Why getting the Obamacare exchanges to work was difficult

http://www.washingtonpost.com/blogs/the-switch/wp/2013/10/04/heres-why-getting-the-obamacare-exchanges-to-work-was-so-difficult/

by RougeFemme • 13 years ago

49 37 13 years ago

washingtonpost.com

shuzchen• 13 years ago

I'd have to say some of that is likely incompetence on the people in charge of developing the exchange. In Hawaii (hawaiihealthconnector.com) the whole extent of the online marketplace is a web form where you have to give up the SSNs of your entire family just to have someone call you later with quotes. Not exactly what I think of when I think of an online marketplace.

There are many problems with the form too (e.g., can't sign up if your family has more than 4 people). To make matters worse, the form is down for maintenance. Apparently they couldn't figure out how to scale a single form.

It's hard being a supporter of Obamacare when the execution is being done so badly.

pbreit• 13 years ago

This account makes me want to become a republican.

seanmcdirmid• 13 years ago

Romney really messed up royally on his IT during the election. It would have probably been much worse under him.

briandear• 13 years ago

Considering Romney's success in actually managing businesses as well as public-private partnerships with the Olympics judging his abilities in this context based on campaigning IT isn't really a relevant comparison. Let's look at the Bain Capital and Olympics track record as a better metric. Also given that the cost of just the California system was almost half of Romney's entire campaign budget, we're comparing apples to oranges. Part of Obama's campaign successes were due to volunteer engagement not necessarily because he was better at managing IT. Also campaign IT is light years different than healthcare IT. Given the administrative behemoth, it isn't IT leadership that's needed at the top but administrative competence. I'm not knocking Obama, I'm just challenging the assumption that "Romney would be worse because his campaign technology had some issues.."

bowlofpetunias• 13 years ago

That's extremely hypocritical since a public healthcare system could have been much more simple and wouldn't even need these sites if it didn't had jump through hoops to route around right-wing American ideologies.

You're a citizen, hence you're insured and you pay your premium through your taxes. Period. It doesn't have to be any more complicated than that.

Granted, most Western countries these days also have very convoluted systems due to ideologically driven shifts to privatization (few if any of which have made healthcare any cheaper or more efficient btw). But most of them are not as convoluted as Obamacare, and all of them have been the result of evolutionary change, not a big bang attempt to catch up with decades of Western civilization.

lifeisstillgood• 13 years ago

As a Brit, who quite understands the failings of Government IT (#) I still think it must be an awful lot simpler just to ask "Are you an American? Yes - then get cover"

really guys, we all know technology cannot fix foolish requirements.

(#) www.oss4gov.org

cantbecool• 13 years ago

Is there any states so far where the rollout was seemless? I work in the public benefit industry as a developer and all I have hearing are nightmare accounts.

mikestew• 13 years ago

Maybe it's difficult to scale and there were some hard deadlines, but there was some shear incompetence, too. As evidence I present WA's system that is storing passwords in plain text, has off-by-one errors, and reveals system details when you encounter an error. That's what I found by creating an account and trying to log in (which I still can't do). Who knows what I'd find if I were trying.

kjackson2012• 13 years ago

Isn't it strange that one arm of the government, ie the NSA, can get PRISM and all their extremely complex surveillance and correlation programs up and running but these much simpler and more straightforward web sites are generally failures? If anything it speaks to the quality of work that Palantir does, and the government should get them to do all the work as opposed to IBM Global Services or Accenture. Imagine if IBM or Accenture developed PRISM? We would have nothing to worry about then since it would be a complete failures.

brazzy• 13 years ago

Or maybe it's because you simply never hear about failures and shortcomings of such top secret systems. I am in fact quite sure that PRISM had its share of delays, annoying bugs and performance problems.

fnordfnordfnord• 13 years ago

How many failed projects do you think the NSA has suffered? The NSA aren't immune to reality (even though they are well insulated from it). As for why you don't hear about the failures, we know of at least one very big IT disaster project called Trailblazer. Thomas Drake, a former NSA executive blew the whistle on this particular project, and was rewarded for that favor with Espionage charges.

njharman• 13 years ago

What were the costs and schedules of PRISM. Did it and other NSA projects run over budget? Over schedule? Did they have any deployment or scaling issues? How about usability, efficacy and support?

I would argue that collecting and data mining all the worlds data is an easier problem than integrating (U.S.) healthcare systems.

Finally, the NSA projects have suffered a most spectacular project management failure. They were revealed.

andrewla• 13 years ago

Palantir is not involved in the NSA's PRISM program in any way, http://www.siliconbeat.com/2013/06/10/palantir-prism-program....

krapp• 13 years ago

For all we know the PRISM interface is a horrid buggy mess itself. It's not public though.

ianstallings2• 13 years ago

The CA website costs $313M: http://www.latimes.com/health/healthcare/la-fi-obamacare-cal...

Did they have to build a new data center? Hire specially trained astronauts to run it from it's location on the moon? Sitting in special chairs made from exotic materials they reverse engineered from UFOs? I mean JFC where did that money go? It makes the dotcom days look like an era of fiscal responsibility.

cjdavis• 13 years ago

See the previous discussions, here's one: https://news.ycombinator.com/item?id=6492127

It wasn't simply the website - it's the entire exchange including call centers, advertising, etc.

ianstallings2• 13 years ago

Ah, yeah. That makes sense. I can't imagine the call center for that program. Probably looks something like mission control or a war room. Then all the surrounding stuff. When you throw in facilities plus all that surrounds the program it makes sense.

gcb1• 13 years ago

its is always dot com days in the world of government contracting.

DanielBMarkham• 13 years ago

"...Even though in this type of setting the development teams are using what you might call agile methods, there's still a huge layer of requirements and review and sign-off..."

Aieeee! Brain explosion.

If there's a huge layer of requirements, review, and sign-off, to the point that it's impacting value creation, then they're not using agile methods.

Agile doesn't have a unique, firm definition. Best I can come up with is "best practices around iterative and incremental development"

There's no best practice I know of that requires spending tens of billions in new IT infrastructure to service 350 million Americans with some fairly simple data needs. Sure, they may be using _some_ agile methods, like having nice chairs that have those cool ergonomic options, but they're missed the forest for the trees. Reminds me of the old joke "Aside from that, Mrs. Lincoln, how'd you like the play?"

I found the article most uninformative. Nice example: "...These projects so big is that there is a very rigorous security oversight involved and layers of audit, layers of rules. The kind of thing that small start-up companies who are just winging it [don't deal with]..."

No, lots of startups deal with high-security situations. These are known problems and have hundreds of existing players with known solutions. The real issue here is the way the environment for the work was structured, not the nature of the work itself. Such comments are misleading at best, duplicitous at worst.

The problem here is that this is a reporter talking to some industry schmuck all too willing to make apologies for "that's just how things are" instead of actually answering the questions. Since the reporter doesn't know any better, there's no context or follow-up.

My money says the reason there were problems is directly related to a large political system dividing up the spoils of new work and insulating itself from being blamed for any disasters. Since lots of folks made money, and nobody in particular is to blame for any of the issues, looks like the system performed as it should.

The real lesson here for startups -- and it is an important one -- is that you can't use people to solve problems that are so far inside the existing system as to have created lots of excuses and barriers for why things have to be done a certain way. Identifying risk is fine, giving up and saying that there's no other way to accomplish things is not.

The larger problem here is using reporters and MSM outlets to analyze how large groups of people perform complex tasks in nuanced environments. Most of the time they're the wrong tool for the job. They're great for telling stories, how one person perceives the way things are, but not so much at analysis. Most of the time what passes for analysis is simply an assemblage of stories, either on deep background or assembled piecemeal from phone interviews.

hdctambien• 13 years ago

Did anyone expect a bunch of "lowest bidder" contracting firms to build something for someone else that works perfectly on day one when companies like Blizzard[1], EA[2], and SquareEnix[3] don't get it right when they are building something for themselves.

Especially considering how the lowest bidder has worked so well in the past[4].

[1] http://www.pcmag.com/article2/0,2817,2404481,00.asp [2] http://arstechnica.com/gaming/2013/03/clogged-streets-simcit... [3] http://gamerant.com/final-fantasy-14-launch-issues-servers-s... [4] http://www.boston.com/news/specials/big_dig_problems/

coldcode• 13 years ago

And yet the static part of the site, written in Jekll, is available on github, has barely any issues at all. Of course it's easier to write read-only static systems but I have rarely ever seen big enterprisey consulting firms get anything right.

DennisP4• 13 years ago

I haven't been able to get into healthcare.gov yet, but you start with a button labeled "apply." Did they not expect anyone to just curiously browse?

Because for browsing, it doesn't seem to be much data. My state has about a dozen regions, and the only other variables are age and smoking status. You could do the whole thing with a static site, using a little javascript at the beginning to direct to the right folder.

You could handle huge traffic with a few nginx servers. Put it on AWS with Cloudfront and you're not even hitting the servers for a lot of requests.

Then send people to a database-backed webapp when they're actually signing up.

mkr-hn5• 13 years ago

You sound like you know all the legal, technical, and regulatory issues they faced in designing the system.

jrockway2• 13 years ago

I doubt there is a legal issue that would prevent the site from being statically served with ngnix.

DennisP4• 13 years ago

Prices and coverage of these plans is public information. For anything involving personal data they'd do the same thing they do now.

You'd want to adjust prices to account for subsidy but that's a simple function and you could do it clientside with javascript.

jessaustin• 13 years ago

...some of your larger companies, your Twitters, your Googles, your Amazons, these are things they do to be able to scale up, scale down their servers as needed to handle the traffic. I'm not exactly sure what's in place in terms of the federal government infrastructure...

If only Amazon provided some sort of "Web" services, or Google offered some sort of application "Engine". Imagine, if new projects could rent computing resources from these companies, and make use of their scaling expertise?

(Actually, AWS is the default for federal contracts now.)

Misterburns• 13 years ago

I used to work in government IT. A lot of people are wondering why the projects so pricey and why there are so many issues.

1) The RFQ/bidding process isn't as logical as you'd imagine.

2) There are layers on top of layers on top of layers of bureaucracy. The government is its own regulator, not the market. There are no shareholders or VCs that can curtail the government's power. Elections and recalls are slower signals by orders of magnitude.

3) government projects fail all the time. You just don't hear about it because then heads would roll, which is faux past in the public sector.

dpweb• 13 years ago

Nice PR. Anxiously awaiting the article of how Facebook goes down all the time because its handling 600 million users a day. How bout this approach, which can work..

1. We F.d up 2. Were sorry 3. Heres what were doing to fix it

scribblemacher• 13 years ago

I work for a IT government contractor right now. We don't do work even close to the size of these exchanges, but even in our work the amount of bureaucracy and overhead involved is mind-numbing. To put a simple form on our web page requires an FRS, SDS, binder of validation documents, review and approval from several managers. It could take months just to make a simple change. Lots and lots of wasted time and grant money.

Why getting the Obamacare exchanges to work was difficult

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