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The ObamaCare Rollout, Organizational Dysfunction, and Public Relations in the Administration

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By Lambert Strether of Corrente.

Administration officials and defenders often claim that demand and volume overloaded the Federal exchange when it was rolled out. This claim is, in fact, not true, and I’d like to see what that lie tells us about organizational behavior inside the administration, and how it will react to future ObamaCare problems — which will be numerous.

First, some examples of the false claim, both from the administration and its defenders:

Barack Obama (U.S. President) 2013-10-01: [W]e found out that there have been times this morning where the site has been running more slowly than it normally will [1]. The reason is because more than one million people visited healthcare.gov before 7:00 in the morning. And we’re going to be speeding things up in the next few hours[2] to handle all this demand that exceeds anything that we had expected.”

Joan McCarter, Senior Political Writer for Daily Kos, 2013-10-01 [3]. “The glitches that the administration warned would be inevitable, that Republicans have been pre-gloating about for weeks so far, all come down to the primary glitch of our broken health care system: overwhelming pent-up demand for affordable health insurance, available to everyone.”

healthcare.gov error message (the Federal Exchange), 2013-10-02: “”We have a lot of visitors on our site right now and we’re working to make your experience here better. Thanks for your patience!”

Paul Krugman, Op-Ed writer and blogger, the New York Times, 2013-10-3: “[T]he glitches of October won’t matter in the long run … [a]ppear, for the most part, to be the result of the sheer volume of traffic, which has been much heavier than expected.”

“Senior Administration Official”, 2013-10-04: “The amount of demand is really driving the issues. But we’re adding capacity every hour.”

Todd Park (U.S. Chief Technology Officer) 2013-10-05: “These bugs were functions of volume. Take away the volume and it works.”

Kathleen Sebelius (U.S. Secretary of Health and Human Services), 2013-10-17 “[Sebelius] said that some of the website’s glitches wouldn’t have been identified ‘unless millions of people flooded the marketplace.’ The system had been pressure-tested at five times the highest volume that the Medicare.gov website had ever seen, she added.[4]

Nancy Pelosi (Minority Leader of the U.S. House of Representatives), 2013-10-20: “They were overwhelmed to begin with. There is much that needs to be done to correct the situation, but 19 million people, 19 million people, unique visits. …. [A]ny system that deals with that many millions of people frequently does have a glitch.”[5]

How do we know these statements are not true? Two reasons:

1. The site crashed when it opened at midnight on October 1. It immediately crashed for me, and for others. Capacity problems build slowly as visitors consume site resources. It beggars belief that volume instantly overwhelmed the Federal Exchange at midnight, especially in the absence of “Black Friday”-type marketing done for the opening. (Seriously, couldn’t the vaunted administration marketing team have gotten some cute, telegenic kidz to “camp out” somewhere waiting for “the doors to open”?) Also, whatever it is that Americans do on the Internet after midnight, it’s probably not buying insurance.

2. Pre-launch testing that the White House should have known about showed the site crashed with 200+ users. CBS:

CBS News has learned the website failed with a small test pool of 200 to 300 people that included employees from the government and insurance companies. The government employees worked at their own computers and desks within the Centers for Medicare and Medicaid Services, which oversaw the health care implementation.

According to sources familiar with the process, CMS employees were provided fake personal information to enter into HealthCare.gov rather than their own data and were given a date that testing would begin. However, on that date, the employees were told it was being postponed.

When the testing finally took place in late September, the testers started trying to create an application. Just a couple of pages into the process, everything “ground to a stop,” said one source.

“It froze. It couldn’t go forward. It crashed,” the source said.

A couple of days later, testers tried again and had a similar outcome. They were never able to successfully browse plans for cost estimates.

“It was unequivocally clear from testing … this wasn’t ready,” said a source close to the testing.

C’mon. 300 people crash the site? That’s not volume. That’s not demand. That’s a broken system!

* * *

So, how did such a large group of nominally reputable people come to make this false claim? Easy enough for administration defenders like Krugman and McCarter; they assumed the guys on their team were telling the truth and really, if not, so what? But how about the insiders and the decision makers? That’s an interesting question in organizational behavior. Generally, I fall back on the eternal question: Are the elites — in this case, the Democrats — stupid and/or evil? I think we’ve got “evil” covered; cementing pure rent extractors like the health insurance industry into the heart of the health care system is evil, no two ways about it, so how about stupid? I think this article from WaPo gives some clues to the particular form of stupidity that pervades this administration. Going back way before the pre-launch test above:

Inside CMS, meanwhile, some staffers were aware by late 2012 that the work of building the federal exchange was lagging, according to a former HHS official — a much earlier timeline than has been previously disclosed. Some employees in the main office involved with building the exchange repeatedly warned at meetings late last year and in January that so many things were behind schedule that there would be no time for adequate “end to end” testing of how the moving parts worked together, the former HHS official said.

“People were just like, well . . . it’s a dynamic we can’t change,” the former official said. “There wasn’t a way to push back or challenge it up the line. You had the policy people, largely at the White House, pushing the deadlines and tinkering with the policy, rather than the people who had to run the critical operating path design and program the system.” …

White House officials say they were focused on whether there would be enough insurance plans for sale in the new marketplaces and on whether enough people would enroll. They say they didn’t have a clue how troubled the Web site’s operation was.

Only during the weekend after HealthCare.gov’s Oct. 1 opening did the president’s aides begin to grasp the gravity of the problems, the White House official said. Obama soon began getting nightly updates on the performance of the Web site, which has still been unavailable to Americans for hours at a stretch over the past week.

But that was still to come. A month earlier, on Sept. 5, White House officials visited CMS for a final demonstration of HealthCare.gov. Some staff members worried that it would fail right in front of the president’s aides. A few secretly rooted for it to fail so that perhaps the White House would wait to open the exchange until it was ready.

Yet on that day, using a simplified demonstration application, the Web site appeared to work just fine.

Let’s unpack that “simplified demonstration application” just a little. We have an earlier report from the Wall Street Journal:

When CMS presented HealthCare.gov to White House officials over the summer, they displayed a demonstration version of the website composed of screen-shots of the real exchange and overlaid with interactive features.

That version re-created the user interface, but didn’t include the underlying mechanics—such as identity verification and eligibility determinations—that have foiled the site’s launch. Displaying such versions for demonstration purposes is common in the computer industry. But it left senior officials unaware of the more complicated and ultimately troubled workings of the exchange.

We can’t know whether the “summer” “demonstration version” was the “September 5″ “demonstration application”; I’m guessing yes. But look at what we have here: We have organizational behavior that is so dysfunctional, so unable to pass bad news up the chain to the White House[6] that three or four months before launch (“summer”) the developers won’t say the project is out of control, and less than one month the developers are still showing a fake site! And rooting for it to fail! Did nobody blow the whistle?

Until the tell-all biographies are written, we can’t know why the administration’s organizational behavior is how it is. But we can speculate freely!

1.) The White House is a hostile workplace for women:

‘The president has a real woman problem’ was the assessment of another high-ranking female official. ‘The idea of the boys’ club being just Larry and Rahm isn’t fair. He [Obama] was just as responsible himself.’ … ‘[L]ooking back,’ recalled Anita Dunn, when asked about it nearly two years later, ‘this place would be in court for a hostile workplace … Because it actually fit all of the classic legal requirements for a genuinely hostile workplace to women.’

And at this point we remember that Obama’s HHS report, Kathleen Sebelius, is a woman, as is Marilyn Tavenner, head of CMS, and any bad news from them could have been discounted, much as CEA Chair Christina Romer’s counsel was discounted. (Summers made Romer feel “like a piece of meat.”) To be fair, Sebelius says nothing to this effect, but then she’s almost visibly falling on her sword to protect her boss.

2.) Or perhaps there’s an Emperor’s New Clothes dynamic going on, a case of “pluralistic ignorance.” CNN:

“They had been claiming that the Obamacare rollout was his top priority and that he was receiving regular updates, which was inaccurate. And he gave remarks on October 1 about how great it was and that people should go sign up,” the aide said. “Assuming that he didn’t know that the website didn’t work, why did they let him make that speech when they knew it had crashed in testing? Did really no one recommend a delay to the President? It just seems odd.”

Well, it didn’t seem odd to the courtiers to let the Emperor walk through the streets naked! Or, if it did, they successfully suppressed their qualms.

3.) Or perhaps we’re looking at the group dynamics of a sociopathic ruling class. I wouldn’t even have raised a tinfoil hat-type possibility like this except Obama’s remark that “[I'm] really good at killing people.” But consider:

We can think of the entire hierarchy of elites within elites within elites that comprises the political class as a sorting mechanism that filters sociopaths to the top strata, rather like the CIA’s lie detectors sort people who can beat lie detectors (again, sociopaths) to the top. From Confessions of a Sociopath:

Sociopaths, mimicry, and blank slates
I think mimicry is interesting, and I think a lot of empaths think it’s freaky. What I find more freaky is what constant mimicry suggests — that you have no baseline “you,” that you are always just reactions to outside stimuli. …

I have a good friend who was initially very frustrated that I didn’t seem to have defaults: no default understanding of right and wrong, no default beliefs, no default personality even. Everything had to be reasoned, everything had to be constructed anew. It can be frustrating for me too. It’s time consuming. And sometimes it disturbs me how impressionable I am. Being a blank slate [or screen?], sometimes I can surprise even myself with non sequiturs or unpredictable behavior. It’s sort of scary.

So what happens when you have a relatively self-contained class or faction composed mostly of sociopaths, and they all start trying to mimic each other? Nothing good, I would imagine. Their fate would be, perhaps, like Terry Pratchett’s Auditors– or the humans in Phillip K. Dick’s Game Players of Titan.

I don’t know what outcomes the group dynamics of sociopaths would produce, but making sure bad news is heard seems unlikely to be at the top of the list.

Finally, whatever the outcome, we’ve seen (and Yves has many times pointed out) that the White House, and Obama, personally, seem to think any problem can be solved with better public relations:

–“[O]n February 14 [2011], the president meditated on the most important things he’d learned as president … ‘The area in my presidency where I think my management and understanding of the presidency evolved most, and where I think we made the most mistakes, was less on the policy front and more on the communications front. I think one of the criticisms that is absolutely legitimate about my first two years was that I was very comfortable with a technocratic approach to government … a series of problems to be solved.

Yeah, well, how’s that technocratic thing workin’ out for ya on healthcare.gov, big guy?

* * *

So, given those two characteristics of organizational behavior at the White House — inability to hear bad news, and using public relations to solve every problem — what’s challenges are in store for ObamaCare until the New Year?

1.) This week’s enrollment numbers will be bad. That’s baked in because of the website fail. But what kind of numbers will there be? Reuters:

The Obama administration will release healthcare enrollment numbers for Obamacare’s rocky October rollout this week that could be more important for what they fail to say, than for what they do.

U.S. Health and Human Services Secretary Kathleen Sebelius told the Senate Finance Committee last week that the early tally would be “very low.” … Before the October 1 website launch became a debacle, internal administration memos anticipated 494,620 enrollees in October and 706,000 in November nationwide, according to congressional investigators. Administration officials declined to confirm the numbers, saying projections are subject to rapid change.

But administration officials have not said whether the data will provide clues to other important questions, including whether young healthy adults, needed by insurers to offset older people with higher health costs, are eager to obtain coverage.

“They could give us very granular data showing enrollment by state, by plan level, how many enrollees had subsidies and at what level – all that stuff. But I think they’re going to give us something aggregated nationally,” said one aide.

It’s actually OK that the numbers are low in absolute terms; the MA enrollment for RomneyCare was initially low, and built to the final deadline. There are two metrics that matter: First, the order of magnitude of the enrollees compared to projections. 494,620 vs 49,462 is just barely passing; 494,620 vs. 4,946 would be very bad or, in Washington parlance, a “concern”; and even I don’t think there will be 494 enrollees. Second, the actuarial soundness of the pool; if the entire pool has a pre-existing condition, the insurance companies can’t profit. Unfortunately, the website debacle selects for the already ill, since only they have the incentive to sit through the days and the hours it takes to sign up. So I would expect the administration PR effort to: (1) roll out the heart-tugging YouTubes; (2) conceal the actuarial soundness, to avoid any hint that ObamaCare is already entering a death spiral; and (3) Focus on Medicaid signups, which are, after all, a success. And (4) claim next month will be better. Leading to….

2.) healthcare.gov will still be a mess by December 1. Here’s Czar Zients walking it back last Friday:

In a conference call with reporters, Zients said progress this week has been marred by roadblocks. He described HealthCare.gov as being “a long way from where it needs to be.”

And a figure of much greater clout, Leon Panetta yesterday:

“The president’s trust on this program is really going to be dependent on his ability to fix it,” Panetta said in an interview aired Sunday on CBS’s “Face the Nation.” “They said that they want to fix it by the end of November, but that’s going to be tough. These are complicated processes, and you’ve got to make very sure that you are, in fact, fixing it.”

And insurance figure Bob Laszewski writes:

It is now becoming clear that the Obama administration will not have Health.care.gov fixed by December 1 so hundreds of thousands, or perhaps millions, of people will be able to smoothly enroll by January 1.

Why do I say that? Look at this from the administration spokesperson’s daily Healthcare.gov progress report on Friday:

Essentially what is happening is people [those working on the fixes] are going through the entire process. As we have fixed certain pieces of functionality, like the account creation process, we’re seeing volume go further down the application. We’re identifying new issues that we need to be in a position to troubleshoot.

Does that sound like the kind of report you would expect if they were on track to fix this in less than three weeks? Their biggest problem is that they admittedly don’t know what they don’t know.

That sounds like a lot of bad news for the White House to process, especially the unknown unknowns part. And I don’t know of Zients has the clout to bring bad news up the chain; he’s really just a short timer. (Perhaps that’s why Panetta suggested a task force.) Nevertheless, I would expect the White House public relations effort to (1) declare victory, in that the “vast majority” of people can enroll, no matter what the reality of the situation. After all, this is the crowd that launched the website for one of the largest IT projects in American history without end-to-end testing, so having leaped over that block, why would they stumble at the straw of declaring it fixed? (2) If the back-end gets overwhelmed from a surge of new applicants, (a) stress the heroic efforts of the phone and paper processors, (b) blame the Republicans, and (c) even blame the insurance companies. (3) Roll out the Silicon Valley types they roped in for alibis; doubtless they were selected to be photogenic as well as technical. Also too (4) roll out the heart-tugging YouTubes.

3.) ObamaCare health insurance plans on the Exchanges will include a lot of junk. The website woes have kept the quality of the plans in the background, but we expect to be hearing more on this from Michael Olenick. (Also keep in mind the phrases “out-of-network” and “balance billing.”) Bad news delivery here depends not only on internal channels but on ombudsmen, consumer complaints, and so forth, which will be much harder to suppress. I’d expect administration efforts to (1) depend heavily on blaming the policy holder, and, naturally, (2) heart-tugging YouTubes.

Pass the popcorn.

NOTE The ObamaCare Czar, Jeffrey Zeints, also made the false claim that volume/demand Big Lie, but since I don’t have a direct quote, I’m leaving him off the list for now. Today is my day to be kind!

NOTES
[1] BWA-HA-HA-HA! Also note lawyerly parsing of “will.”

[2] “In the next few hours” could that Obama’s staff still can’t tell him the truth,

[3] That was fast. Whatever else the adminsitration can or cannot do, it can certainly get its paid shills to snap to attention and begin to regurgitate with impressive speed. No problems with volume there!

[4] This is a two-fer!

[5] Interestingly, Pelosi is repeating the long-abandoned “millions of hits” talking point three weeks into the process. That transcript is weird, too. Full of word salad. If the Democrats don’t win back the House in 2014, I don’t think Pelosi will last as Leader. She doesn’t make sense when she talks.

[6] We see a similar dynamic in Connecticut.

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106 comments

  1. AbyNormal

    …and i’m going to standby those rollout numbers, just as i do from the BLS, CBO, LPS, MTS, OIG, SAR, SLGS, and lastly the SOL popcorn for the Obots!

    1. Jim Shannon

      The problem has been fixed for free! Go visit the site the government should have created!
      http://www.thehealthsherpa.com/
      Type in your zip and your off to the races!
      We needed a single payor system with escalating out of pocket deductibles based on income between 1% and 20% and instead we got more of the same where the consumer contiues to pay for the corruption of free markets and government by the CentaMillionaire$ and Billionaire$ who will never have enough and refuse to pay meaningful taxes like 100% of all income from all sources over $5,000,000!
      Change the TAX CODE! Then and only then will the consumer have a chance to compete with big money corruption!

  2. Jim Haygood

    ‘You had the policy people, largely at the White House, pushing the deadlines and tinkering with the policy, rather than the people who had to run the critical operating path design and program the system.’

    An acquaintance of mine was a White House staffer when HillaryCare was rolled out to the Congressional committees in 1993.

    It was the same then as now: a bright attorney, with Big Ideas for society, assuming that the grunt work of actually, you know, writing legislation and computer code, could be carried out by an army of faceless technocratic drones.

    Why would the opinions of these worker bees — much less lowly consumers — be of any interest? They are merely the hewers of wood and drawers of water, while their leaders have castles to build!

    1. jrs

      It’s the same nearly everywhere (although not every software project fails this spectacularly).

      The worker bees are almost always just worker bees often required to do things that make little sense to them (in some cases the bureacracy is so dysfunctional that if they actually “worked to rule” nothing would work, things only work because they secretly don’t listen to whatever the manager is on about today and actually try to achieve the real goals of a project). Projects are almost always pushed with deadlines that come from outside rather than the bottom up.

      I can say pretty much every company I’ve worked for I’ve seen the same behavior, that if they were faced with a catastrophe of the size of an Obamacare project there’s a good chance they wouldn’t speak up to those higher on the chain either. The attitude would be to do what one could while following rules and with resignation. “Well what can you do, we get paid regardless”. Some joking among themselves about the hopelessness of it all to lighten the mood, jokes about having to look for another job soon when the whole thing fails, haha. But not much challenging the “superiors” because that is simply not done. If it is at any jobs certainly not that kind of white collar work. Though they could have secretly snuck out info to the press, I could see that being done much easier than I could see challenging the superiors being done.

      1. Procopius

        Well, Obama has so demonized and persecuted whistleblowing that it takes a much braver person than ever before to leak “confidential” information (anything that’s embarrassing to any government official, agency, or policy). I’ll bet anybody who had passed word of this failure to the press would be in court for many years to come.

  3. Banger

    I like your ideas about sociapaths. Indeed, what is a society of sociopaths like? Here is what I’ve seen: sociopaths are often surrounded by empathic enablers, often women who are administrators. Often these people are more loyal than others because they feel only they understand their sociopath who, deep down, really is for good etc. Sociopaths are often blindingly charming and skilled manipulators. So, much depends on the team each of these sociopaths have assembled, particularly the true-believers, who will do the heavy lifting and the dirty work. All people who have access to the President as senior advisers have these teams.

    At any rate, one thing we all know is that the Obama team managed to seduce almost the entire American left in it’s myriad shades during the election and to support the awful ACA so when in doubt they can count on the millions of enablers who still support Obama and company to march to their cause. Just turn on NPR to listen to panels talk about how good Obamacare is an when these minor glitches are fixed any day now etc. Americans will be pleasantly surprised at the great deals in store for them.

    1. AbyNormal

      As the lean leech, its victim found, is pleased
      To fix itself upon a part diseased
      Till, its black hide distended with bad blood,
      It drops to die of surfeit in the mud,
      So the base sycophant with joy descries
      His neighbor’s weak spot and his mouth applies,
      Gorges and prospers like the leech, although,
      Unlike that reptile, he will not let go.
      Gelasma, if it paid you to devote
      Your talent to the service of a goat,
      Showing by forceful logic that its beard
      Is more than Aaron’s fit to be revered;
      If to the task of honoring its smell
      Profit had prompted you, and love as well,
      The world would benefit at last by you
      And wealthy malefactors weep anew —
      Your favor for a moment’s space denied
      And to the nobler object turned aside.
      Is’t not enough that thrifty millionaires
      Who loot in freight and spoliate in fares,
      Or, cursed with consciences that bid them fly
      To safer villainies of darker dye,
      Forswearing robbery and fain, instead,
      To steal (they call it “cornering”) our bread
      May see you groveling their boots to lick
      And begging for the favor of a kick?
      Still must you follow to the bitter end
      Your sycophantic disposition’s trend,
      And in your eagerness to please the rich
      Hunt hungry sinners to their final ditch?
      In Morgan’s praise you smite the sounding wire,
      And sing hosannas to great Havemeyher!
      What’s Satan done that him you should eschew?
      He too is reeking rich — deducting you.
      The Sycophant/Ambrose Bierce’s The Devils Dic.

    2. McMike

      It’s an interesting concept. I just called it the “Sociopath State” (Google will surely reveal that this is not original).

      Anywho… I wonder what happens when the sociopaths outnumber the enablers. Who do they exploit? Who do they get to carry their water?

      Do they crawl up their own backsides, like two serpents consuming each others’ tails?

      Too many chiefs, not enough injuns?

      1. Banger

        True sociopaths are fairly rare in the population–virtual sociopaths are much more common. They acquire the attributes of sociopaths because that’s what you need to have to get to the top (ambition is not sociopathy). In the end these types become prisoners of their own legend (and their handlers) and rely on pharmaceuticals and addictions to stay the course because conscience is always there in the background and rises up now and then.

        1. McMike

          “True sociopaths are fairly rare in the population–virtual sociopaths are much more common”

          True enough clinicaly. The end effect is about the same though.

          The evidence of conscience trying to peek out is most apparent in the gyrating incoherent self-serving justifications they offer for themselves. (Hello, Ms. Rand).

        2. from Mexico

          And if the drugs aren’t enough to deaden the basic unity of human experience that assures us of some possiblity of empathic and symbolic identificaiton with others, then there are always the neoclassical economists, bolstered by the full authority and prestige of our nation’s top universities and the Nobel Prize Committee in economics.

          They’re there to assure the virtual sociopaths that they are just being “rational.”

          Gary Becker, with his theory on crime, is the epitome of this. As Robert H. Nelson explains:

          It says in the Ten Commandments in the Bible, Thou shalt not steal (Exodous 20:15). For Becker, however, understanding (and preventing) crime is explained not by such Christian homilies, but by hard economic motives. Indeed, stealing is simply another form of rational maximization of individual income and utility. Most people refrain from stealing because it would not be profitable for them; for some people it happens to be profitable and they become theives. Economically, a theft is a “redistribution” of resources, in much the same broad category, technically speaking, as a government welfare program.

          Of course, most people would naively object that stealing is morally wrong, but that the welfare form of redistribution of income is legitimate because it has been approved by a democratic political process. However, the Chicago school also finds that official rationales in politics often cannot be taken at face value. Welfare programs really involve coercively taking money from some people to give it to others. If collective “theft” by government can be analyzed without one’s feeling a need to interject extensive moral commentary, why not put theft by ordinary criminals in the same economic category? As Becker argues, the “basic motivaiton” of criminals is the same as that of “other persons.” Criminals are distinguished not by their lack of moral character, but by the fact that “their benefits and costs differ,” perhaps in part a consequence of their having different physical and mental endowments for crime.

          Becker at one point comments that stealing per se is not inefficient. In a real sense, “frauds, thefts, etc., do not involve true social costs but are simply transfers, with the loss to victims being compensated by equal gains to criminals.” However, responding to their private incentives, people will steal up to the point where the objects gained (stolen) have a money value equal to the work effort in doing the stealing. It is only in this sense that it is possible to judge criminal actions as inefficient (“wrong” in the morality of economics) because acts of stealing produce no useful outputs, and yet can absorb considerable productive resources of society (the time and effort of the criminals themselves)….

          Individuals may constrain their behavior of their own accord (based on some concept of “justice” in their mind) but there is no place where “society” meaningfully says, “this is not allowed because it is ‘wrong.’ ” Only those who may allow themselves to be affected by individual sentiments such as “guilt” will be significantly influenced in their behavior….

          [T]he meaningful existence of any collective “values,” “religion,” “culture,” or “justice” that go beyond maximizaiton of individual benefits and costs does not exist anywhere.

          –ROBERT H. NELSON, Economics as Religion

      2. Lambert Strether Post author

        It’s purely speculative and I don’t want to go all armchair psychoanalyst. At the same time, I think the idea of State as a sort of characterological racking tower with an extremely refined product — a sociopathic elite — as the end product. Note that we could regard this is completely functional, if you regard “deterrence,” for example — the willingness to incinerate a few billion people — as functional. We’ve certainly built a society that demands that function.

        I keep thinking of this passage from Terry Practchett’s Guards, Guards!:

        [Vetinari] waved his thin hand towards the city and walked over to the window.

        “A great rolling sea of evil,” he said, almost proprietorially. “Shallower in some places, of course, but deeper, oh, so much deeper in others. But people like you put together little rafts of rules and vaguely good intentions and say, this is the opposite, this will triumph in the end. Amazing!” He slapped Vimes good-naturedly on the back.

        “Down there,” he said, “are people who will follow any dragon, worship any god, ignore any iniquity. All out of a kind of humdrum, everyday badness. Not the really high, creative loathsomeness of the great sinners, but a sort of mass-produced darkness of the soul. Sin, you might say, without a trace of originality. They accept evil not because they say yes, but because they don’t say no. I’m sorry if this offends you,” he added, patting the captain’s shoulder, “but you fellows really need us.”

        “Yes, sir?” said Vimes quietly.

        “Oh, yes. We’re the only ones who know how to make things work. You see, the only thing the good people are good at is overthrowing the bad people. And you’re good at that, I’ll grant you. But the trouble is that it’s the only thing you’re good at. One day it’s the ringing of the bells and the casting down of the evil tyrant, and the next it’s everyone sitting around complaining that ever since the tyrant was overthrown no-one’s been taking out the trash. Because the bad people know how to plan. It’s part of the specification, you might say. Every evil tyrant has a plan to rule the world. The good people don’t seem to have the knack.”

        “Maybe. But you’re wrong about the rest!” said Vimes. “It’s just because people are afraid, and alone—” He paused. It sounded pretty hollow, even to him.

        He shrugged. “They’re just people,” he said. “They’re just doing what people do. Sir.”

        Lord Vetinari gave him a friendly smile. “Of course, of course,” he said.

        I wish very much there was some scholarly literative on the group dynamics of sociopaths.

        1. anon y'mouse

          a lot of Pratchett is brilliant in that way, about so many things. poor man!

          thank you for the memories…

          he also has in that book a good analysis of what keeps the poor where they are, with the whole -quality vs affordability- thing vis a vis the simple purchase of a pair of boots.

          probably Pratchett’s most political book.

        2. Procopius

          You know, I’d put that speech right up there with the Inquisitor’s speech to Jesus in… was it The Brothers Karamazov? So long since I read it. Actually, I think I like Pratchett’s work more.

        3. Butch In Waukean

          In Greene’s story the sociopath was an outsider, but the pathology is the same.

          Harry Lime and Holly Martins, looking down on war-shattered Vienna from the the top of a ferris wheel:

          Martins: Have you ever seen any of your victims? .

          Harry Lime: You know, I never feel comfortable on these sort of things. Victims? Don’t be melodramatic. Look down there. Tell me. Would you really feel any pity if one of those dots stopped moving forever? If I offered you twenty thousand pounds for every dot that stopped, would you really, old man, tell me to keep my money, or would you calculate how many dots you could afford to spare? Free of income tax, old man. Free of income tax – the only way you can save money nowadays.

          Harry, with his bogus penicillin. was “very good at killing people.”

      1. jrs

        It does make me angry that ingorant flies are only now getting angry about a website and losing plans and did not get angry about targeted asasinations, plus other civil liberties violations. I mean the guy is a murderer. Hello? Hello? Obama’s fall in approval ratings is pretty cold comfort at this time. I do hope he becomes infamous but I’d hope in the end for the right reasons (which isnt’ a bad website).

    3. from Mexico

      I too am glad that Lambert is raising the specter of the existence of sociopaths.

      The notion that there are bad people who do bad things, and in high places, is certainly not a popular one with the apostles of scientific management. The followers of this secular religion hold that the scientific managers of society should be given the necessary power and can be counted on to act with it in “the public interest.”

      As Eliza Lee explains in “Political Science, Public Administration, and the Rise of the American Administrative State,” only in such a way is it possible for “the truth and objectivity of science” to substitute for the interest-group favoritism, for “the unenlightened majority” of past American politics, thus providing a much firmer “basis of [American] democracy.” This would stimulate a new “sense of political community” in the United States, based on “the adoption of science as the common language of discourse, bringing about an end to irrattionality, rivalry of power, and authoritarianism.” The “social significance of science” was that it would now provide “the legitimate basis of public authority” for American government.

      What could go wrong?

      As Arthus Schlesinger Jr. noted:

      The notion of sinful man was uncomfortable for my generation. We had been brought up to believe in human innocence and even in human perfectibility. This was less a liberal delusion than an expression of an all-American DNA. Andrew Carnegie had articulated the national faith when, after acclaiming the rise of man from lower to higher forms, he declared: “Nor is there any conceivable end to his march to perfection.” In 1939, Charles E. Merriam of the University of Chicago, the dean of American political scientists, wrote in “The New Democracy and the New Despotism”: “There is a constant trend in human affairs toward the perfectibility of mankind. This was plainly stated at the time of the French Revolution and has been reasserted ever since that time, and with increasing plausibility.” Human ignorance and unjust institutions remained the only obstacles to a more perfect world. If proper education of individuals and proper reform of institutions did their job, such obstacles would be removed. For the heart of man was O.K.

      http://www.nytimes.com/2005/09/18/books/review/18schlesinger.html?pagewanted=all&_r=0

      1. DakotabornKansan

        One of my favorite encapsulations of Kafkaesque logic by people in high places…

        During a question and answer session with the Education Committee on “The responsibilities of the Secretary of State for Education,” Michael Gove British Conservative MP, Britain’s Secretary of State for Education, was asked to explain what makes a good school good.

        He doesn’t appear to understand what an average is:

        Q98 Chair: If “good” requires pupil performance to exceed the national average, and if all schools must be good, how is this mathematically possible?

        Michael Gove: By getting better all the time.

        Q99 Chair: So it is possible, is it?

        Michael Gove: It is possible to get better all the time.

        Q100 Chair: Were you better at literacy than numeracy, Secretary of State?

        Michael Gove: I cannot remember.

        http://www.publications.parliament.uk/pa/cm201012/cmselect/cmeduc/uc1786-i/uc178601.htm

      2. Lambert Strether Post author

        Looks like Madison was smarter than Schlesinger. The famous passage from Federalist #51:

        The provision for defense must in this, as in all other cases, be made commensurate to the danger of attack. Ambition must be made to counteract ambition. The interest of the man must be connected with the constitutional rights of the place. It may be a reflection on human nature, that such devices should be necessary to control the abuses of government. But what is government itself, but the greatest of all reflections on human nature? If men were angels, no government would be necessary. If angels were to govern men, neither external nor internal controls on government would be necessary. In framing a government which is to be administered by men over men, the great difficulty lies in this: you must first enable the government to control the governed; and in the next place oblige it to control itself. A dependence on the people is, no doubt, the primary control on the government; but experience has taught mankind the necessity of auxiliary precautions.

        Much to disagree with there on the nature of the state; but little, I feel, to disagree with on the nature of humanity.

        * * *

        Some people visualize power structures — or at least our power structures, as triangles. I have wondered if the size of the triangle matters in relation to the number of sociopaths populating (as I have argued) the apex. I’m guessing the bigger the triangle the more influence apex sociopaths have in proportion to the influence of sociopaths in smaller triangles but I freely confess I have no evidence or reasoning to back up this intuition. I wish there were a literature on these ideas.

    4. Jerome Armstrong

      “sociopaths are often surrounded by empathic enablers”

      And we surrounded by the narcissists!

  4. DakotabornKansan

    Even if the computer glitches are worked out, complexity is baked into Obamacare.

    “The exchanges have to deal with millions of enrollees, they have to deal with income verification, they have to deal with thousands of private insurance plans. It’s a very complex system. And unfortunately, that complexity also contributes to high expense. The private insurance industry that is offering the insurance through the exchanges has overhead costs that are about four times as high as traditional Medicare. And in addition, we are going to have overheard of about four percent added to insurance overhead just for the exchanges. So it’s a complex system, a very expensive system and when we see the way it’s performing, we understand why we need a simple single payer system that could save about $400 billion on administrative simplification.” – Steffie Woolhandler, MD, MPH, FACP, CUNY School of Public Health

    1. Jim Haygood

      ‘High expense,’ you say? Why, just let the peasants cut back on cakes and lattes. Eric Peters explains the economic calculus of our elite overlords:

      Government – the people who run it – have this blind spot about economics. Because for them, economic laws don’t apply. Cost-benefit considerations that normal people must entertain are, at most, abstractions for those who wield political power. That is, people who wield organized violence.

      Thus, Obama (or whomever; the particular personage of the Dear Leader at any given moment is incidental) can simply decree that – for example – all new cars will be able to withstand a rear impact by a car traveling 40 MPH, or be able to barrel roll a dozen times and not have the roof crush, or average 35.5 MPG. Let the engineers figure it out.

      And let you and me pay for it.

      http://ericpetersautos.com/2013/11/09/why-not/

      Nancy Pelosi has health care for life. Why don’t you, comrade?

      1. Cynthia

        The ACA has nothing whatsoever to do with health care! It’s a subsidy direct from the middle class to the health insurance providers at the tip of a spear.

        More proof that the Democrats are the party of the multi billionaire plutocrats and the welfare-industrial complex. The middle class people who work are merely their sheep to be shorn.

      2. jonboinAR

        The downside of government regulation: per your example, it can be heavy handed and impractical.

        An example of the upside of government regulation: The air in Los Angeles, CA is much cleaner than it was in the early ’70′s despite there being several times as many autos on the road. How did this happen? By the creative response of the auto industry to government emissions regulation.

    2. Cynthia

      Private insurers will continue to search for innovative ways to keep their premiums competitive, such as narrow networks, high deductibles, and selling in only healthy, profitable markets. Their waste of our health care dollars can be demonstrated by last month’s report from the Office of the Actuary of CMS that projects that, in 2022, government administrative costs for health care (Medicare, Medicaid, VA, IHS, Department of Defense, etc.) will be $70 billion, whereas the administrative costs of the private insurers will be $313 billion! What a waste!

      Administrative costs are seldom mentioned as a source of rising health care costs. It is the elephant in the room that few want to talk about probably because these costs represent the incomes of an ever growing number of bureaucrats and administrators, a situation which will only increase under Obamacare.

  5. TarheelDem

    Ars Tehnica reported on the discovery of an online DDOS tool targeting healthcare.gov. The program has been a target for various kinds of sabotage, which should have been guarded against even if it was not anticipated. Republican behavior about this law has been unprecedented in being beyond the normal range of political action in the US.

    The major obstacle at the moment standing between the current mess and single-payer Medicare-for-All is breaking the stranglehold of the Norquist Pledge. That either happens by Republicans abandoning that commitment and considering meaningful changes in tax law or being replaced by members of Congress who are will to change tax law. Transformation from where we are to Medicare for All will require a huge change in tax law that will likely result in saving for ordinary people (if you account for the high prices for insurance and health care that are at the heart of the health care crisis). Until that occurs, Obamacare is the best we can politically do. But within that framework, one can nationalize Medicaid, one can expand Medicaid even further, and one can point out that Medicaid largely subsidizes middle-class long term care.

    Snickering and pointing to the failure of a web site doesn’t move to the delivery of health care either despite the therapeutic effects of schadenfreude that hits a communication operation that thought defending the public option by primarying an opponent of that provision “retarded”.

    1. Banger

      Though I have some sympathy for your argument assuming that the ACA is workable–and I now have major doubts it is–I suspect the overhead will be very high to get this highly complex system actually working. As a former gov’t IT contractor I can say that what I’ve seen looks very typical of what I’ve seen and I know how this ends and it won’t be pretty–I could be wrong and maybe hordes of contractors might improve matters, we’ll see.

      However, I stridently disagree that this is the best deal we could have gotten back in 09 or now. The reason why we had to “settle” for the ACA is because the “debate” was fact-, reason-, and science- free. Why? Because the Democratic Party and the WH had made a deal with the some of the sleaziest and most criminal elements in American society to keep the highly irrational, kleptocratic and cruel system essentially intact–this is a system designed to extract money from Americans citizens first and secondarily deliver somewhat decent HC to those that could afford it. The Administration refused to provide the clear alternatives that exist in the ENTIRE developed world (we are the only ones I know of with a system like this) such that nearly all Americans have no clue what other countries do for health-care unless they’ve watched Michael Moore’s movie or actually have live abroad or had family members who have. The Administration, the Democrats, the mainstream (courtier) press, and the devoted and deluded enablers of our PR President chose not to present facts that would have devastated conservatives. FACTS!!!! Imagine that! But they chose, instead, to make a cowardly deal with executives from Big Medicine to make sure they and their heirs were guaranteed endless trophy wives, big tabs in Las Vegas, the best ho’s that money can by and the assortment of toys and dodads that the fabulously rich enjoy.

      This is not the best we can do! It is the best the cowardly and mainstream left can do. At best this could be a mild improvement over the cruelest HC system in the world and maybe that’s to be welcomed I suppose–if we even get there.

      1. TarheelDem

        If the system is unworkable, the way forward is toward Medicare-for-All or toward heavier regulation like the Swiss and German systems. People with pre-existing conditions who have capped their maximum financial risk are not going back to the days in which a serious cancer could result in foreclosure and bankruptcy.

        And it is not to great a pivot for Obama to point out again that this was a system that was designed by the Heritage Foundation and pilot-tested by Mitt Romney. And to say that he was wrong to move in that direction; now let’s move in the direction of Medicare-for-All–which can be implemented in about six months, given that the IT infrastructure is a matter of scaling from just seniors to all citizens. And that the number of qualifying tests drops quickly when you are just testing for a Social Security Number. Don’t even have to test for age anymore. Take away deductibles and co-pays and you take away means testing for assistance with those.

        What we have learned is that a full public system is more efficient than a public-private quasi-market system.

        1. Alexa

          It is a fallacy that no individuals and families “will bankrupt” now that the PPACA is in place.

          Here is the combined total of the plan Deductible and In- and Out-Of-Network OOPs for two BC/BS plans that are sold both in the individual market (starting in 2014) and on the Federal Health Exchange.

          Bronze Plan: Family Maximum OOP (NOT including the insurance plan premiums): $74,800

          Silver Plan: Family Maximum OOP (NOT including the insurance plan premiums): $44,000

          Does anyone seriously believe that meeting these out-of-pocket maximums could/would not “bankrupt” some families?

          Oh, and the “monthly premium” for these two policies:

          $383,87 for Individual Plus Spouse for the Bronze Plan

          $433.64 for Individual Plus Spouse for the Silver Plan.

          And we went directly to a Blue Cross/Blue Shield “Broker” for these quotes–so these premiums are NOT estimates!

          [From all that we've gathered, we wouldn't even waste the time to get a premium quote from the Federal Health Exchange.]

          If the current crop of mostly corporatist/conservative Democrats can’t/won’t do better than this–get rid of them, and put in lawmakers who can/will!

          1. TarheelDem

            Under the legislation, insurers cannot impose event, annual, or lifetime maximums. How are they getting around that provision that went into effect as soon as the legislation became law? That doesn’t just apply to plans offered under the exchanges. It applies to employer-based plans as well.

            1. Alexa

              There is nothing to get around–the limit for out-of-pocket costs applies ONLY to “in-network” providers.

              Or at least that is true of Mr A’s self-funded company plan.

              This has been verified to me by his plan’s administrator (an insurance company).

              There are two Out-Of-Pocket Maximums–One “In-network” and One “Out-of-network”

              There are dual track: Deductibles, Co-pays, and Maximum Out-of-Pocket Costs.

              When one goes “out-of-network,” the expense incurred does NOT even count toward the OOP “Out-of-network” costs.

              And the difference between what the insurance company pays the out-of-network provider and what they bill (Usual and Customary) is billed to the plan beneficiary (employee).

              The “cap” that the ACA puts on costs, applies to “In-Network.”

              But that’s not always possible.

              We’ve got so-called “in-network” providers who have 30 our of 40 of the services and/or departments in the hospital “classified” as “out-of-network.”

              We’ll be forced to run around the hospital carrying a huge, very detailed and complicated employee benefits (medical plan) handbook while we get even the most trivial procedure or test done–if we hope to protect ourselves from out-of-network OOP HUGE expenses.

              Why do you think so many people are so angry about the ACA?

              From what I understand, “fully-insured” plans, cannot impose both in- and out-of-network “services” under a “in-network” provider–the way that “self-funded” plans can.

              But today, more than half of large companies (since the signing of the ACA) are self-funded.

              So this is small comfort to millions of Americans.

            2. Yves Smith

              I don’t know if you are an Obot or just uninformed, but Romneycare which provides BETTER coverage than Obamacare, has had only a trivial impact on medical bankruptcies:

              http://emptywheel.firedoglake.com/2011/07/11/romneycare-didnt-end-medical-bankruptcies/

              And as for Obamacare, those caps mean bupkis if:

              1. The costs you incur before payments kick in are enough to bankrupt you (you can easily incur $5,000 to $20,000 in uncovered costs per year for a family, which will bankrupt a lot of people (nearly half of the people in America are one paycheck away from not being able to pay their bills)

              2. You incur costs out of network, which happens all the time now and will happen even more with narrow networks. What if you need a specialist who is not in your network? It now happens all the time for routine surgeries that you can’t make your doctor or hospital assure that everyone on the team is in your plan, even if the hospital is in your plan. Google “balance billing”.

        2. Banger

          We can try to move in that direction but Congress and the Administration are solidly opposed to such a system. How do you propose to move in that direction?

          1. TarheelDem

            Health care transcends ideological opinions when is it a reality within a family. That is why there was momentum for health care reform in 1990-1992 and 2007-2008. The for-profit health care system can’t help itself; it is broken. And everybody knows it. Repeal of Obamacare will not happen for that reason.

            So the issue becomes how to move forward. Romneycare, having been proven in Massachusetts, was the go-to answer for the insurance industry and their financed experts in 2008-2009 even if that was not they played it with their lobbyists. If Obamacare bring widespread dissatisfaction, Mitt Romney’s statement about nationalizing of Romneycare will have proved correct. Fifty regulators are too complicated. The models then are single, nationalized public-private plan. Heavy regulation of private plans. And Medicare for All. The public understands Medicare for All. Heavy regulation of private plans is like car insurance; that likely is not a winner. Explaining the Swiss and German plans were too complicated in 2009; that hasn’t changed.

            The smoothest transition will be to eliminate the age restriction on Medicare and fund it through taxes. Now the question that will hamstring the politicians will be what taxes to fund it with. Increase the Medicare tax, which is a payroll tax? Well that will work if it is a saving over the mandatory premium for Obamacare. Advocates of Medicare for All would do well to benchmark the tax impact on ordinary Americans to be less (especially much less) than the Obamacare premium just like Obamacare advocates are benchmarking the Obamacare premium against comparable COBRA coverage.

            If Congress feels the ire of the public, the question for them will be what to do. Repeal of Obamacare is politically suicidal after enough folks have had medical bills paid out of it. Every alternative but Medicare-for-All is too difficult to explain. Medicare-for-All shifts costs from paying privately to paying to government, but could create substantials savings for doing it.

            And the elephant in the room is middle class use of Medicaid for long term care, which should be brought into any Medicare-for-All legislation.

            1. Bridget

              “Now the question that will hamstring the politicians will be what taxes to fund it”

              There’s always the $250 billion to $300 billion per year worth of taxpayer subsidized employer provided health insurance. Voila!

              1. Lambert Strether Post author

                Mothball a carrier group. The DOD “lost,” IIRC, something like a trillion dollars. Take whatever part of that wasn’t really on the intelligence black budget, and use it. And so on.

                1. TarheelDem

                  I like your thinking here.

                  That means that it comes out of the general fund of discretionary expenditures. That tends to be vulnerable funds politically unless it is military spending.

                  Having the politics fixed enough that health care (i.e. social infrastructure beyond bricks-and-mortar infrastructure) is a sacred cow would be a welcome change.

            2. roadrider

              Just as you did on FDL you are making an incorrect assumption about the costs of an ACA policy vs COBRA. I currently have COBRA coverage and it costs me $432/month with no deductible and an OOP maximum of $3000. An ACA silver plan in my state would cost me nearly twice as much in premiums and comes with a $6000 deductible.

              The key point is that when you purchase COBRA coverage you are getting a group rate not an individual rate. In addition, my ACA rates reflect the age discrimination built into that legislation which lets insurers charge as much as 3 times as much for older consumers. There may be those younger buyers who are eligible for subsidies who will do better with the ACA than with COBRA but to generalize from those cases to everyone is simply wrong.

              Another point. I’m currently unemployed so if I were to purchase an ACA policy I would have to estimate my income for 2014 which I can’t possibly do because I have no idea when I will get a job or how much I will earn. I suspect that my income would be estimated from what I earned this year which would put me over the line for subsidies. So, the ACA says this to those losing their jobs and employer health coverage: You can choose COBRA, which may be too expensive for some or you can buy a policy on the exchange which, unless you are very young and eligible for subsidies, may cost you even more, maybe a lot more. Plus, you have to play income-estimation roulette and risk tax penalties if you guess wrong.

      2. TarheelDem

        There was one important reason that this was the best that we could do in 2009. Max Baucus has presold a solution to the insurance industry and they wrote the bill. And he used the ghost of Daniel Patrick Monyihan’s defeat of Hillarycare as the narrative to control the narrative and the process in Congress. And…Kent Conrad used his Budget Committee and his desire for deficit and debt control (politically popular in North Dakota) as a backstop for any reconciliation gambit.

        Lieberman, Baucus, Conrad, Landrieu, Lincoln – that gets the vote down to 55. And there were probably five to six Senators shaky on the public option (Hagan was one) and only a minority willing to nuke the filibuster. When Conrad was saying the votes weren’t there, he was saying that he and Baucus and Lincoln were working very hard to make sure that the votes weren’t there. Just as the Blue Dogs unsuccessfully did on the House side.

        Could a stronger push from the beginning have overwhelmed Baucus’s strategy? We’ll never know. Yes, we were betrayed. But more than one person was involved in that. The old white guys shouldn’t be given a pass. And notice that these skunks have either been defeated (some for Obamacare that they didn’t vote for) or are bailing to pick up their post-Congress paychecks. That trend will likely continue over the next few cycles.

        1. 12thmonkey

          Until enough people get sick and tired of the soaring costs of insurance, the private market calamity will continue. Most people get insurance through work and so they have no real, workable idea how much insurance costs; especially since it is tax free. National health insurance like the rest of the civilized world would be the best plan but for historical reasons and current reasons, ain’t gonna happen for a while. The ACA is the pig we have and it is a step in the right direction. For the millions (Medicaid) about to be insured, I will take it.

          1. Lambert Strether Post author

            If it’s the only step in the direction you want to take, it’s not the right step. What part of cementing private heatlh insurance into place forever and handing them rent to the tune of thirty cents on every dollar for no health benefit whatever do you no understand?

          2. TarheelDem

            The insurers and providers can restrain themselves. Their greed will create a crisis out Obamacare sooner instead of later. The first steps might be tinkering with medical cost ratios, co-pays, and other elements of the ACA. But eventually, the idea of just relaxing the age restriction on Medicare will become acceptable and demanded. (Unless the Congress figures a way to screw up Medicare; watch for that in the next six months.)

            1. different clue

              Obama’s long-range goal is to destroy Medicare thoroughly enough that the profitisable wreckage can be Ryanized and voucherised and sent into Obamamcare. If Medicare is destroyed and privatised, there will be no talk of “expanding Medicare”.

        2. Banger

          I’m pretty convinced that a true public debate featuring the facts would have eventually overcome the corrupt Senators–it may have taken two years rather than one though. Washington insiders (who I know so well) always underestimate the power of truth just because people who aren’t paying complete attention are so easily fooled–but that “fooling” (aka con-game) eventually breaks down in a year or two when those who actually have a warrior hearts stand up for the truth. Why, if you are on the left and believe in these things, would you want to live with the pack of false assumptions the ACA rests on for its existence.

    2. McMike

      The DoS attack is indeed a notable and underexplored aspect of this debacle.

      Jeebus, you’d think with the NSA at his disposal, they mighta seen this one comin’.

      1. Jeremy Grimm

        A DoS attack is the very least of the hacker worries facing the healthcare site. Besides, any website that expects hundreds of thousands and fails in test with a couple of hundreds of users provides no service that might be denied. When and if the ObamaCare site somewhat works, the complexity and apparent bugginess of the site promise openings to attacks much more serious than a simple DoS attack. An exploit that garners hoards of user personal information could help ObamaCare provide something unplanned for — it could end banking and credit card use as we’ve know it, and more.

    3. Lambert Strether Post author

      On the DoS: Just because the tool is out there, which is all the Art Technica site shows, doesn’t mean it’s been used. The administration is incredibly anxious to shift blame, and they also have access to the server logs. If the DoS were happening, it’s easy to show and in their interest. So it’s not happening.

  6. denim

    “Programmers attempt to build an alternative to healthcare.gov

    Three San Francisco programmers took on the problems of healthcare.gov and constructed their own version of what the website should be. Meet the team behind thehealthsherpa.com. John Blackstone reports.”

    http://www.cbsnews.com/video/watch/?id=50158818n

    And succeed! according to this piece.

    1. Lambert Strether Post author

      Well… Maybe. Do they have an API to the Federal Hub? If not, I doubt this anything more than a toy. For example, reading this story, the site doesn’t calculate subsidies.

      So while this plays into several narratives, among them “government can’t do anything right,” and “youthful prodigies,” this looks more like a bid for publicity and funding from an SF startup than anything else, to me.

  7. Elizabeth

    The failure of the website is much less important than substantive analysis of the structure of the program, what it means for folks in various states, doctors and hospitals opting out of the exchanges, specialists opting out, dropped coverages for failure to meet ridiculous requirements…that’s where the analysis is needed right now.

    1. Lambert Strether Post author

      True, but it’s the failure of the website that makes that hard, because that’s where the plans are compared.

      In addition, the sheer complexity makes a teaching moment possible on the virtues of a simpler system: Single payer.

      Finally, the post tries to make the point that the rollout is a useful window into the nature of the Obama administration which is, after all, still a player in this process.

    1. HotFlash

      Thanks for keeping on with this, Lambert. I have been avoiding reading much of your series, I admit (can’t stand torture porn). I still can’t believe how opposed many of my dirt-poor relatives are to single payer, even when they are just over the border in MI and I (Cdn, eh) tell them all the time.

      I think there is a lot to be said for the idea of sociopath-in-chief being the last to hear bad news from inferior sociopaths, and much has been. Two fine examples:

      1.) from Adam Hochschild’s excellent article on the Battle of the Somme today at NC:

      “The multiple belts of barbed wire in front of the German trenches and the well-fortified machine gun emplacements were still largely intact.

      “Officers looking through binocular-periscopes had already suspected as much. Plans for any attack, however, have tremendous momentum; rare is the commander willing to recognize that something is awry. To call off an offensive requires bravery, for the general who does so risks being thought a coward. Haig was not such a man.”

      (Full article at http://www.nakedcapitalism.com/2013/11/veterans-day-95-years-on-the-enduring-folly-of-the-battle-of-the-somme.html#U97ve1krsFwZE6LB.99)

      2.) this one from “True Lies” https://www.youtube.com/watch?v=FAgZlwSGYE8

  8. Bob Swern

    Much of what I do, on a day-to-day basis, in the real world of software development dovetails with addressing the noted points of failure, once one dives beneath the spin on this project.

    It’s common knowledge (in the consumer finance/credit sector) that accurate income verification is close to being the proverbial Holy Grail in the consumer credit software vertical, too.

    There are MANY points of failure in the digitized/digital worl do of income verification, and this is due to the basic fact that virtually all stats that ARE available are, essentially, outdated (by the time they’re available for access). Furthermore, a second reality-based dynamic comes into play here, and it’s this: if you’re underbanked, earn a lot of your income in cash (i.e.: if you’re income’s dependent upon tips, or say you work in the construction industry as a day-laborer or small-project contractor, chances are you’re earning a lot of cash/unreported/underreported cash income), or self-employed, more than likely there’s going to be an “issue” regarding accurate income verification.

    These problematic demographic skews are, precisely, the same types of occupations/market segments where there are points of failure in the consumer credit (approval/decline) process, today. AND, they mirror a large portion of the population that’s seeking out Obamacare coverage, as well.

    Perhaps most importantly, the “HIT RATES” (when one receives a functional respone–recent, verifiable results–from services such as Equifax–I’ve worked with them, directly, on this service), are notoriously LOW (65%-75% real-time accuracy, meaning 1/4 to 1/3 of all respondents’ applications are stopped dead in their tracks, awaiting human intervention/follow-up), ESPECIALLY as it relates to the demographic makeup of that sector of the public that’s most likely to benefit from Obamacare (see above).

    What happens, in the consumer credit space (where the same processes are deployed as they are in Obamacare as far as income verification’s ccerned), is that the process comes to a grinding halt, on a customer-by-customer basis. And, manual verification–i.e.: call the employer, get 1099s from the consumer, etc.–takes over.

    This process leads to a VERY high percentage of UNFINISHED/UNPROCESSED applications in the consumer credit space; and, I”m sure the result’s little different in healthcare. IN fact, I know that’s the case.

    There is NO RELIABLE, COMPREHENSIVE income verification resource (timely/accurate) on the market, today. It’s the HOLY GRAIL of consumer finance. It does NOT exist.

    This is going to lead to much lengthier approval periods for Obamacare, and ERRORS in the various software processes between the various entities linked-up in the web databases that manage/support it. (You’ll have lots of open queries/unfinished “processes,” that by definition will kluge up the platform, both nationally and at the federal level.)

    Of course, what this also means is that the COSTS–per processed Obamacare application–are going to skyrocket, easily increasing infrastructure expenses by 300%-500% (increased call center expenses, overall personnel costs, infrastructure to properly managed digital documents, such as customer “stipulations,” etc., etc.).

    (And this doesn’t even account for the myriad/other problems reported, such as insufficient server allocation[s], lack of load-balancing, etc.) I’ve written about this at my blog at Daily Kos, too.

    –Bob

      1. Splashoil

        Bob, If you feel lonesome over at Kos, the O’bots have HR ‘d many of us silent. Looks like a losing battle with paid operatives and the willing blind. There is no path forward if we can’t talk about it.

    1. HotFlash

      You say, “It’s common knowledge (in the consumer finance/credit sector) that accurate income verification is close to being the proverbial Holy Grail in the consumer credit software vertical, too.”

      Interesting. So, if one of the results of Obamacare registration is better information for the credit rating agencies, due to the ability to verify directly with IRS and other govt agencies, which would otherwise be privacy-barred, that would be a bonus for them? Fascinating.

      1. Bob Swern

        The ACA application process is just one of at least a couple of ways that the IRS is doing a deeper dive on all of us here in the unwashed masses. Look to the NSA, who, in addition to sharing/sourcing info with the DEA is also very much doing the same with the IRS. Yes, it’s just a matter of time–assuming matters proceed along the same unconstitutional trajectory that they are now–wherein our government will be sending us a BILL based upon their “collect it all” efforts, for “PRETAX” (i.e. “PreCrime”) based upon their illegally-gotten knowledge of every moment (and transaction) in our lives.

        Orwell’s rolling in his grave.

        1. TarheelDem

          Excellent point and a good reason not to further additional means testing of government programs. Also to deal with long term care in a way that does not drive the middle class asset spend-down.

    2. TarheelDem

      From an IT perspective there are three areas of project failure to investigate:
      1. Late-breaking changes in the number of states and the additional requirements they dumped on the project. NC dumped a state exchange in July 2013, for example.

      2. Incomplete implementation of HIPAA data transactions, particular the one to standardize beneficiary enrollment. The healthcare.gov project essentially had to negotiate a common data standard, publicize to the implementing companies, and ensure that the insurance companies had their ends of the interface written by October 1. That seems to be the biggest problem and it also affected some state exchanges, like California. This is the source of the high rate of enrollment errors in the first week.

      3. Deliberate sabotage through DDOS attacks on launch day. Code targeting healthcare.gov has been found on the internet. Waiting for follow-up stories of it being used.

      4. The credit verification (primarily of assets and net worth I suspect) that you identify in this comment.

    3. Lambert Strether Post author

      I’ve always wondered what the real purpose of ObamaCare really is. Now I get it: It’s the “holy grail” of consumer finance. That dovetails suspiciously neatly with the requirement to report changes in your income, ostensibly so that your subsidies can be recalculated.

      Thanks for an extremely illuminating commemnt.

      * * *

      I have the feeling that although from the outside, to us poor schlubs, ObamaCare’s complexity is overwhelming, to the elite, ObamaCare and its purposes are really very simple, just nothing to do with health care.

  9. Barmitt O'Bamney

    Looking forward to your magnum opus, Obamacare: a Post Mortem, a bestseller of 2014, I hope. This reads like a early chapter.

    Go into the light, Obamacare! There is peace and serenity in the light.

    1. Cynthia

      If Obamacare crashes and burns, what will Obama’s legacy be? The most ineffectual President in history, who made nobody happy except bankers and fascists.

      1. Mark P.

        Technically, William Henry Harrison was more ineffectual because he seemingly auto-darwinated from narcissism by getting pneumonia after a two-hour inaugural address in cold rain, and ‘served’ in office from March 4, 1841 to April 4, 1841. (Granted, long speeches were the custom then, as in the debates between Lincoln & Douglas.)

        But otherwise, yeah.

  10. par4

    The Democrats are f@#ked! 10s of millions losing their policies and having to pay more for Obamacare. No amount of spin is going to fix that. I suspect when that starts happening support for repeal will really start growing.

    1. different clue

      The Republicans will oppose and obstruct repeal at that point. The Republicans and the Catfood Obamacrats work for the same social class.

      If someone moves a suit against it all the way to the Roberts Court, the Roberts Court will strike down that suit for the same reason it upheld Forced Mandate.

  11. Yancey Ward

    +1000 for Bob Swern’s comment above. I don’t think anyone has really anticipated the mess that might be caused by having 20-25% of the applications for subsidies denied for inadequate income verification, or the flip side of clawing back subsidies that are improperly awarded should the standards get relaxed.

    1. AbyNormal

      and i shiver (uncontrollably) at the thought of how many terminally ill will be hungup in the system

      they’ll never report the total of lives lost

  12. Brooklin Bridge

    What comes across to me in this post is just how much Obama is at the center of things and just how much the failures and successes we see in his administration reflect HIS priorities. The yes men, the issue with women, are part of that very problem, but not it’s sole explanation. They are symptoms first and ironic causes of this particular fiasco second. It has become evident that Obama’s mission as he set out to become President was to leverage what was left of the Democratic Party brand and use the mirage to sell out the people. 1) Use the liberal brand to get elected. 2) Use it to camouflage his traitorous intent to introduce and legitimize government coercion into relationships between citizens and private enterprise.

    Once he had accomplished that goal, his job was done as far as ACA was concerned; his priorities were satisfied. Whether or not the software that signed up the cattle for the slaughter worked or not was small potatoes by comparison. He was the man who had cemented fascism into American democracy, legitimized it, rammed it through a totally corrupt congress and gotten it stroked by a Supreme Court that would only have been happier if the process had included stringing him up to a tree limb as a way of showing their appreciation. From that point on, Obama’s itinerary was maintaining the war machine, increasing Presidential power in myriad ways (right to spy, right to monitor, right to kill; anyone, anywhere, anytime) and gutting SS and Medicare as much as possible to prepare those asset heavy programs for the same end as health care; a sick exploitive relationship where government and private enterprise collude to extract abusive destructive rents from the citizenry.

    Obama and FDR have similarities in their circumstances and how they reacted to them. Both men were president in socially and economically wrenching periods of extreme stress and suffering. And both men were instrumental in moving the ship of state into historically pivotal directions it would not or could not have taken otherwise.

    1. Doug Terpstra

      Barack Obama has certainly raised deceit to an art form beyond Machiavelli’s duplicity. That will be the essence of his legacy, IMO. And there may indeed be similarities with FDR in seizing pivotal fulcrums in socioeconomics to drive revolutionary change, even in tactics, but it’s important to note that the direction of such change could hardly be more opposite.

      1. Brooklin Bridge

        it’s important to note that the direction of such change could hardly be more opposite.

        Indeed. It is this antithesis that makes the comparison so grotesquely striking.

      2. Brooklin Bridge

        (sorry, didn’t complete comment before hitting Submit)

        it’s important to note that the direction of such change could hardly be more opposite.

        Indeed. It is this antithesis that makes the comparison so grotesquely striking, but the point is how central both figures were to the machinery as well as the unfolding events of history.

      3. Benjamin

        How much of it is masterful deceit though? What’s most striking is how people just refuse to see. It’s blatantly obvious he isn’t on their side, yet over and over and over and over they go out of their way to deny it and rationalize his obvious betrayals and failings.

  13. Bridget

    It’s a puzzlement. They just keep spinning and spinning, as though they are convinced that they only have to get through the next few days or weeks and the whole thing will magically straighten itself out. Can it possibly be that the magnitude of the pending Obamacare disaster has still not penetrated their skulls?

    I have often noted that Obama, when the SHTF, indignently says stuff like “I told them this”, or “I said that X is what needed to be done”. It’s always occured to me that, since he basically never ran so much as a lemonade stand, he really thinks that the world works by powerful people uttering their brilliant thoughts, and minions wave magic wands and it all unfolds just as he imagines it will.

    And then there’s the reputed Rasputin, Valerie Jarrett. Perhaps she’s making sure that nobody tells him that there are no magic wands and the whole thing is turning into an entirely predictable pile of poo.

  14. Brooklin Bridge

    Obama’s priorities are ultimately despotic. He wants power and fame. He is in the same back and forth struggle between the corporate world that despots of previous ages were in with organized religion and his efforts to bend health care towards further and more enhanced private exploitation with government assistance are simply a small part of that struggle. To us those interests seem exactly parallel; one supports the other until the citizenry that supports them both collapses like Dostoyevsky’s famous horse beaten to death by the rage of its master at its refusal (inability) to budge any further.

    But while corporate interests are ascendant, it would be a mistake to imagine that Obama is simply a willing and compliant worker-bee, much as it looks that way for the time being, any more than it would be safe to assume that there is no equal power struggle going on between government, corporate interests, and the military industrial complex.

  15. jfleni

    “The White House is a hostile workplace for women”: That’s certainly part of it, especially considering the hostility of jumped-up p***ks like Timmy, Larry, Rahm etc to the carefully considered, non-ego boosting opinions, of knowledgeable women.

    But really the blame is simpler: the whole US internet system, lock, stock, and barrel is a huge technical failure, constructed mostly of “free-enterprise” theology, driven by those many of the same kind, of jumped-up, preening, turkeys as before. How can it be a surprise that if profits and greed come first, performance comes last!

  16. Jay Goldfarb

    In the article on the Obamacare Rollout, the following appears: “…Obama’s remark that ‘[I'm] really good at killing people.’ ”. This is of course a very provocative statement, and, appropriately, a link was provided. Unfortunately, when I searched the linked article for the word “killing” I found that it only appeared once in a completely different context and not as a direct quote from Obama at all.

    We all know that people associated with propaganda organizations such as Fox News are apt to jump on such quotes, accurate or not. I think it is important to correct this or to provide a more relevant source.

    1. Jay Goldfarb

      Sorry, I clicked on the wrong link! (The hyperlink on the quote itself.) Please disregard my comment!

  17. Ed S.

    Lambert,
    Awesome recap (and color commentary). Eventually, the web site will work, but I think that then you get Year 2 of the debacle (from your recap):

    Second, the actuarial soundness of the pool; if the entire pool has a pre-existing condition, the insurance companies can’t profit. Unfortunately, the website debacle selects for the already ill, since only they have the incentive to sit through the days and the hours it takes to sign up

    Actuarially, the key is to get healthy people to subsidize sick people. Or, in O-care marketing terms, get the “young invincibles” to sign up. Not. Gonna. Happen. (Have these guys ever heard of the “conversion funnel” The BEST commercial sites typically have a conversion rate of under 10%).

    So in Year 2, the insurance companies look at their exposure and raise prices dramatically. And at that point, the death spiral begins in earnest.

    Finally (and this is not a defense of medical insurance companies) – why exactly would any expect an insurance company to provide “affordable” coverage? Insurance cost will be based on expected expenditures. Even if administrative cost, overhead, and profit was zero, why would we expect a company to provide a service that costs $10,000 for $5,000?

    Medicare for all is the only solution.

    1. scraping_by

      Thanks for reminding people how insurance works.

      Note, too, it’s often currently healthy people subsidizing currently sick people. The base purpose of medicine is to let people get back to their lives, and one assumes, contributing to the world. Including insurance.

      And nobody is bulletproof, so their time in need will most certainly arrive. While wiping out all assets is one option, another is to agree to help others and take help when needed.

      True, there are terminal cases and permanent disability and malingering and the math doesn’t always even up. But life’s uncertain, and that’s no support for dividing up into healthy vs unhealthy, givers vs takers, when we’re really all in the same risk pool.

      Avoiding divide and conquer: a full time job in current Amerikay.

  18. anon y'mouse

    the more things are brought to light about this issue (thanks, Lambert!) the more I am convinced that we should’ve just hired the people who run Amazon.com to make this website for us.

    aside from pluralistic ignorance and emperors without clothes, we have to consider that what is going on here is that these people are convinced that they are the smartest people in the room, and do not know what they do not know and are too concerned with saving face as Smart & Competent people to admit that. so every time something goes askew, more orders fire from on high to ‘attack that problem (surge)’ when the problem was that you had the wrong people in charge from the getgo. these types do, what exactly? bomb people and make wars and so on. they are classic “if all you have is a hammer” types.

    silly non-sequiter: last night, I finally watched the more recent Wizard of Oz film. aside from it being typical Disneydreck “all you need is hope and a comedic sidekick”, being totally miscast, having CGI that looked more fake than the original 1939 special effects and so on, I found the entire film to be a metaphor for America and Obama’s presidency. a flimflam man arrives in spectacular fashion to balm the wounds of a childlike public, and conquers evil through technological showmanship. the only problem is, Obama’s flashbang lazerlight show failed, and the witches were not convinced.

    1. DolleyMadison

      The problem with your analogy is that the Great and Powerful Oz was exposed to be a GOOD person, unlike his persona. In this case, the man behind the curtain is a sociopath intent on making damn sure none of us ever get to go home again.

    2. Jeremy Grimm

      I’m not sure Amazon could be the saviour for this software fiasco. The level of complexity inherent in ObamaCare seems several magnitude more complex than selling products the way that Amazon does. What I find more objectionable in this idea is the way it plays into the meme that businesses can do things better than government. I hope you don’t want to go in that direction. ObamaCare promises to be an unmittigated fiasco, not unlike the government’s many efforts to integrate the IRS database, or upgrade the FAA’s flight control programs.

      In my opinion, the problem with government large scale programming efforts arise from old fashioned hubris and giving too much freedom to the Managerial Demiurge which drives program micromanagement to a level where programmers spend as much time attending, adapting to and reporting in management reviews as they do at programming and test. for amusement — try reporting bad news at a weekly review of the project schedule and micro-milestones review. The problems telling the tippy-top that all is not well echo all through the organization.

      I’m don’t believe this is problem with government vs private industry software. Government only looks worse than private industry because it trys larger efforts than most private industry could or would fund. The Federal government and teams of private contractors put man on the moon. I know that reminder of past glory is growing old. It was an effort of our Federal Government and what remains of NASA continues to do things private idustry would not even attempt.

      1. anon y'mouse

        no, you’re right. I didn’t mean to give that impression (that corps are always better than gov. at reaching any goal attempted). also, I agree that obamacare is probably many more times as complicated as Amazon is (or was–they now integrate 3rd party sales as well. but it is still a retail model, I guess. would be more parallel if amazon had to assess the customer for viability –income, subsidy, citizenship, etc.– with each transaction). still, this problem DOES seem to arise when it comes to gov’t software quite often—they seem very willing to spend a ton of money on things that don’t work, will never work and were never going to work. then, they typically turn around and do it again! ((gee, it’s almost like they want to look incompetent in this realm in some ways. nah, too conspiratorial))

        surely, people in private software industry have much more to say to this issue than -I- do. I was just putting on my ‘business head’ cap and thinking that as an owner/manager, I wouldn’t want to be shoveling money into an ever-expanding pit with nothing to show for it.

  19. Matt

    I don’t know what they are going to do, but whatever is, it is going to be stupid.

    Quite an optimistic post. Granted Obama should be able to delegate. But if you do not delegate well, then you are planning for failure.

    The only thing between Obama and impeachment is that only those who need the subsidy need the federal exchange. The rest can buy it directly, well at least I could if I needed to.

    It will get worse when your income or residence changes and by golly you can’t get a new plan until next January 1, and there are no retroactive subsidies.

    1. JerseyJeffersonian

      Matt,

      You have raised an insidious issue; namely, one’s access to an insurance policy, and the terms of that policy, are widely variable depending upon where one lives within the nation. Instead of leveling the proverbial playing field for every citizen in the nation, the policies can be very, very different from one county and another, even within the same state, let alone from one state to another, depending upon a myriad of factors. The way that one’s access to policies, and the costs of those policies can change due to those factors, will likely tend to freeze many people in place both geographically, and economically, as the enhanced dangers and risks will weigh heavily on them, particularly when there are dependents involved. Will people hazard becoming entrepreneurs and becoming self-employed, or moving to try and improve their lot? I would venture that the answer to this is no, the numbers of those willing to take on these risks will be fewer even than now, at a consequent cost to the advancement of citizens economically, and a cost to the nation of the innovation and vitality that having this leaven in the society brings. Nowadays, many people have found it too risky to leave the confines of their corporate employment because the costs of private medical insurance coverage are too daunting, and the consequences of a health emergency for them and their families under plans they can afford keep them where they are.

      And now, many of the employers who used to provide medical insurance coverage are dumping their employees into the private market, bringing to life their worst fears, but without even the possibility of an improved situation. The employees individually lack the bargaining power that accrues with banding together in securing some leverage on coverage and rates. Will the employees get the money that their employer spent on their medical insurance and its administrative costs added to their pay? Don’t make me laugh. Bargaining power, zero. Rates, higher. Funds to afford the higher costs, the same (in actuality, an outright cut to pay, as some of their pay was already contributing toward insurance).

      Serfdom. Less social mobility. More fear associated with change. In the late Roman Empire, social roles became ossified by law; if your father was a baker, you were mandated to be a baker. In this legislation’s effects, much the same ossification happens, but without being upfront about it. Maybe you don’t have to do what your parents did, but you are more likely to need to remain in place in your class status. Corporations and capitalists are hyper-empowered, while most citizens are diminished.

        1. JerseyJeffersonian

          I think that you have the right of it in the Sociopath Hypothesis. They lead the parade, and cover is thereby granted to all of the other motivations of the merely greedy and self-serving.

          1. JTFaraday

            I’m not fond of the sociopathic personality hypothesis. I think the basic problem is that we live in a culture where the unifying cultural mythology–the American Dream!– glorifies ascent, and where it has been broadly acceptable to kick down.

            A dedicated squadron of Americans has been so committed to kicking down, that by now they have kicked the floor out from under themselves.

            At some point, where power is sufficiently concentrated amongst those who scrambled to the top of the pile, I suppose “sociopathic figures” begin to emerge, but I don’t see how you can extract these from the culture that produced them.

        2. Matt

          The effect of the ACA seems to be just increasing medical costs and medical cost bankruptcies. More and more bills will not be insured and then billed at the higher rates described.
          As 10 million individual policies are canceled and the subsidy program is so unworkable and devoid of reality fewer people will be insured than there are today.
          More and more people will play emergency room roulette. They will be one trip to the ER away from bankruptcy.
          Those that do buy higher insurance with higher deductibles and co-pays and 0 out of network coverage will be have even less discretionary income.

  20. ep3

    Yves, I still see this as a ploy to continue to destroy the credibility of gov’t programs. It is strange that the hannitys and limbaughs have only been bashing the failure of the site, and not the site failure as an example as a complete failure of all gov’t programs.
    Second, what are the odds that failure is a 2016 benefit? Say this continues to bring down democrat poll numbers. So in 2014 republicans win the congress. They immediately repeal certain parts of Obamacare (specifically the exchanges). This then creates new avenues for Hillary to campaign in 2016 to fight against changes imposed by the republicans. And these series of changes are all based upon improving profits for the insurance companies. Notice that nowhere in this debate has anyone (except the wonderful digby & yves) said to trash the exchanges for Medicare for all/single payer.

  21. Ziad Abdelnour

    What is wrong with Capitalism Today?

    There is not one single day that passes without I hear some of my Wall Street peers complain about the state of affairs of capitalism in America today and how different it has become compared to only a couple of decades ago

  22. lawnorder

    The “Big Volume” is definitely a lie. I logged on Oct 1st to register and my Illinois site had HTML errors that prevented anyone from completing the form. specifically, the 3 security questions were coded as drop down list AND free form text entry making it impossible to complete that part of the form (you can’t type on a dropdwn list, and you can’t complete a dropdwn list that has no entries). HTML was still broken 2 days later (it has since been fixed). THAT has nothing to do with volume.
    Besides HTML errors that would shame a 12 year old making his tumblr template for having, the site has glaring design errors. The fake site presented to the WH during the summer had it right: register people without checking their eligibility. High volume sites should NOT use all this validation on the entry form. That is back end stuff. First get everyone registered, then let them shop the marketplace and only close the deals if the person is eligible. To have that all be done at registering time makes the site sluggish and overly complex. And considering all that eligibility checking is not saved and passed forward to the marketplace process is a waste of time.
    This system was designed by someone who never dealt with any large volume process. It shows. And THAT can not be fixed now, so now the useless eligibility checking is here to stay and make the web site fixing a nightmare.

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