By Lambert Strether of Corrente.
Believe it or not, it’s only one hundred days until ObamaCare’s 2015 open enrollment period begins, so this is as good a time as any for 30,000-foot view of ObamaCare and governance. Barney Frank, with the seeming candor that so well becomes him, did just that in HuffPo the other day:
“The rollout was so bad, and I was appalled — I don’t understand how the president could have sat there and not been checking on that on a weekly basis,” Frank told HuffPost during a July interview. “But frankly, he should never have said as much as he did, that if you like your current health care plan, you can keep it. That wasn’t true. And you shouldn’t lie to people. And they just lied to people.”
And Frank is right about Obama’s lying, but in directing attention to Obama’s lies Frank distracts us from a larger concern: The apparent impunity for organizational dysfunction and misconduct during the rollout. This latter is far more serious; we expect, even enjoy, a certain amount of lying from elected officials; but we don’t expect a broad spectrum of executive misbehavior, from routine rules violations to epic and bizarre levels of incompetence, to come to light with nobody held to account. British politicians resign in disgrace; Japanese gangsters lose a finger or two; and in America, generals resign after boinking their biographers, but if you’re in America’s executive branch — at least under Obama — you’ve got it made. You’ve got impunity, just as surely as if you lived in a country run by generals wearing sunglasses. Katherine Sibelius, for example, was allowed to go quietly after Obama was elected. They don’t even care enough any more to find scapegoats!
Rather than rehearse the debacle of the ObamaCare rollout once again, I’d like to present one image:
For those who came in late, yes, this is a “punch card,” the storage medium in 1966, when the Social Security Administration rolled out Medicare on July 1, after less than one year’s implementation. (Yes, back then data was actually saved, not on hard drives or flash storage or USB sticks or even in The Cloud, but on thin sheets of card stock with holes punched in for the bits and bytes. It’s like steam punk! For those interested in a time when government actually could be expected to function, not least by those themselves in government, see here on Frances Perkins.)
So here’s how the Medicare rollout went, back in the day when mammoth-slaying programmers used crude stone tools:
Back in 1966, Medicare started paying bills for 18.9 million seniors ( for coverage) just after Pres. Johnson signed it into law. … Despite predictions of chaos, and worries that the newly-insured seniors would flood the health care system, there were . Hospitals continued to operate smoothly and no waiting lists materialized.
The contrast to the ObamaCare rollout couldn’t be greater. If you take the 1966 Medicare rollout as the standard, the ObamaCare rollout isn’t even in the ballpark. Heck, it’s not even on the road to the ballpark! And has anyone been held to account for that? For the difference between a roaring success and a ginormous failure? Any firings? Any resignations? Even to spend more time with the family? Any heads rolling? Is the feckless indifference (“What we’re also discovering is that insurance is complicated to buy”) of Obama’s presser on the “rough rollout” really enough? Apparently so. I feel like I’m living in Alice in Wonderland, that’s so crazy pants, but yes, it’s apparently so.
Anyhow, having not been distracted by Barney’s focus on Obama’s lying, I’d like to focus on four continuing
running sores aspects of ObamaCare. The first three concern apparent impunity for past failings; the fourth, impunity for future ones. They are:
- Back End Fails on Data
- Back End Fails for Insurers
- Contract Violations
- The Expectations Game
Back End Fails on Data
Here’s what the back end does (the HHS jargon for the back end is the “data hub”). From the recent GAO report, “Ineffective Planning and Oversight Practices Underscore the Need for Improved Contract Management”:
The data hub routes and information among the [Federal Marketplace] and external data sources, including other federal and state sources of information and issuers. For example, the data hub confirms an applicant’s Social Security number with the Social Security Administration and connects to the Department of Homeland Security to assess the applicant’s citizenship or immigration status.
In other words, it’s the back end’s job to make sure that data submitted by the “consumer” is consistent with the data available electronically from other sources, like the Federal government and the states. From a report by the Inspector General of HHS:
A marketplace uses the Data Hub to that the applicant’s information is consistent with Federal data sources, such as tax filings and Social Security data.
if when the back end stores data that is inconsistent, we are in Garbage In, Garbage Out mode: The impact for the “consumer” could range from a bad mailing address to not getting expected coverage at the hospital. It’s not even clear how the “consumer” finds out their data is bad, or how they correct it. An example for Florida:
[Luis Martinez of Hialeah], who has stents implanted in his coronary arteries, said he has tried repeatedly for more than a month to comply with the government’s requests for additional documentation to resolve inconsistencies in his personal information — or risk losing his $457 monthly subsidy, and health insurance for him and his wife, Rocio Balbin, 46.
Martinez has receipts showing that he mailed at least five identical packages — containing, he said, copies of his U.S. passport, his wife’s residency card, their 2013 income tax statement and his Florida driver license — by certified mail to the HHS-designated address in London, Kentucky.
Why the inconsistencies that people like Martinez suffered? Problems in the back end:
Attempts to verify an applicant’s information were often stymied, she said, by early problems accessing the so-called Data Hub, an electronic information clearinghouse that connects multiple government agencies, including the Internal Revenue Service, the Department of Homeland Security, the Department of Labor and the Social Security Administration.
So is the back end producing and verifying consistent data yet? It’s not clear:
The insurance exchanges use the Data Hub to verify a consumer’s information against federal records, such as tax filings and Social Security data. However, which would expedite the process, or manually, which would take much longer.
Well, the back end (“data hub”) is electronic, so if they’re doing manual verification, they’re not using the data hub, right? So incredible as it may seem, the back end could still be broken. How big is the problem? Here’s what HHS says:
1.2 million consumers had inconsistencies in their income information. About 461,000 consumers needed to verify citizenship, and about 505,000 were asked to prove their immigration status.
(The HHS Inspector General’s report has many other examples that will curl your hair if you’re a data person.) Sibelius said the back end was “built and paid for” back in April 2013, if she wasn’t lying, the Feds paid for a broken system. That’s a lot of “consumers” to clean up, especially since there are only 100 days ’til a new wave of enrollments. And if the back end still isn’t fixed, 100 days is not very much time to complete the work and do the testing. Heads should roll for this. Are they?
Back End Fails For Insurers
Back in October 2013, we wrote that if the backend failures were intermittent, they would be very hard to solve. In December 2013, we noted that the tech wizards Obama called in to fix healthcare.gov had not fixed the backend, even though that was their number one priority. And when Stephen Brill wrote his hagiography in Time about the tech dude “trauma team” that fixed healthcare.gov he never mentioned that they focused solely on the “consumer-facing” front end, and never mentioned the back end at all. Of course, nobody was held accountable for the backend debacle, any more than anybody was held accountable for anything, and the back end still hasn’t been fixed. Politico:
While an all hands’ “tech surge” repair project got HealthCare.gov working for consumers by December, not all the problems are solved. The automated back-end systems that insurers need to help balance their books and get paid properly are being rolled out in phases. It won’t be finished until sometime next year.
[Andy Slavitt, once of UnitedHealth, now at CMS] also acknowledged that the site’s back end, the portion that insurers rely on, is still not complete. Health plans are being paid, but based on enrollment estimates. Completing the business end will go into next year, he said.
Paying insurers on the basis of guesstimates, and settling up later–What could go wrong? This, again, is the back end Sibelius said was “built and paid for.” Heads should roll for this, too. Seen any?
The contract violations are a lot simpler. The Times reports:
In an effort to meet the October deadline, [William T. Woods, a senior official at the Government Accountability Office] said, “changes were being made in contract requirements at the direction of people who did not have the authority to do that.”
Moreover, he said, federal health officials ordered contractors to perform additional work, at additional cost to the government, without the knowledge of the contracting officer, the only person who was authorized to change the terms of contracts for the federal exchange.
So, these “people” and these “officials”: If statutes, rules, and regulations for Federal contracts mean anything, their heads should be rolling, too. What are the odds, I wonder?
The Expectations Game
The new word seems to be “bumps.” Let’s watch for it! From a report by Kaiser Health News on the House hearing focused on the GAO’s report, Melissa Attias comments on Andy Slavitt’s testimony:
[ATTIAS:] By bumps, he’s saying there are things in place to make the process smoother but that it won’t be perfect. For example, he said, it’s now very clear who can give work to the contractor and how that work gets approved, which was an issue identified in the report. He also said the new contractor has skin in the game to make sure it delivers.
Oh, OK. Let me know how that works out, Andy. Any heads rolling at an agency that didn’t make it “very clear who can give work to the contractor and how that work gets approved”? No?
We’ve identified four major failures for which nobody in government has been held responsible.
1) There are millions of inconsistencies in ObamaCare’s data, it’s not clear how the data can be rectified, and it’s not even clear that the systems that produced the inconsistent data are on track to being fixed by the time ObamaCare enrollment opens again, in just 100 days. The back end system that is producing these outcomes was pronounced to be “built and paid for” by HHS Secretary Sebelius in April, 2013. No heads rolled.
2) The insurance companies are being paid on based on estimates, and that will continue for some unknown length of time, at which point (presumably) the books will be cleaned up. Again, the back end system that is producing these outcomes was pronounced to be “built and paid for” by HHS Secretary Sebelius in April, 2013. No heads rolled.
3) There are many contracting violations in the course of building the Federal Marketplace, and its back end. No heads rolled.
4) The new CMS head, Andy Slavitt, is playing the expectations game on the coming enrollment cycle, presumably to ensure that no heads roll in future.
#FAIL, #FAIL, #FAIL, #FAIL, and no heads rolling.
I don’t know what you call that but impunity.
 Unless you’re a whistleblower, in which case Obama will come after you with everything he’s got.
“we expect, even enjoy, a certain amount of lying from elected officials; but we don’t expect a broad spectrum of executive misbehavior, from routine rules violations to epic and bizarre levels of incompetence, to come to light with nobody held to account.”
In links today re Bank of America: “It’s very important that no executive ever do time for accounting control fraud because confidence.”
So that’s (private) banksters, and obama care is government…but it’s getting (getting?) awfully fuzzy between “our” government and the corporations they represent.
Obamacare was written by and for the insurance corps, big pharma, medical industry. (just like dodd-frank written (or un-written) by wall street and the corporate farm bill, energy policy the same, etc).
So I think american’s are rather getting quite used to our revolving-door public servants working competently or not to further the corporate agenda.
And epic incompetence re Obamacare…well, private corporations to the rescue (Google, Oracle…).
 Unless you’re a whistleblower, in which case Obama will come after you with everything he’s got.”
Lambert, thanks for a morning chuckle.
in his comfortable shoes, no less.
I got a policy, and decided to cancel it. I was unable to–first Healthcare.gov said it was cancelled, then they said that they had apparently screwed up the cancellation, and there was no way to cancel it because they could not find my application because it had been deleted. On subsequent phone calls they said there was no provision for people what had unsuccesfully tried to cancel through Healthcare.Gov, and I would have to wait until one was put in place, in order to cancel my policy. My insurance company said they couldn’t cancel it without Healthcare.gov’s permission, They advised me not to pay the premiums. After 4 months, the policy was cancelled due to nonpayment of premiums, Then the insurance company said in writing that it had been retroactively cancelled a week after I applied for it. I don’t know of this was a back end problem or not, but I do know they couldn’t find a record of my application using SSN, my name, address, etc. The whole experience just left me with an impression of appalling disorganization.
“they couldn’t find” their a$$ with both hand$.
PNHP’s Don McCanne writes, “The experience of Salwa Shabazz should enrage us and drive us to demand health care justice for all.”
“Last week, Salwa Shabazz arrived at the office of a public health network here with a bag full of paperwork about her new health insurance — and an unhappy look on her face. She had chosen her plan by phone in March, speaking to a customer service representative at the federal insurance marketplace. Now she had problems and questions, so many questions.
“I’ve had one doctor appointment since I got this insurance, and I had to pay $60,” Ms. Shabazz told Daniel Flynn, a counselor with the health network, the Health Federation of Philadelphia. “I don’t have $60.”
Mr. Flynn spent almost two hours going over her Independence Blue Cross plan, which he explained had a “very complicated” network that grouped doctors and hospitals into three tiers. Ms. Shabazz, who has epilepsy, had not understood when she chose the plan that her doctors were in the most expensive tier.
“None of that was explained when I signed up,” she said. “This is the first I’m hearing it.”
Independence Blue Cross has focused on making sure people understand the tiered-network plan that Ms. Shabazz chose, which was popular because of its relatively low price but also particularly hard to understand. Ms. Shabazz, 38, paid only about $32 a month in premiums, with federal subsidies of $218 covering the rest. But she could not afford the $60 co-payments to see her specialists on her annual income of $19,000.
Her financial situation worsened when she had to quit her job at the Pennsylvania Liquor Control Board in June because of the epilepsy, she said. She had called the federal marketplace to report her change in income, and had received a letter that she handed to Mr. Flynn, hoping he could explain it. The news, he said, was not good: With no more paychecks, she had fallen into the so-called coverage gap, earning too little to keep qualifying for the subsidies that made her premiums affordable, but likely still not qualifying for Medicaid because Pennsylvania has not expanded that program, as 26 states have under the Affordable Care Act.
“You’ll probably have to cancel your plan,” he said.
Ms. Shabazz’s mother, Waheedah Shabazz-El, who had accompanied her to the appointment, shook her head as her daughter wiped away tears. “There are so many layers to this,” Ms. Shabazz-El said.”
Whose heads will roll?
Where are the Hans Littens of today?
Hi DakotabornKansan, thanks for the interesting historical reference.
The smart people say the ACA is a resounding success. How can they be wrong (sarc)
Big thoughts by a guy who has a big brain (sarc)
Krugman if I recall used to make fun of Washington’s “very serious people” (maybe still does), those who used misinformation, ignored facts, etc (mostly big bad republicans) to advance odious agendas like Fix the Debt.” Yet he’s really one of them, just advancing his own kind of Brand Democrat agenda. Obamacare, and the TPP is another.
And of course he has quite a faithful, adoring flock of NPR-style Liberal/Democrat fans who believe he is the god of the most truly serious of people, along with smart and brave and mavericky, taking on the beltway nonsense, etc.
Krugman has turned into a sycophantic hack where Obama, and particularly Obamacare, are concenred. Just as laughable is Dean Baker who really thinks that people are quitting their jobs because they can pay $5-6/year (plus $2-6K/yr in deductibles and 20-40% co-insurance) for a craptastic, don’t-get-sick Obamacare policy.
If my recollection from a few months ago is correct (of course, His Excellency might have changed it all by executive ukase last Friday night), Obamacare premiums for 2015 are to be announced a week after the midterm elections, on Nov. 15th.
Are they expecting bad news? You’d think that with a staggering $150 billion a year in federal subsidies, not only would Obamacare coverage be free, but also they’d provide a chauffeured limousine to whisk consumers to their medical appointments in leather-upholstered comfort.
Nevertheless, as with college tuition, the ‘user pays’ principle mandates that Obamacare premiums must go up, enough to hurt, no matter how amazingly large are the subsidies. No pain, no gain!
I thought I heard something on the propaganda nooz about insurance premiums on the CA exchanges being predicted to go up something like 15% this year. A lot of psycho-babble about why this is so & how the rabble should bow, scrape, tug forelocks and generally suck it up & STFU.
Those who vote “R” will blame it all on that dastardly Muslim, Obama. Those that vote “D” will find some way of blaming it all on mean-bully “Republicans.” And the 1% will laugh their *sses off all the way to their off-shore account$. Can we say: CHA CHING!!??!!
This is the only thing I am interested in for mid-terms (other than voting out any incumbent on the ballot).
I think we will see less than a 50 percent turnout, and less than 2 percent vote outside of the two tribal choices. Yet they want to bitch, and get mad when you ask they why they keep voting the same schmucks back in. The definition of insanity is what again? Unbelievable.
What troubles me most about ObamaCare is that it shifts more and more money and power away from doctors and nurses toiling away on the front lines of care and gives to it to the overpaid, over-pampered suits manipulating the knobs and levers behind the curtains. That’s because ObamaCare adds financial as well as bureaucratic complexity to our healthcare system. If the architects and designers of ObamaCare wanted to create a better and more affordable healthcare system for our country as a whole, they should have made it their top priority to fix a healthcare system that’s overly burdened by financial and bureaucratic complexity. But no, they did nothing of the sort. In fact, they did the exact opposite.
In the end, healthcare costs will continue to grow unchecked and out of control as patient care deteriorates even further. What ObamaCare has done is create a healthcare system that places a whole lot more value and importance on capital and management than it does on labor and the primary recipients of labor, that is the patients.
The “apparent impunity for organizational dysfunction and misconduct” which Lambert eloquently describes is a plague that has infected pretty much every recent federal government program or military campaign. Military historian Thomas Ricks wrote an article called “General Misconduct” in which he notes that NONE of the generals who performed so incompetently in Iraq or Afghanistan have been fired or demoted. He contrasts WWII, when Marshall and Eisenhower fired or demoted literally dozens of inferior officers or commanders – no “impunity” back then! As Lambert says of the comparison between the Medicare and ACA rollouts, the contrast could not be greater. Given that they still haven’t “fixed” Iraq or Afghanistan, will they ever be able to “fix” the ACA?
‘NONE of the generals who performed so incompetently in Iraq or Afghanistan have been fired or demoted.’
Don’t even mention 9/11, when their own headquarters had a little fire on the lawn.
You call that a failure? If you compare the damage from the towers, where the jihad fueled fires reached nearly twice the temperature of jet fuel or anything else that would legitimately be in a skyscraper leading to a complete collapse of physics, to the Pentagon, where the they so deftly maneuvered the building to take the hit in an unoccupied area, had designed it well enough for titanium engines to just bounce off the walls leaving no impact marks, and a fire suppression system that prevented stacks of paper at the edge of the destruction from even being singed, I’d say they did a remarkable job. Or were you lamenting the failure to use their AA defenses under “obviously” emergency conditions?
Thanks for this update on craptastic ObamaCare, which if anyone chose to pay the slightest bit of attention, it was obvious from the get-go that it was mess of plan dreamed up in the back rooms of the rightwing Heritage Foundation with final hammering out behind closed doors with the Fat Cats in BigIns, BigPharma, BigMedDevice, BigHosp, etc.
Why “D” voters choose to go along with this nonsense is beyond me, and I’ve stopped even trying to figure it out. I assume that the propaganda brainwashing has done it’s trick, plus my take is that USians are not only teh stoopit it burnz, but they are lazy know-nothings who simply don’t want to pay attention to anything.
When O took Kucinich on frickin AirForce One to, uh, “convince” him to support ACA, I knew beyond a shadow of a doubt that the Fix was in, and we were well & truly screwed. I don’t know if they hung poor Dennis out of the plane by his feet to make him come to the dark side, but something bad happened in that plane. It’s been downhill since then.
Here’s the Q to ponder: WHY *should* O be “paying attention” and making sure that Obamacare rolled out well and, you know, sort of “worked”??? WHY bother? USians are now braindead tools, eagerly lining up for their latest dose of propaganda b.s. Rightwingers are titillated by the usual suspects about Benghazi!!!111!!! and TanMan’s idiotic “law suit.” So-called “leftwingers” are riled up about how intransigent the “R” Team is, so that they dutifully circle the wagons around their Sainted Savior Ronald Reagan with a good a tan.
Again: WHY bother to do bupkes when the authoritarian rubes’ll toe the line & clap ‘n cheer for THEIR TEAM uber alles.
My “D” friends are shocked! Shocked! I tell you that I have very loudly announced that I will never ever vote for Hillary the Inevitable. I mean, really, they simply cannot believe my perfidy. And they make excuses the live long day about Obamacare bc their Hero, Obama, is “such a nice man and has a lovely family.”
Maybe it’s time to stop throwing brickbats at the players and start pitching Team Players out of the stands.
Pontius ‘Obama’ Pilate feels ACA failings are not on him. He feels this way because the program was handled — from design to launch — by others, not him personally.
This statement —
“….changes were being made in contract requirements at the direction of people who did not have the authority to do that.” Is against the law! Only contracting officer can make the request. People down the food chain cannot do so directly. I know this one from experience. Depending on scope, DoJ can be called upon to investigate and they will.
You can count that as number 5!
If the goal is to transfer public money to connected private parties under the smoke screen of “see, it works!” without having to actually do the hard work to make it work, then mission accomplished.
Success is relative. If one looks at this (cynically) from the perspective of those who benefit from the contracts and the data, then this program IS a resounding success.
wish this site had a “like” button. Very astute.
Bullseye! In Massachusetts we breathlessly await the outcome of current efforts to simultaneously set up new software ($121M and counting) for a state exchange AND prepare to throw up, er, in with the federal exchange just in case plan A isn’t ready for 11/15/14. Either way “those who benefit from the contracts” Win.
Lambert, thanks for the update.
I’ve come to the realization that the US will never do anything big right or well in the near term, again. Though some knew it and many felt it before but were hoping it wasn’t the case, the (inept and obscenely expensive) rollout of Obamacare has confirmed to the public that our officials lie. The yawn that all this lying elicits, while frustrating to NC readers/ bloggers / commentors, occurs for a very logical reason.
We largely don’t care about any of the large scale scandals and cover up lies because our jobs depend upon continuing or accelerating the status quo – imagine if the military industrial complex, the medical industrial complex and the educational industrial complex were all well managed and produced results that didn’t require additional fixing? What would happen to the jobs of the those who are brought in to clean up the mess? What would happen to all of the jobs that were no longer needed because all of the waste, fraud and abuse in all of these systems was eliminated? What would happen to all of the jobs of those who are tasked with perpetuating the scam? A massive block of our citizenry would lose their jobs – not a good thing for a peaceful society.
It was said of the former USSR, “we pretend to work, and they pretend to pay us”. The same thing has happened in the US, except for the past 20 or so years, we all thought we were actually working. We thought that we were being paid with real money and that the debt would eventually work itself out. Only now do we see that we are active participants in a make work society. For those who work in low wage jobs, they really do pretend to get paid by their employer – without goverment assistance, they would be abjectly poor and likely (for good reason) refuse to work at all. Those of us who depend on private goverment contractors are as dependent upon goverment largess as the person recieving public assistance. We work we get paid but know that our job would not exist but for goverment programs.
At the end of the day, the bigger the project, the bigger the mess, the bigger the war, the bigger the security threat, the bigger the system – the more people to employ. Our President knows this – as do all other politicians. They will argue over the details but the ultimate goal is low unemployment – holding anyone accountable for failures risks success – a troubling outcome for our political class. The failure of the Obamacare rollout most likely was, as often written here, a feature not a bug.
“At the end of the day, the bigger the project, the bigger the mess, the bigger the war, the bigger the security threat, the bigger the system – the more people to employ.”
Actually, you could just shorten this to “The bigger the government, the bigger the mess.” It’s the logical consequence of a monopoly power having no possible competitor and a license to kill — inevitably drawing psychopaths to itself like fruit-flies to rotting bananas.
What the US House of Representatives preparing to sue the president is just chopped meat? They are holding him accountable, they are preparing to authorize legal action for his despotic whims over the employee mandate in the ACA. First there is a mandate then there is not a mandate, then there is! It’s like a Donovan song.
If you can’t tell the difference between accountability and accountability theater, why are you here?
Because all of the world is a stage all and of us actors. Our identities, each and all are social fictions, constructed of this particular time and this particular place interacting with our genotype. I am here because it pleases me and I can learn something. The question is, do YOU know what accountability is? And who writes the script for these theater productions? And is theater a more potent political opposition technique than you charge, something of inconsequential behavior? The last law lawsuit against the ACA resulted in the majority of states able to opt out of Medicaid expansion. Another one is shutting down access to abortions. That includes my state of PA. Thanks to that little theater, hundreds of thousands have no insurance at all. Billions of dollars are denied many local rural hospitals. That’s lot of widespread results, intended and unintended for lawsuit as theater. Who knows what the results may be? What would Abe Lincoln say about theater?
If I am a politician, especially a Democrat president, then “accountability” means I get to face the TV cameras and read a teleprompt that says “I take full responsibility” for something for which I will never make restitution; nor will I suffer any other consequence or further humiliation.
To Be Fair: Obamacare is so complex and so badly written (remember those 1000 pages – written by a lobbyist?) that it probably couldn’t be administered. Oregon failed radically, with a governor who was totally behind it.
That said, Lambert’s point remains valid: there’s a long history of Obama administration incompetence and impunity. This stuff actually goes back to Clinton, who was famously a details guy but still usually failed to hold anybody accountable – suggesting that he was happy with their performance.
Maybe Obama is, too.
Scalia famously remarked that being forced to read the entire law was cruel and unusual punishment. Large law is a common trait of bad law, and this strange legislation will prove to be no exception.
I’m relatively young and healthy, so I’m thankful that have the option of remaining uninsured. But I have hope that at least a few very sick folks who genuinely need it will get help from Obamacare, at least in the short run. As for a more long term solution for those who desire healthcare, abandoning the US might be the best option.
Nobody said fascism was going to be pretty.
I was around for the first Medicare rollout (My mom was an Ops. Supervisor for a district SS office, and they were handing Medicare). My first intro to a teletype, which lead me into data processing. In all fairness, you cannot compare the Medicare rollout to the Obamacare rollout (and I’m NO APOLOGIST for the Obama administration).
If you weren’t around (and inside), which I was, it’s hard to realize how ‘simple’ Medicare was when first implemented. There wasn’t all this DB validation, all paper processing was done on paper and sent to Baltimore where HEW (Social Security) had two huge buildings, and they literally pushed racks of tapes back and forth across the street as ‘data transfer’. The joke was about the fact that Social Security could be brought to a halt forever if some clowns hijacked a couple sets of racks of data tapes. It was simple – became complex over time, but the primary consideration for eligibility was AGE. You had to be 65. SIMPLE.
So, in all fairness, Medicare was a far simple, easier to implement solution. Not like this unbelievable operating nightmare these WH political clowns conjured up.
Secondly, the (a) back end databases, and (b) the data validity issues. Personally, I think it’s hopeless. A lot of these types of errors are contaminating the databases, which means you basically need a horde of DBA’s wandering around through an undocumented system, trying to correct db ‘exceptions’. Everybody assumes it’s wrong data, but most of the time it’s going to fall into 3 categories – either missing, incomplete, or incorrectly formatted. It could easily be as simple as invalid date formats (‘mmddyyyy’ vrs. “mm/dd/yy’ vrs. “mmddyy” [how many Y2K date problems for true legacy systems; i.e. YY date format got solved by ‘IF “yy” greater than ’20’ and less than ’99’ then format ‘xx’ = “19” else ‘xx’ = “20”] – remember those little jewels.
They are supposed to be interfacing with at least 8 different (other) systems, working in all sorts of platforms and software development applications, and not only are the original developers long gone, many of their successors are also long gone. When they say it’s going to be up and running next year, good luck with that. I’ll believe it when I see it.
Those are just a tiny sampling of the types of problems they are having to work through. And being reliable 90% of the time is a receipt for overall system failure.
The persons a who should justly lose their positions over this are not the hapless functionaries–there are so many–who failed to execute the impossible task of administering this absurd law, but the preposterous megalomaniacs who decreed it.