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Michael Olenick: How My Experience with Healthcare.gov Shows “Better” Software May Not Be the Solution

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By Michael Olenick, a regular contributor on Naked Capitalism. You can follow him on Twitter at @michael_olenick

This piece about my attempts to enroll on healthcare.gov runs the risk of being long, frustrating, and potentially repetitive, but that simply reflects the experience itself. But it also gives a taste of the nature of the problems and where the remedies might lie.

Much has been written about the rightfully maligned healthcare.gov website though little of that involves people, on the federal exchange, who actually try purchasing health insurance. Unlike contractors and federal employees who do not use the site, I have the misfortune of falling into this category. Since I’m also a software developer, I thought it worthwhile to document this strange experience.

I initially tried to sign up October 1, the day the exchange site opened, and every day after. Initially I’d sometimes get to the third screen of the account creation process – the one that asks security questions – but the questions were blank so I was thwarted from creating a login. One time the questions were there and I did create a login but I was never able to use it again.

Coming to the conclusion that the system reserved the username but lost the password – which later came out in the popular press but was never acknowledged by the government – I tried a new username. Finally, after weeks, I could log in. My sense of accomplishment was palpable: soon I could view unaffordable mandatory health insurance plans that cover 60-70% of my costs but include guaranteed insurance industry profits. This is progress!

After answering some odd questions to verify my identity the system told me I might not be who I say I am. My hopes were raised – maybe a random person wanted to purchase health insurance for my family and pay the full price – but I had to call a phone number to progress. After an hour on hold with Equifax a phone operator confirmed the system actually did verify my identity but, for whatever reason, told me to call in anyway. Apparently this is a common “glitch.” I’ll admit that the Equifax rep displayed the patience of Buddha, single-handedly increasing my feelings of goodwill toward Equifax, which was not hard because I had no goodwill toward Equifax before the call. However, I never figured out why a credit bureau is involved in taking applications for health insurance.

Being verified I marched onward in my quest for medical insurance.

Let’s take a breather for some background about how I found myself tangled in the governments half-billion dollar boondoggle of a website. I work as a research fellow for a European business school but I am based in the US. As an external contractor health benefits aren’t included so I get to buy health insurance for my family.

My state of Florida – led by Tea Party Governor and former healthcare executive Rick Scott – opted out of building a state-based insurance exchange so I use the federal exchange, or try to at least. Florida doesn’t have a state exchange because Scott, who paid the largest fine in Medicare history before being elected Governor, couldn’t find a way to make a buck for himself or his cronies so opted out of building a state exchange. Apparently, Scott didn’t think of creating an overpriced “consulting” firm, the latest rage in government scams.

Unlike many complainers, I largely support the Affordable Care Act. It should be a single-payer system, but I’m willing to accept the idea that a great journey begins with a single step and see the ACA as a start.

Getting back to the website, I eventually finished entering the pertinent information for my small family. I electronically signed my application, expecting to see plans, but instead was told the application is “pending.” Given our ages, medical conditions, and lack of eligibility for a subsidy. I half expected Obama himself to show up with a list of plans; we are the target audience. Instead I waited days, finally digging back into the application to be told me there was missing information. I went through the same process again, giving the same information about my family. This was easy because, for the most part, the “missing” fields were pre-populated from my last time through.

In my second try I was able to fix one especially weird glitch from my first attempt. That is my wife was listed as my spouse, and my daughter was listed as my daughter, but the system thought my daughter was also my wife’s spouse. Never mind that our daughter is seven years old and my wife already had a spouse (the system appears to be open minded, I suppose). In my second attempt, the fields were editable and I was able to correct this anomaly.

Again days passed with no emails, phone calls, knocks at the door, or any indication things were progressing. My wife asked me what’s happening and I showed her, submitting the same data a third time. Days later I tried a fourth time, from an iPad, with predictably dismal results. I thought I’d check again on the status while writing this piece but, on a Sunday at 11:18AM, I’m told that the system is down after I try logging in. Duh! .. there is obviously nobody who might want to try signing up for healthcare as part of their Sunday morning chores. [Follow-up while editing: it eventually came back up as dysfunctional as ever; “they” tell us Verizon can’t keep basic web servers alive, which is difficult to believe.]

The government apparently spent about a half billion dollar on this mess and, though it’s there seems to be an excuse for each and every dollar spent. It’s high volume, went the initial response. When Rep. Anna Eshoo, Democratic ACA supporting Representative from Silicon Valley pointed out that it’s much lower volume than many mainstream systems, the Illuminati of healthcare pivoted. Actually, beams the 1984-style government announcement, it was never really a volume problem but the data is very complex. This morning, during Congressional testimony, it sounds like the bureaucrats have pivoted again and that they are back to high volume.

All this struck me as odd, especially for the unsubsidized plans, because there really is nothing substantively complex about it. That’s the beauty of the ACA: preexisting conditions do not matter so there is actually much less information to collect than web-based systems insurance companies wrote that have existed for well over a decade. If people need a subsidy the system must check with the IRS, but banks do that routinely now when issuing mortgages. I read the system must also check with DHS, though – like the credit bureaus – can’t fathom why (if DHS is looking for terrorists in hospitals I’d suggest they skip patients and go to the billing department). In any event I don’t qualify for a subsidy so none of these checks should have been necessary – just show me the plans I’m expected to buy and let me purchase one – but the system still bombed out.

At this rate it might make sense to process people by hand, one at a time. If Fannie, Freddie, and the FHFA can process mortgages, which they can, those agencies implementing the ACA should be able to forward healthcare applications to private companies, which they clearly cannot.

Few people point it out but this fiasco is the predictable result of rigged government contracts. To put things in perspective I looked for some other outstanding government contracts to see how they rig “open” bidding; the methods quickly became obvious.

On the “RFP-EZ” marketplace there is one RFP to build a reservation system for the national park service, a straightforward project a small software business could bid for. Except there is one odd requirement: the system is still up for bidding on October 27, 2013, and it must launch between January 1 and February 1, 2014. That is, there will be no more than two months, including winter holiday, to build and test the system after contract approval. It’s almost as if somebody already built a system and now just needs to win an impossible bid in order to get paid. Almost…

Similarly there’s a project to provide a database of all publicly rated debt issues and issuers, including all historical ratings, credit migrations, and defaults. Successful vendors will not only keep up the data in real-time but will also keep the structure of the deals affected, and store the data so that it can be converted into many other programs. Finally tech support includes not only the use of technology but also “guiding OCC users through the use of the data.” Something tells me that the OCC – an agency that’s arguably the pinnacle of government incompetence, corruption, and waste – already has somebody in mind for this gig.

Lambert and NC readers questioned whether open source could have prevented this mess. In short .. I think so, or at least that open source methods may have helped (OK .. at the very least they wouldn’t have been harmful). On launch date Hacker News, the popular community for the geekdom, dissected the tiniest bit of healthcare.gov and found they were still using test code post-launch. By noon on launch day the tech community found specific problems, and suggested specific solutions, that the half-billion suited up DC contractors apparently did not notice for months or years. Granted it was not that hard because the files were marked “test,” but at least they took a moment to check, unlike the contactors paid handsomely to do the same.

Now the administration tells us that the misnamed Quality Software Services, Inc. (QSSI) – the firm that apparently botched both the signup and verification process – has been hired to fix the problems. This time will be different, I’m sure. Maybe they’ll try something new, like outsourcing the project. We know that did not happen before because they testified to Congress they did not outsource healthcare.gov. Of course, just like it only takes a moment to find the test code it doesn’t take much longer to find that QSSI applied for 23 H1B foreign worker visas from October 2011 through September, 2012. Most of these positions were for computer software engineers, and all but one are for workers from India, most to be paid $80,288/year. Maybe those are for a different project, though in that case QSSI miraculously could find people for healthcare.gov but couldn’t for a different project. Similarly, the other contractor CGI Federal applied for 13 positions during the same time period though with more geographic diversity: 10 from India, one from China, one from Bangladesh, and one from Venezuela.

Well, it’s not like there are out of work older American programmers who specialize in this field, except that there are. Unemployment for older programmers, oftentimes with backgrounds in large systems, is actually epidemic. However, that’s a different story though one deserving a lot more attention than it gets.

Since griping without solutions is not helpful I’ll offer some specific solution. Ask Amazon to build a healthcare sales portal, quickly. If Obama bet Bezo’s $100 Amazon couldn’t finish a functioning portal in a week I suspect they meet the challenge, in a week or less. They’d probably even be willing to process payments. Similarly Google and Microsoft might welcome the challenge, if nothing else just to show that they can. Government could have used healthcare.com (not .gov), an eerily similar health insurance marketplace that appears to work, though I’m assuming the owners did not know who to properly bribe (strike-out and replace with lobby). That is not because private business is always better than government, a widely misused argument for anti-government demagogues. But, in this very narrow and specific case – showing buying options from third-party businesses and completing a sale – the function really is the same and the private businesses have lots of practice.

One contractor during last weeks bloodbath in Congress said the government paid his firm $30 million and that he’s processed 3,000 paper applications. Given these economics, $10,000 per application, we could fly families to DC, put them up in style for a night, have a government and insurance company worker hand process an application, and still come out ahead. That’s facetious except, discussing the idea with Yves, maybe it should not be. There really is not much information needed to figure out the list of Obamacare plans. We know that census workers took much more complex information, at an accelerated pace, and did a good job. Maybe we should just switch to a paper system where helpers sign up every uninsured person in the US. That approach would have worked and might not end up being that expensive long-term, especially if the insurance companies would pay a referral fee to cover the temporary workers, like they do to brokers for new business.

The other virtue of a manual approach would be to understand the most efficient task sequence, which matters more than most people, including software developers, realize. From the New Yorker, emphasis mine:

The computers using Marchant calculators were working too slowly, so Stan Frankel, another graduate student in the computation group, recommended they try new I.B.M. tabulating machines, which used punch cards to perform calculations. Feynman agreed, but the I.B.M. machines and the technicians to maintain them were slow to arrive. In his 1975 lecture “Los Alamos From Below,” Feynman described his solution:

In this particular case, we worked out all the numerical steps that the machines were supposed to do—multiply this, and then do this, and subtract that. Then we worked out the program, but we didn’t have any machine to test it on. So we set up this room with girls in it. Each one had a Marchant. But she was the multiplier, and she was the adder, and this one cubed, and we had index cards, and all she did was cube this number and send it to the next one.

We went through our cycle this way until we got all the bugs out. Well, it turned out that the speed at which we were able to do it was a hell of a lot faster than the other way, where every single person did all the steps. We got speed with this system that was the predicted speed for the I.B.M. machine.

By organizing the human computers at Los Alamos as though they were I.B.M. tabulators, Feynman was able to match the speed of the I.B.M. machines. His “numerical steps” were literally a computer program, albeit a simple one carried out by people cranking noisy calculating machines. In 1945, Richard Feynman discovered something that remains true today: the problem of producing software is, first and foremost, a problem of organizing people.

Obviously a single payer system would have been much easier to implement: produce an SSN and proof of citizenship then you’re done. But that would cut out the layers of cronies. Accountability in the modern era being only for the little people this is obviously a non-starter. So we’ll wait to see if QSSI, who built a large part of the mess – and who botched testing it – can quickly repair it. Of course we could treat this like the census and encourage people to use paper, but that wouldn’t be much fun. I mean if a person called about “glitches” (read: serious software defects) rather than saying “come back in the next three years and we’ll fix them” tech support took their info and hand entered it. I’d rather not bet the health of my family to come up with this low-cost solution that is immediately available but that’s not my choice, is it?

All this would be funny in a snarky kind of way except that, of course, it is not. There will be people with preexisting conditions who cannot get insurance or who lost their insurance as a result of the ACA, and they will still not be able to purchase insurance by December 15 that will go into effect January 1 leaving a gap. They will be sick and end up in an emergency room and/or hospital, leaving with slightly better physical and exponentially worse financial health for no reason other than a lack of insurance due to the gross incompetence of the DC crony crowd. CGI’s Cheryl Campbell repeatedly crooned to Congress that she has insurance, as did overtly arrogant CMS employee Marilyn Tavenner. I guess since this does not affect them, or anybody who really matters, it does not matter what happens to the uninsured Americans paying for their latest escapade.

But the $10,000 per person cost to process 3,000 paper applications when one part of the system failed drives a key point home: a manual process being faster, more accurate, and cheaper than the computerized process shows that the Administration somehow saw technology as a magic bullet when it is just a tool. In fact, it’s becoming clear the project is rife with management problems; focusing on technical symptoms, although tempting, is trying to have the tail wag the dog. We’ll be returning to this topic in future posts, namely how well some more advanced (as well as not so advanced) approaches could have kept healthcare.gov out of this morass and which ones might help get it out faster.

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78 comments

  1. s spade

    I hope all the people who see government as the solution to social problems take a long hard look at this post. Cronyism uses social problems like jujitsu to exacerbate looting and history has found no antidote so far apart from the guillotine.

    Now, if we discovered some way to eliminate monopoly and restore competition and allowed failed banks to fail and incarcerated criminal executives…….

    1. Beppo

      Full communism solves all these problems. Hopefully, we only need a few more fake reforms of capitalism and we can all get to work.

    2. Banger

      What is being pointed out here is the failure of the “downsize” government reforms of the 80s and 90s. The contracting system is a source of the problem here and was supported by conservatives and fake liberals whose main interest was in actually sabotaging government.

      Deep corruption in contracting exists at all levels of government today–the contractors who get money for nothing do help stimulate the economy of course but provide poor quality work–I know this because I was a government contractor. Some of us tried to do good work but the system is rigged to benefit those who do mediocre work and have great marketing departments.

      1. jrs

        That’s definitely probably the initial cause, cronyism, crony capitalism, corporatism, contractors, corruption, or whatever one wants to call it.

        But on the other hand Hoover dam was built by contractors, ahead of time and under budget. But the government negotiated a much harder bargain in those days:

        “On January 10, 1931, the Bureau made the bid documents available to interested parties, at five dollars a copy. The government was to provide the materials; but the contractor was to prepare the site and build the dam. The dam was described in minute detail, covering 100 pages of text and 76 drawings. A $2 million bid bond was to accompany each bid; the winner would have to post a $5 million performance bond. The contractor had seven years to build the dam, or PENALTIES WOULD ENSUE.” [wikipedia]

        What do you want to bet the makers of healthcare.cluster@#$# don’t pay any penalties?

        But the existence of the ongoing problems illustrates why the common person hates government (not the tea party ideologues, in fact not even those with excellent moral and ideological reasons like hating the war machine, but even the utterly non-political person). Government’s utter irresponsiveness and indifference. The average person is served with a service that doesn’t work, and all they get is a long series of excuses, meanwhile there is the potential for real suffering, they can’t get health insurance in a system designed allegedly to improve the available of health insurance! And this is all met, perhaps eventually with attempts to fix the system, but really mostly with indifference (too bad, so sad, isn’t Obamacare wonderful?). Meanwhile there’s the class element. Everyone knows that once government services become unservicable those who can afford to buy their way out. It’s what has happened some places with public schools. Schools were lousy (perhaps for deep sociological reasons but the end results WAS that the schools sucked! despite how much everyone tried to lie about or make excuses about that obvious truth). Those who could afford to opted out. The Obamacare website doesnt’ work. Perhaps those who can afford to will just go to the private market and those who still have employer coverage don’t have to worry about it. But those not in that class (category really but it does act like class here and it does have class elements) are stuck with inferior garbage that government is not near serious enough about fixing. That’s why the average person hates government.

      2. Profane

        Speaking as someone who has been working for a sub-contractor for a state program (in which I am simply ‘customer service’), this is true.

        Contractor
        —> Sub-Contractor
        ——> Temp Agency
        ———> Me (and most of the rest of their staff)

        And because I’ve been there longer than three weeks, and am not a complete idiot, I spend over half my day correcting the mistakes and misinformation that my coworkers (most of whom don’t stick around for more than a month) dispense. And the bad thing is, all we do is explain why there’s a problem and how to fix it. We aren’t actually able to change anything, which is probably a good thing.

        Nevermind having strict call times in which ‘cutting short’ calls is encouraged (via just not giving people additional information that may cause further delays unless they ask for it directly).

        So…technically, I am living off of government welfare. Just after it trickles down. (I barely make ends meet, but the original contractor has national revenue of over $100 million. And a good chunk of it comes from my state.)

        1. beenthere

          You are absolutely right. I am an over-50 programmer who worked on my states Medicaid project for two years. I was the only American in the group of 50 or so developers. Some would arrive in this country on Saturday and start “working” on Sunday knowing nothing about insurance or the medical field. The sub-contracting company wouldn’t even talk to most Americans. I was hired because I had worked on the legacy system and left as soon as another opportunity became available. Most of the developers hopped from state to state collecting checks with no concern for the quality of the product they were to deliver.

    3. Mcmike

      “Now, if we discovered some way to eliminate monopoly and restore competition and allowed failed banks to fail and incarcerated criminal executives……”

      I have the solution!

      A robust, active, transparent, responsible, and accountible democratic government!

      Wholesale turning our backs on the very idea of government, simply because the current iteration has been captured by the elite, seems terribly short-sighted. Particularly because that is exactly what they want us to do, which seems reason enough to go the other way.

    4. dw

      well oddly enough the same problems noted in every story about this mess. happen in the private sector too. they too also will have picked out a vendor prior to issuing an RFP. they to will have a mess on their hands when it fails. it just usually doesnt register to any one other that their customers usually. and there isnt a lot of interest from politicians to make noise about it

      1. jrs

        Oh private sector I.T. projects can be pretty disasterous, a point I think I’ve raised repeatedly. But the SCALE of the rollout for the private sector is usually less. Your are a startup company your first version of the website is crashing daily. Ok but you are a startup, just slowly gaining customers, you’re not the the government (and you usually DO have backup, what you were using before, even if it’s just a call center – it’s backup and IT WORKS). Growing pains.

        An I.T. project is going horribly wrong, 10 of your employers have spent a year working on a project you finally have to pull the plug on, it just doesn’t work, it can’t be made to work. Ok but this usually just takes place on one future project that you had hoped would be a new launch. Your customer’s don’t notice. The scale of the catastrophe in I.T. is usualy not done at the level of Obamacare. It would be like Amazon suddenly launching a brand new website that crashed all the time and couldn’t make a sale. And you can bet that would be news. BTW, I find the Amazon website slow.

        1. Banger

          Sure they can go wrong in the private sector–but it’s less systemic–my own experience in a medium sized company was that the IT work we turned out was excellent with none of the ridiculous constraints I experienced in government work. The projects, for example, that go on year after year after year that accomplish nothing–I could be wrong.

    5. bluntobj

      Spade,

      I almost fell out of my chair at reading such a rational reply. It’s quite out of character in most comment threads.

      Also, to OP:

      “Obviously a single payer system would have been much easier to implement: produce an SSN and proof of citizenship then you’re done.”

      Good luck with the citizenship part. And being done so easy? No, no. The fun is just beginning in oh so many deliciously bureaucratic ways.

      1. jrs

        Frankly the best way to implement a government program and make it work is just to make it as simple as possible – wealth distribution is actually simple, call it negative income tax, call it guaranteed income, around here we call it GDP sharing.

    6. middle seaman

      Private sector entities tend to be as bad as the government. Government has excellent systems, e.g. Nasa, and terrible one. Industry contracts out as well. Awards by companies are as biased as government awards.

      1. JGordon

        Too true. As history has shown, every large organization devolves into corruption, decay, and dissolution over time. The falacy of the “liberals” is thinking that government is an exception to the that rule. It’s not.

        Keeping that fact in mind, you’d have to be incredibly short sighted and arrogant to think that’s a good thing for the government, any government, to be overwhelmingly dominant in society. Giving the government the ability to print money, snatch weapons, incarcerate increasingly large segments of the population, launch multiple unprovoked wars, assassinate kids with flying robots, spy on every electronic communication you deliberately or accidently make, etc, is a sure fire recipe for unmitigated disaster. Whereas if we limited the power of government and the corporations that control the government we could at least mange that down to a mitigated disaster.

    7. JGordon

      Those who trust the government absolutely deserve what they get. Whether that’s trusting to the government to mandate health insurance, print money, or snatch guns (for “safety”) every bit of power it appropriates for itself and the corporations that own it is a little bit less freedom for the plebs.

  2. DakotabornKansan

    Obamacare puts 7 million people into an exchange.

    What a dysfunctional mess, as you so well describe, they’ve gotten us into.

    But just imagine…

    Paul Ryan’s Medicare reform plan is just like Obamacare, only bigger.

    Ryan wants to do the same thing for seniors. It puts 50 million seniors into a government run exchange.

    Chris Hayes @ http://www.youtube.com/watch?v=hUoNgAbT1TU

    1. Banger

      There are two ways to look at Obamacare, one is that it is the beginning of a single-payer or equivalent system that will eventually emerge because progress is inevitable and it all gets better–on the other hand, Obamacare could be seen as a way to create a new kind of government program–guaranteed customers (serfs) for the “private” sector.

      1. Paul Tioxon

        Banger,
        I agree. Medicare, Medicaid and Chip, right now have about 100 million people served. That’s 1/3 of the national population. VA Health benefits serves millions more. When you add in the 30 million or so uninsured that are piling into Medicaid as fast as they can in the states with exchanges, we are looking at half the country under government health insurance with a year or so.

        That is the target market of uninsured, more than the private health coverage. The crappola health care plans that they used to sell for $100/mo, that paid nothing at all, have been cancelled. The insurance is uniform in benefits from the for profits now, no more insurance in name only with denial after denial when you submit a claim. But that is all besides the point. Medicaid is drawing the people in and the real battle is with the 36 states that opted out of local exchanges, making Medicaid expansion more difficult and blocking some people from getting on above the poverty level. That is the real problem that I see.

        Furthermore, as for profit plans go up and up and up in price, people with stagnant wages will drop insurance or companies will, leaving the government to deal with the problem. Private health care insurance is bound to increase in price, even if the rate is slowed a bit, but the increases of the past decades have shown that people just lose coverage altogether because it is just to expensive at the bottom half of the income stratification. As this creeps up into the more stable middle class, wage increases vs health care benefits will become a trade off. Right now, the people who work at solid Fortune 500 type firms with solid but pricey benefits don’t won’t to be touched by any of this. When the price tag starts to burn their fingers, they will be entering the same boat as the half of the nation with government programs, and we will hear a cry for a new round of government health care reform.

    2. BondOfSteel

      How many go to the federal site vs state run exchanges? Most of the state run exchanges seem to working fine.

      IMHO, we’re likely to see Obamacare both succeed and fail, depending on where you live.

      1. Paul Tioxon

        VERIZON’S CLOUD FAILURE CRASHES CAUSING ENTIRE FEDERAL AND STATE AND DC WEBSITES TO DOWN TOGETHER.

        “..this was the first problem caused by a cloud service provider.

        The failure originated in a Verizon Terremark data center and likely affected other companies that purchase computing power from the tech giant, though Verizon has thus far not responded to media inquiries on the cause of the problem.

        It is also unclear how many potential customers attempted to reach the site while it was down only to receive a message that said: “We are experiencing technical difficulties and hope to have them resolved soon. Please try again later.”

        The outage affected both the Federally Facilitated Exchange which serves insurance customers in 36 states, and the individual exchanges in 14 states and the District of Columbia. The state-based health insurance exchanges as well as the federal system, are dependent on the data hub to operate properly.”

        http://fcw.com/articles/2013/10/28/cloud-failure-crashes-healthcare-gov.aspx

        1. Selden

          The situation has actually gotten worse. The signin server (somewhere in Verizon’s cloud) has been down since Tuesday PM. And a few moments ago, even the landing page for healthcare.gov was down (although it came back by 2150 EDT). This is truly a screw-up of epic proportions.

          I spent most of my career in IT-related activities, and there was no way I was going to try to login for the first week. I waited until October 17, and found the process fairly straightforward — less than 10 minutes. Five days later, I asked for quotes (even though I am have both Medicare and retiree health insurance coverage), which took less than 5 minutes. At that point, I thought the reports of problems were overblown, but this is the second outage of more than 24 hours since Sunday.

          1. Michael Olenick

            Selden – I’ve read about experiences like this but I’ve never seen one but mine is exactly the opposite, the site is a dysfunctional disaster. I’m working on a follow-up from last week’s piece: this story came together while gathering information for that one. What state do you live in? I think they may be allowing access state-by-state, even for the federal system; using geography as a crude filter to limit load on the system.

  3. tongorad

    “Unlike many complainers, I largely support the Affordable Care Act. It should be a single-payer system, but I’m willing to accept the idea that a great journey begins with a single step and see the ACA as a start.”

    Stopped reading at this point. The ACA was imposed on us to prevent single payer. Moreover, as Lambert has pointed out, the ACA is the neoliberal blueprint on how to destroy what’s left of our safety net.

    1. anon y'mouse

      no love here for the ACA as it is only a harbinger of what is to come in all spheres that used to be, or remain presently, ‘public’ or government.

      but, this guy is fair in his assessments of what is going haywire. if one of us ‘anti’ type people wrote this, it would just be an attack piece. he doesn’t veer into apologetics that I can see.

      if you don’t know what the other side thinks, how can you ever prepare for what they will do? or even try to influence them? you can’t. this is why I chastise myself for shutting my brain down when certain people open their mouths. what they have to say is instructive simply because it highlights what we are ‘supposed to know’ or ‘supposed to think’. this guy here is simply giving the ACA the benefit of the doubt, and doesn’t come off as a shill.

      even if he were, you’d be discerning enough to sniff it out, eh? i mean, you are an NC member.

  4. Brooklin Bridge

    Few people point it out but this fiasco is the predictable result of rigged government contracts.

    The priority of Obama and his administration is looting on behalf of and at the direction of private enterprise and that is what we are getting in the ACA health insurance application software fiasco; looting in one more ugly form. Open Source disqualifies itself for that job as it would make it considerably harder. It simply won’t be used, now or in the future.

    Obama’s priority is NOT to have a simple easy web site for ACA enrollment, though he would have surely taken credit if that had miraculously happened. If anyone seriously wants software that will work or software that is open so they can find out why it’s not working, they must first transform web sites such as Huffington Post and media outlets such as MSNBC into Open Books with real journalists so that people know what’s going on. Then and only then is there a slim chance that ACA software will be written for any other purpose than to fill some contributor’s pockets.

    I’ve pointed out before that it’s not as if Obama or his Administration are unable to direct agencies to make viable sophisticated software systems as the NSA and Drone control systems beautifully attest to. It’s simply that unlike spy and other social control software which Obama DOES want to work, ACA enrollment doesn’t matter that much. Ultimately, it will work more or less and in the meantime,
    1) TPTB are happy; corruption rules
    2) Obama gives government a black eye as our resident troll has been up all night waiting to be the first comment to point out(remember the big goal now – privatize everything)
    3) Media gets to exercise it’s principal function of controlling the public’s knowledge and opinion; getting them to swallow virtually any fiasco in the service of the administration (acting in the service of corporate behemoths).

    1. Banger

      I think you credit Obama with more power than he has. He goes along with the system to get along–that’s it. Obamacare was a compromise among competing power-blocks not anything clearly planned or thought about as a pragmatic solution to our HC issues. The insurers threatened to start firing automatic weapons unless they were cut in on the deal so they got their cut and everyone else got a bit of a cut, even “the people” to the extent they matter (which is not very much). The system itself went into motion the Monty-Pythonesque federal gov’t contracting kicked in to make sure a lot of money was spent and thrown and criminally-minded contractors to put a lot of money in their pockets for what appeared to be computer code written by inexperienced and probably bright programmers from India who often have real smarts but don’t see the big picture or have the experience, as the author noted, with big systems.

      1. Mac

        I think you are right, doubt Obama had much to do with ACA. Your description fits my understanding, Obama’s part was that he was here when it happened, nothing more.

      2. mac

        I agree with Banger, I doubt Obama had much to do with the ACA. It is a kludge cooked up by various interests
        and Nancy was really right they did not know what was in it and needed to pass it to find out.
        Obama seems to really have little idea about what is going on. I suppose he is guilty of not being “in charge” but little in the way of actual impetus for actions.
        Just a suit and a teleprompter used by a man who was elected by folks wanting to prove to themselves they were not prejudiced.

  5. profoundlogic

    It would seem that the ACA, as Obama’s signature piece of legislation, is indicative of his tenure in the White House. A system built on cronyism, handouts to big corporations, and numerous lies to the American people, people looking for a substantive change to improve their situation and stop the bleeding. Like much of the prescription poison pushed on American populous, the side effects of the ACA are turning out to be worse than the disease.

    1. Banger

      People here have the wrong impression of how American politics works. Politicians are, essentially, like real-estate brokers. Obama’s job was to first negotiated an agreement with stakeholders based on their relative power to do damage or to reward his people. Then his job was to sell the result. After that he’s on to the next thing. It is the people who should have inspected the house they just bought.

      Obama was a marketing campaign meant to neutralize the left and African Americans as dissenters. Because we elected a “black” President that meant the system worked and we should start to support it rather than oppose it and, sadly, most of us fell for the con and, due to cognitive dissonance still fall for the con.

  6. ignim brites

    One gets the feeling that the ACA will be the Afghanistan for the political class of the United States.

  7. Mcmike

    (As highlighted above…)

    The point of everything is pilfering,
    War health care banking spying
    Once you internalize that, you will see,
    That everything works perfectly.

  8. Banger

    All this has nothing to do with health-care it has to do with the rot that is Washington DC. The American right-wing went on a deliberate campaign, starting in the 70s to destroy the federal government as an effective power in the United States in order to create a U.S. pre-Progressive era at minimum and, at maximum, a neo-feudal state that goes back to the Middle Ages. This project has been well-documented in every detail by many books on the subject. In the 80s the Democratic Party joined into this project while trying to modify it.

    The result has been the enfeebling and corruption of the civil service, the growth of Big Contracting, and a culture of malaise in the bureaucracy you have to live through to understand. Regular sayings like “no good deed goes unpunished” are clear. Contractors cheat and game the system in every way possible, their “clients” for IT contracting are usually incompetent and depend on other contractors who may or may not be honest to monitor contractors. The whole thing is deeply, deeply disgusting. I’ve had the opportunity to view it from the gov’t side, the lobbyist side, the PR side, and the media side and I can assure you the current crop of right-wingers have a point when they criticize the federal gov’t. On the other hand there are cadres of dedicated intelligent civil service employees and contractors doing the best they can to make things work–but the system (imposed by Congress) works against them and they are losing.

    1. Mcmike

      Privatization playbook 101:

      - Declare without evidence that a public system is in crisis
      - Work behind the scenes to make that declaration come true

      Conservativism, in its contemporary guise, is soley a process of destruction, deconstruction, regression, and raiding.

  9. Walter Map

    A credit bureau is involved in taking applications for health insurance because they’re on the list of corporatists that have paid to play for A Piece of the Action.

    Keep in mind that the purpose of the ACA is to enrich the Financial Industrial Complex, and that providing a way for people to sign up for overpriced crap ‘health insurance’ is merely the means to that end. That the system is a mess is irrelevant because people are compelled to use it no matter awful it is. What does matter is that it’s hugely profitable to the real customers.

    We’re told it was terribly complicated and required a great deal of heroics to get so many dozens of corporatists properly seated on the gravy train, but they’re happy with the big new revenue stream. Your happiness was never a consideration.

    1. denim

      You are so correct. The ACA is totally a private health insurance program. The government is acting as a salesman and hopefully a regulator like it does for Medicare Medi-gap policies that are necessary to fix the inadequate coverage of Medicare Part B for retirees. If Obama is truly for the middle class, he will insure that the premium are truly split 20% to the private company’s coffers and 80% to the actual health care provider.

      1. human

        If Obama is truly for the middle class, he will insure that the premium are truly 100% to the actual health care provider.

        There. Fixed it for ya.

    1. Walter Map

      That wouldn’t make any millions for Obama’s corporate sponsors, so it’s out of the question.

      Remember that the real money is in prolonging the problem, not solving it. You’d be amazed at how many times the cure for cancer had to be hushed up, or how many researchers had to be disappeared before the rest shut up and just played the game. Modern R&D is so focused on coming up with solutions that the people who create the problems sometimes have a hard time keeping up. That’s where the federal government comes in.

      People shouldn’t wonder about why Amerika has so many horribly intractable problems: it’s because they’re profitable.

  10. financial matters

    The ACA has generated more good discussion on health care than we’ve ever had. If Obama wants a legacy he should embrace that. We see more clearly the insurance companies, the health care providers, the health care administration complex, the pharmaceutical companies, the kickbacks.

    And we are seeing in spades how difficult it is to try and run a private/public system and how unfair it is to the general consumer. As a result there has probably never been so much support of single payer, frustration over the insurance companies as part of the FIRE sector and wanting to change ‘consumer’ to ‘patient’.

    I don’t think Obamacare can be scrapped at this point but I think all the efforts of Lambert and others to dissect out the system and its malfunctioning on the ground should spearhead an effort to morph it into single payer.

    1. Banger

      It would be a hard sell. We would have to sell it two ways: 1) as a way to save money (easy case to make); and 2) a rational case can be made that all of us, not just the poor, would benefit. But the problem with this is that among many Americans, reason is not yet fully accepted as a legitimate way to solve problems. About half of all whites are so blinded by racism that even if it helps them personally to have a single-payer system, the notion that black children would benefit is too difficult galling a concept to bear.

      1. LucyLulu

        1) Not easy at all. Recall axiom #1: The private sector can ALWAYS deliver products cheaper and more efficiently than government can. Private companies can also offshore. Some of the emerging economies are offering new ultra-efficient (and quick!) medical degrees. 2) In addition to the moral hazard imposed by helping the poor (see…. they believe in Darwinian selection, after all), TPTB have nothing to gain from single-payer. They have good health insurance, they’re happy with it, and they want to keep it. If other people want good insurance, they too can get elected to Congress or hired as a major corporate executive. They need only work as hard as the present occupants (and be blessed with half of the same amazing talent).

    2. Mcmike

      Hmm, I am leaning towards the opposite conclusion: this fubar will be blamed on government incompetence and the inherent problems with socialism, and it will kill single payer for at least another generation.

      1. financial matters

        It could definitely go either way and there are a lot of headwinds against single payer.

        But I don’t see how insurance companies are going to come out looking good here. We have seen too much that is behind the curtain. By far the majority of people are paying too much for too little.

        Medicare has its own set of problems but I think most people look forward to that security. And I think it helps put health care back where it should be which is more of a social issue.

          1. Walter Map

            You could follow my example. I’m grateful that I am not young in so thoroughly finished a world. It’s only going to get worse because the machineries of corruption are entrenched and well-maintained to prevent it from getting better. You have to pity the children. Their destinies are misery.

            Contrary to Conventional Wisdom, the U.S. does not actually have an economy. What it does have is an enormous collection of outrageous scams, all carefully balanced in such a way as to mutually support each other. Think of it an a house of cards, built on a national scale. Deceit, corruption, and coercion are systematically cultivated at all levels and in all institutions, right down to the PTA meetings and Boy Scout retreats. Amerikans take it for granted, accept it and expect it. Eventually it will all fall down through the sheer weight of its own inquities, and you’ll want to be well out of range when that happens.

  11. RoboCommenter

    In the upcoming HBO series, “Kathleen Sebelius” removes her mask right in the middle of her congressional testimony and it is revealed that she was really Nancy Reagan all along!

  12. TarheelDem

    One question that has not been answered yet is how many back-end interfaces to insurance companies were involved in the project. One article identified mistaken error messages from insurers’ systems on the HIPAA 834 transaction as a huge generator of errors in the front-end web portal. Which spoke to incomplete implementation of HIPAA data transaction harmonization, an IT project from the Clinton era.

    1. Walter Map

      To answer your question, there are no back-end interfaces to insurance companies. That’s the two-billion-dollar project set to start up mid-2014.

      It’s interesting that you brought it up, though, because coming up with convincing fake backends was a major technical challenge that took two years all by itself. The transactions are routed to a warehouse in Uttar Pradesh where 14,000 eight-to-ten-year olds process them by hand. The owners expect to get a bathroom installed about the same time the backend interface project is rolled out.

    2. Michael Olenick

      Hi – We’ll be working on follow-up’s but I doubt that the 834′s from the insurance companies generate errors because an 834, by definition, is a signup file. So they’re transferred from the government to the insurance companies who send a verification back the other direction. At least with my own experience, that I can’t think is that atypical, the system never got anywhere near generating an 834 because I was never shown a list of plans, much less given the opportunity to sign up for one. However, there may be other transactional elements that are causing errors (again, that seems unlikely though because I never got far enough that I think anything was sent to the insurance companies).

  13. John Yard

    The author hit the nail right on the head : when an organization wants to grant some benefit ( job, contract ) to an outside entity it will simply create a bid so specific so only one entity in the universe can meet the specifications.

  14. Eureka Springs

    Enrollment neoliberal ACA style is designed to keep people from getting health care. The .gov site is part of the problem whether it ‘works’ or nay. Why are so many falling for the trap… a trap which on every metric is designed to fail us?

    Establish single payer / expanded medicare for all at moment of birth. No forms, no questions needed beyond name and addy etc. None of which ever needs to be taken care of except on a single page clip board in ANY medical facility. Complexity here is both extremely expensive, immoral, the big tell. See NHS for comparison.

    Now we have to kill ACA as well as killing any government subsidy of private insurance. I don’t recall ever seeing a sci-fi flick where the way to kill a beast was to make it much much bigger / more formidable.

    If I get sick I will pay to play private for massively profitable credit agencies, insurance companies who are guaranteed 20 percent than the 3 percent medicare overhead would cost, and drug dealers who we are not allowed to even try to negotiate prices. When I get better I wont. When they chase me for money as part of co-pays or penalty I will make it as expensive as possible for them to collect.

    I would much rather chip in to help my fellow citizens with actual health care which doesn’t make one ill by stress and bankruptcy. Until that’s possible… I will resist.

  15. DolleyMadison

    “My sense of accomplishment was palpable: soon I could view unaffordable mandatory health insurance plans that cover 60-70% of my costs but include guaranteed insurance industry profits. This is progress!”

    Hilarious! Except not…

  16. Yancey Ward

    I think real problems are data corruption at the back end, and I don’t know how easy it is to fix this. This view is supported by anecdotes filtering out from the insurers’ end about multiple applications, and missing or garbled data. There was a blog entry a couple of weeks ago from someone who wrote that apparently, just starting the application process gets it submitted for subsidy calculation/approval and submitted for processing. At the time, I didn’t have any evidence this was true, but this weekend’s claim by the IRS to have verified income on hundreds of thousands of applications from the federal exchange makes me think the writer was completely correct. It could explain the stories of multiple applications with missing data- the system is just submitting everything no matter whether it is complete, or even submitted by the applicant for a policy and purchase. If so, this will be a mess, and likely will require a start over at some point.

  17. c1ue

    Mike,

    Were you actually able to see and/or sign up to a plan?

    How did the plans offered compare with what you had available on the ‘free market’ today? vs. 1 year ago? vs. 3 years ago?

    This background information would be useful.

    1. Michael

      Hi – Nope! I filled out the data again — this time very single optional field — and I still can’t view the plans. I do know the price of plans that work for my family outside the exchange because we were changing plans so shopping anyway; the ACA estimated plans seem to be significantly more expensive. ACA plans may cover more services but, thankfully, we don’t require much in the way of healthcare services, which is where my comment about us being ideal insurance customers comes from.

      On a note unrelated to the website nobody seems to think about a simplified overall system where doctors and hospitals charge posted and reasonable prices and drug companies sell generics at reasonable markups. If a person got really sick or hurt themselves they’d have insurance. It doesn’t really make sense that low-cost OTC drugs in Europe, or even prescription drugs, seem to sell for an order of magnitude more here in the US even though they’re exactly the same (not chemically the same; the same drugs manufactured by the same companies in the same factories).

  18. Ronald Pires

    Why Is A Credit Bureau Involved?

    You have no use for a credit bureau being involved, but the credit bureau does. As we speak, your now confirmed identity is being “run” looking for past bills that may have lost you, but found their way to a credit vulture. If you receive a letter in the next few weeks in the mail about such a bill, even if it’s a mistake, and even if it’s not from Equifax, thank ObamaCare for hooking you up. And remember, even if it’s a mistake, it’s now on your credit record. Welcome to ObamaCare.

    1. jrs

      A more distubing question might be why is the DHS involved? (although perhaps not a disturbing as it initially appears).

      Basically: are they running checks against a terrorist watchlist when you sign up for health insurance? Many private companies are required by law to run these checks (it’s in the Patriot Act). Is Obamacare doing so?

  19. Lyle

    Note that since you don’t qualify for a subsidy you can go to ehealthinsurance.com, or indeed a company you are interesteds web site and sign up. No need for using the healthcare.gov web site. Or you could get a list on the ehealthinsurance.com web side of providers, pick the plan you want, and then go to the providers web site to see networks and sign up there.

  20. craazyboy

    I’ve been working on a theory about how the website works. I think they integrated existing systems at Experian, Homeland Security and MERS.

    When you sign up for ObamaCare, you get married to your mortgage, divorced from your land title, and added to the TSA potential terrorist list. On your next trip to the airport, you are denied purchase of an airplane ticket, but approved for the Airline “club” visa card with the $50/year annual fee.

    1. jrs

      Yea it does become at least a bit of a complex system when you figure how many entities are being communicated with: the IRS, Experian, the insurance companies, DHS (this might be integrated with the credit check), whatever figures out the subsidies, which you think would be a relatively simple calculation but if every state has it’s own Medicaid cut off, maybe not!

  21. docg

    I saw this train wreck coming some time ago. Not because I foresaw the software problems, but it was clear even then that the program was overly complicated and also that those organizing it seemed oblivious to the likelihood of unintended consequences.

    I nevertheless support it, and hope at least most of the kinks can get worked out. Not because I’m a big fan of Obama (imo he’s been a huge disappointment), but because there are very serious problems with our current health insurance and health care systems and even Obamacare, warts and all, would be preferable to the status quo, which keeps getting more and more expensive and out of control every year.

    Single payer is definitely the way to go. And maybe when enough of our mad Tea Partiers are paying most of their monthly salaries on health insurance premiums, we might see some action in that direction from Congress. Clearly something has to give.

    1. Walter Map

      Teanuts and other pubs could have gotten a lot more traction out of their opposition to ACA by exposing it as the scam it is, but they didn’t. They couldn’t very well do that without exposing themselves for having come up with the scam in the first place.

      The real reason they oppose it is because Obama got on their turf and stole their schtick. It happens a lot, which is why Republicans have so deeply resorted to racism and religion to stay in office. With some exceptions, Democrats are now the party of the Financial Industrial Complex. Republicans are mostly wannabes.

  22. Carol Sterritt

    Mr Olenick, I think you actually found a way to make this whole snafu into an Affordable, Truly Affordable, Health Care process. If the process allows people to have multiple spouses, as occurred, when the System alowe dyour daughter to becomeyour wife’s other spouse, perhaps all we need to do is band together into polymonogamous units, which will exist for the sake of enrollment. Then my $ 1,100 a month Calif exchange rate policy will acutally be ffordable, if split up among multiple spouses and not just one.

  23. jfleni

    RE Healthcare.gov: “project is rife with management problems”. Thats for sure and they are not the only ones. Note the comments about the success of the census and other purely manual systems.

    A huge part of the problem is the fact that entering data in multiple Web pages depends on patchwork of multiple networks which are supposed to work together, but which hardly ever do.

    It’s like going cross-country on Interstate Highways (you may remember those and Ike who created them) and finding that there is no pavement but only gravel trails at the most unlikely and inconvenient places.

    But that’s what the fast buck morons want, and that’s what we (everybody else including xxx.gov) get.

  24. Walter Map

    A huge part of the problem is the fact that entering data in multiple Web pages depends on patchwork of multiple networks which are supposed to work together, but which hardly ever do.

    Many hands make light work wallet.

    1. LucyLulu

      This is THE problem in a nutshell. There are LOTS of systems that must be integrated. CGI testified that end-to-end testing was first conducted two weeks prior to launch, and the tests (obviously) failed. Two weeks is a mighty optimistic timeframe for this phase, even two months would have been tight. Not only that, but nobody was put in charge of this (kinda) important overall design portion of the process. So there were several pieces, all working flawlessly on isolated systems, to fail once pieced together into the final program.

      As Clay Johnson said (and who appeared on Chris Hayes), 94% of all government IT contracts over $10M fail. The US government’s annual IT budget is $84B. $500B goes through the procurement process each year. Why aren’t the fiscal hawk TP’er’s all over this?

      Why? They are too busy stripping the budget of the CFTC, who regulates hundreds of trillions of assets, and using Citibank suggested text to replace Dodd-Frank regulations requiring spinning derivatives out of FDIC institutions.

      “According to the New York Times, lobbyists from Citigroup C -0.66% played a major role in the bill’s creation: “Citigroup’s recommendations were reflected in more than 70 lines of the House committee’s 85-line bill,” Eric Lipton and Ben Protess write. “Two crucial paragraphs, prepared by Citigroup in conjunction with other Wall Street banks, were copied nearly word for word. (Lawmakers changed two words to make them plural.)”

      The Democrats are the party of the Financial Industrial Complex? You may want to check into the various bills that have been coming out of the House Financial Committee the last three years. Like Obamacare, financial regulation has been put piece-by-piece on the chopping block.

      http://www.forbes.com/sites/tomgroenfeldt/2013/10/30/banks-led-by-citi-lobby-house-successfully-to-limit-dodd-frank-on-derivatives/

  25. Bridget

    “Since griping without solutions is not helpful I’ll offer some specific solution. Ask Amazon to build a healthcare sales portal, quickly. If Obama bet Bezo’s $100 Amazon couldn’t finish a functioning portal in a week I suspect they meet the challenge, in a week or less.

    the solution already exists, at least for those who do not qualify for subsidies. Ehealthinsurance.com can show you the plans, the prices, the networks, everything. At least in my state and county, Obamacare is laid out before you in all it’s (expensive) glory. I haven’t applied for insurance with them since Obamacare came online , but my past experience indicates that, once you decide on a provider and a plan, you let them know and the carrier follows up immediately. A few more days and you have your insurance.

  26. oregoncharles

    Very illuminating. Feynman’s experience in building a human computer isn’t new; that’s how lenses used to be designed – it’s a huge exercise in calculation.

  27. Ken Royall

    The writer seems very foolish. He claims to be for single payer, which would put government in complete control of our health care system. At the same time, he admits the incompetence of the government. I remember being young and dumb too.

  28. Mick StJohn

    Hilarious, I loved it.
    but young and dumb??? Not really a critique.
    Also right on lucylulu!
    I still say, since this was private effort, the koch brothers had a hand in this.

  29. Jim Tucker

    Spade – Maybe you missed chapter 2 in that history book. The Sans-culottes, i.e. the people who didn’t wear the fancy britches of the wealthy – the working people – started the revolution. And while it is true that they got rid of a few tyrants, the end of the revolution came about as the Sans-culottes were beheaded by the thousands, and the wealthy wound up in control.

    So they not only didn’t rid themselves of the problems that government was causing, they enabled the cronies to take over.

    Frankly, I’m a big fan of the Industrial Unions, those who wanted the workers to make the decisions and direct the captial (which they do as well as any owner). If they hadn’t been stopped by the owners of business, the Business Unions, and the New Deal partisans of the time, we might well have had a much stronger country, and a more humane one.

    We don’t need to get rid of “government”, we need to get off our lazyboys, throw the remotes at the wealthy, and get involved, quit letting the plantation owners run the place and pretend that we are being taken care of. Freedom is work, and we, the peoples, ain’t doin’ the job that is required of us.

    And until we do we should stop whining about it.

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