.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Ken
United States
Crystal Lake
Illinois
flag msg tools
badge
Avatar
mbmbmbmbmb
jmilum wrote:
bjlillo wrote:
The Federal government has proven themselves to be too incompetent to run a portal which multiple private entities have already done and, rather than seeing this incompetence as a warning, you'd prefer to just hand them even more responsibility? That doesn't seem particularly wise.

medicare works pretty well and a majority of people love that program


If the computer systems for Medicare were developed on the same schedule as the healthcare.gov system was, I'd lay odds that it had some major SNAFUs on day of launch that gave the government black eyes.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
J
United States
Lexington
Kentucky
flag msg tools
admin
Avatar
mbmbmbmbmb
perfalbion wrote:
If the computer systems for Medicare were developed on the same schedule as the healthcare.gov system was, I'd lay odds that it had some major SNAFUs on day of launch that gave the government black eyes.

yeah, when Medicare Part D rolled out, the website wasn't available until 3 weeks later.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Professor of Pain
United States
St. Joseph
Minnesota
flag msg tools
badge
Avatar
mbmbmbmbmb
bjlillo wrote:
Elfbane wrote:
Rather than demonstrating the problems with a "big government takeover" of healthcare insurance, what this is really demonstrating is the need for a single-payer system.


The Federal government has proven themselves to be too incompetent to run a portal which multiple private entities have already done and, rather than seeing this incompetence as a warning, you'd prefer to just hand them even more responsibility? That doesn't seem particularly wise.

You are missing the point. The problem was the reliance on private contractors coordinating information across multiple agencies instead of the Federal Government doing it at one agency, as is done with Social Security and Medicare. (And the reliance on private insurance companies...)
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Ken
United States
Crystal Lake
Illinois
flag msg tools
badge
Avatar
mbmbmbmbmb
Elfbane wrote:
You are missing the point. The problem was the reliance on private contractors coordinating information across multiple agencies instead of the Federal Government doing it at one agency, as is done with Social Security and Medicare. (And the reliance on private insurance companies...)


No, the problem was shitty project management. The government uses contractors for just about everything, and they realistically should. The government is, generally speaking, very bad at application development.
6 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Professor of Pain
United States
St. Joseph
Minnesota
flag msg tools
badge
Avatar
mbmbmbmbmb
Oops! I screwed up something else - forgot to include the link to the Konczal article. Added it to the OP. Here it is with his main points:

However, four bigger problems jump out.

The first has to do with means-testing the program. The biggest front-end problem is that users, before they can register, must “cross a busy digital junction in which data are swapped among separate computer systems built or run by contractors.”
...
This by itself might not be a problem; however, the second issue is that the means-testing is necessary to link individuals up with individual private insurers. As the Washington Post notes, the back-end problems are in part the result of the site being “designed to draw from the offerings of private insurers, each with their own computer systems, rates and offerings.”
...
A third issue, and a major reason this is freaking people out, is that the first two problems could introduce adverse selection, as only the most needy will wait, and wait, to take advantage of the programs.
...
And the fourth and final issue is that the federal government has had to pick up so much slack from rebelling states that didn’t want to implement health care. The state-level exchanges that were actually implemented appear to be doing okay, or at least significantly better. But the general problem is that “More than 30 states refused to set up their own exchanges, requiring the federal government to vastly expand its project in unexpected ways.”

 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Professor of Pain
United States
St. Joseph
Minnesota
flag msg tools
badge
Avatar
mbmbmbmbmb
perfalbion wrote:
Elfbane wrote:
You are missing the point. The problem was the reliance on private contractors coordinating information across multiple agencies instead of the Federal Government doing it at one agency, as is done with Social Security and Medicare. (And the reliance on private insurance companies...)


No, the problem was shitty project management. The government uses contractors for just about everything, and they realistically should. The government is, generally speaking, very bad at application development.

Poorly worded. My focus is on the coordinating across multiple agencies thing. See the Konczal blog. IT is definitely not my area...
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
BoB 3K
msg tools
badge
Avatar
mbmbmbmbmb
There is exactly one problem with this--it was a large-scale software development by government contractors. This has been my job for 15 years and it sounds exactly like most every project I've worked (although bigger).

Large scale software development is VERY hard, and then add in bad and/or changing requirements and this is what you get every time. A lot of people are talking about not enough test time and not enough coordination, but both of those are mostly symptoms of not getting a working set of requirements worked out and tied down (unchanging), and getting all parties to input on / agree to / adhere to those requirements.

I'm laughing the whole time this issue is bouncing around the political stage because it has NOTHING to do with politics, it is simply the world of large scale, bureaucratic software development.

4 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Ken
United States
Crystal Lake
Illinois
flag msg tools
badge
Avatar
mbmbmbmbmb
Elfbane wrote:
Poorly worded. My focus is on the coordinating across multiple agencies thing. See the Konczal blog. IT is definitely not my area...


Understood. I think the big point I'm trying to make is "this doesn't feed in to a larger policy issue. It's a launch screw-up and not an argument for anything better than stronger project management."

It's not an argument for single-payer. Indeed, it creates a stronger argument against it since a massive system failure for something like that could actually impact the care delivered. Which is also an argument I've heard made, which is just a silly because there are computers supporting the many single payer-systems around the world that work just fine.

It's bugs. They happen. Sometimes horribly publicly. They'll get fixed and we'll move on and anyone trying to use the incident for political purposes really should sit in the corner and be quiet for a while.
1 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
BoB 3K
msg tools
badge
Avatar
mbmbmbmbmb
bjlillo wrote:
They didn't even do a pilot program.

Yes this. If you compare this tech to some other successful big name working sites like maybe twitter or amazon or facebook, the big difference is that none of those sites where turned on with a huge cartoon power switch one morning, but developed gradually over years. And even then you have sites like facebook that don't crash and mostly do what they're supposed to and yet still leave MUCH to be desired.

Of course, the other issue here is the examples I gave are commercial sites that are for-profit (or at least trying to be) and so they CARE about working correctly. The ACA site is a non-profit worked on by large corporate contractors who make all their money from service contracts charging for work performed, not quality of said service (regardless of what all their company motto/slogan may be.)
2 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
BoB 3K
msg tools
badge
Avatar
mbmbmbmbmb
bjlillo wrote:
It has quite a bit to do with politics though. This thing wasn't even ready for an alpha release but people are now required to buy health insurance or face fines. ... ...

Oh, I'm not saying it doesn't have political ramification and of course it can be used by political parties for their various bullshit agendas. I'm talking about WHY it happened.

 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
United States
Texas
flag msg tools
badge
"that's a smith and wesson, and you've had your six"
Avatar
mbmbmbmbmb
As we say at IBM...."Beta testers are you"
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
jeremy cobert
United States
cedar rapids
Iowa
flag msg tools
Avatar
mbmbmbmbmb
is there any way we can blame Bush or Racism ? those are usually the prime suspects when things go wrong in this administration.
 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
J
United States
Lexington
Kentucky
flag msg tools
admin
Avatar
mbmbmbmbmb
bjlillo wrote:
Holy crap, every Senate Dem facing re-election is in favor of delaying the individual mandate now? Where were they last week when that would have been useful?


delaying the "enrollment deadline" is not the same as delaying the individual mandate...
1 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Dave G
United States
Illinois
flag msg tools
badge
El Chupacabratwurst
Avatar
mbmbmbmbmb
bjlillo wrote:

It has quite a bit to do with politics though. This thing wasn't even ready for an alpha release but people are now required to buy health insurance or face fines. One party recognized that it wasn't ready and thought that delaying it would be wise. The other party also recognized that it wasn't ready but instead decided to compare those who wanted to delay it to terrorists, kidnappers, and arsonists instead of allowing their pet project to be delayed.


Is this the story now? The GOP shutdown wasn't about eliminating Obamacare, just protecting the poor, unsuspecting public from a website that wasn't ready?
8 
 Thumb up
0.05
 tip
 Hide
  • [+] Dice rolls
United States
Texas
flag msg tools
badge
"that's a smith and wesson, and you've had your six"
Avatar
mbmbmbmbmb
djgutierrez77 wrote:
bjlillo wrote:

It has quite a bit to do with politics though. This thing wasn't even ready for an alpha release but people are now required to buy health insurance or face fines. One party recognized that it wasn't ready and thought that delaying it would be wise. The other party also recognized that it wasn't ready but instead decided to compare those who wanted to delay it to terrorists, kidnappers, and arsonists instead of allowing their pet project to be delayed.


Is this the story now? The GOP shutdown wasn't about eliminating Obamacare, just protecting the poor, unsuspecting public from a website that wasn't ready?


It could be. Why not, as good as any of the other ones. TO THE PUNDIT PHONE!
3 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
Germany
flag msg tools
Avatar
mbmb
You know how it is. When people try to finish things in a hurry, they make errors. Like typing "Whose responsible this?" instead of "Who is responsible for this?"
7 
 Thumb up
 tip
 Hide
  • [+] Dice rolls
1 , 2 , 3  Next »   | 
Front Page | Welcome | Contact | Privacy Policy | Terms of Service | Advertise | Support BGG | Feeds RSS
Geekdo, BoardGameGeek, the Geekdo logo, and the BoardGameGeek logo are trademarks of BoardGameGeek, LLC.