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Well, Duh. (in which RD and Lambert apologize for being prematurely correct)

It’s been almost two weeks since the ACA exchange sign up system has been up and running and we have an initial evaluation courtesy of the NY Times, From the Start, Signs of Trouble at Health Portal:

WASHINGTON — In March, Henry Chao, the chief digital architect for the Obama administration’s new online insurance marketplace, told industry executives that he was deeply worried about the Web site’s debut. “Let’s just make sure it’s not a third-world experience,” he told them.

“So much testing of the new system was so far behind schedule, I was not confident it would work well.”
—RICHARD S. FOSTER, who retired as chief actuary of the Medicare program in January

Two weeks after the rollout, few would say his hopes were realized.

For the past 12 days, a system costing more than $400 million and billed as a one-stop click-and-go hub for citizens seeking health insurance has thwarted the efforts of millions to simply log in. The growing national outcry has deeply embarrassed the White House, which has refused to say how many people have enrolled through the federal exchange.

Even some supporters of the Affordable Care Act worry that the flaws in the system, if not quickly fixed, could threaten the fiscal health of the insurance initiative, which depends on throngs of customers to spread the risk and keep prices low.

“These are not glitches,” said an insurance executive who has participated in many conference calls on the federal exchange. Like many people interviewed for this article, the executive spoke on the condition of anonymity, saying he did not wish to alienate the federal officials with whom he works. “The extent of the problems is pretty enormous. At the end of our calls, people say, ‘It’s awful, just awful.’ ”

Interviews with two dozen contractors, current and former government officials, insurance executives and consumer advocates, as well as an examination of confidential administration documents, point to a series of missteps — financial, technical and managerial — that led to the troubles.

Politics made things worse. To avoid giving ammunition to Republicans opposed to the project, the administration put off issuing several major rules until after last November’s elections. The Republican-controlled House blocked funds. More than 30 states refused to set up their own exchanges, requiring the federal government to vastly expand its project in unexpected ways.

The stakes rose even higher when Congressional opponents forced a government shutdown in the latest fight over the health care law, which will require most Americans to have health insurance. Administration officials dug in their heels, repeatedly insisting that the project was on track despite evidence to the contrary.

Dr. Donald M. Berwick, the administrator of the federal Centers for Medicare and Medicaid Services in 2010 and 2011, said the time and budgetary pressures were a constant worry. “The staff was heroic and dedicated, but we did not have enough money, and we all knew that,” he said in an interview on Friday.

Um, money is not the problem.  After all, the social security system, IRS and Medicare don’t have these problems.  Those of us who have seen modern IT initiatives at work in these modern times have a completely different take on this.  It’s a tale about private companies seeking big contracts, using a lot of money to wine and dine the purchasing managers, executives with big bonuses and lots and lots of subcontractors here and in India that have to do the grunt work.  As I wrote earlier this year when the first signs of unreadiness were posted:

The official line is that employers and their reporting systems are not ready yet.  Also not surprised.  The idiots in charge hired Accenture to run their technology.  The hiring managers should have come to former Pharma people for a performance evaluation of Accenture first but you know, workers are never asked to critique decisions like whether hiring Accenture to design information systems was a good idea.

Here’s how it works.  Accenture breezes into a company with their sharp suits and flashy presentations and completely bamboozles the management with promises of slick vaporware. Then they subcontract out to a couple of companies, who subcontract to India.  The Indian subcontractors do the best they can with limited information and the template code into which every business model must fit.  That gets passed back to the poor guy stateside who has to debug and rewrite everything.  The final result is, well, never final.  I’ve never known an Accenture job that actually completed on time, under budget and with all the bells and whistles that were initially promised.  The Pharma landscape is littered with systems that don’t work very well but have pushed aside the in-house programs they outbid to replace.  Meanwhile, the Accenture guys just move to another company.  Commence the parties and golf outings!

And why should we be surprised?  This health care policy was all about campaigning and the worst kind of politics.  It was not about well crafted public policy. It was about letting the private sector make a profit off of healthcare for the uninsured and those of us already paying astronomical rates for individual policies.  In fact, almost from the start, the Obama administration made it perfectly clear that the dirty f^&*ing hippies could be safely ignored and no one had to pay attention to public options or single payer.  They were not invited to the meetings where “everything is on the table” because the Obama crew and their law and biz school pedigrees already knew what was best for Obama.  Best for us?  What did that matter? Highjacking those Democratic activists who thought so highly of their intellectual capabilities was incredibly easy and after that, they didn’t need to answer to anyone.

I keep saying it all goes back to the primaries of 2008 but does anyone listen?  {{sigh}}

Don’t expect anyone to accept responsibility.  In fact, every subcontractor involved is busily pointing fingers at each other in that NYT article.  Maybe it would have been better to let ONE government agency handle it and NOT insist that every private IT industry partner with their hands out participate.  I expect that the Obama administration and its armchair cheerleaders will say something like, “Well, it’s too late to do anything about it now and the money’s already spent so, you know, suck it up.”.  Then the Republicans will point at it as just another example of government failure when we’ve already had so many instances of government success that could have been better examples.  A better response might be “Medicare for All” where everyone is covered and the government (that would be US, oh best beloved) has the size and power to force cost control measures on the medical industry. It’s only one possible solution from many possible solutions of national health care policies from around the world. Something like single payer or public option would set Republicans’ hair on fire and guarantee Democratic majorities for generations.

I’m not sure what the Obama fan boys (white male graduate student types) thought they were getting when they forced Obama on the rest of us but what they actually got was a guy who is ideologically opposed to New Deal type initiatives and loves modern finance solutions (and how has that worked for us in the past 5 years?) and Accenture was right up his alley.  And note that we haven’t even discussed whether the exchanges offer a good, affordable product that isn’t inferior to the one you might get if you were covered by your employer.  Those of us in the individual market who used to have company plans know the difference.  Our number is legion these days and we’re a lot harder to bamboozle.

As Jon Stewart pointed out last week, the administration has had 4 years to get this right.  That’s a lot of time.  There really shouldn’t be any acceptable excuses.  On the other hand, this *IS* how the private sector works when it comes to big, expensive interfaces.

You get what you vote for.  Oh, you didn’t vote for this?

For more continuing coverage and critique, check out Lambert’s ObamaCare ClusterF^&* series at Corrente where Lambert was prematurely correct on the technology rollout. This post from May seems especially relevant.

One more thing:

I haven’t been paying attention to this site as much as I used to due to real life stuff but oddly enough, a few months ago I was going through the spam filter in my hip waders when I ran across a slew of comments about the upcoming implementation of the ACA.  These comments were all unreservedly enthusiastic about the ACA, which I thought was really weird.  It’s weird because we haven’t set up any trigger words in our settings file that would automatically filter out these kinds of comments.  You can gush all you want about the magic beans in Obamacare and your comment should get through without any interruption.

So, why were these comments automatically tagged as spam?  My theory is that these comments came from a company that was originally hired by either the DNC or the Obama campaign in 2008.  At one point in time back then (about may-June 2008), we got sick of the comments that accused us of being racists or stupid or stupid racists or old women or failing to jump on this historic bandwagon of “yes we can”dom so we started throwing certain usernames and IP addresses of the most persistent and annoying of these commenters into the spam filter.  The policy of this site was to not allow our readers to be subjected to a lot of spamesque peer pressure.  A lot of other sites allowed comments like that through and they quickly became unrecognizable campaign mouthpieces.  We didn’t want that to happen here so we spammed them.

Now, I rescued those comments from the spam filter and put them in the moderation queue for further research but haven’t done the actual work yet because cross referencing them against the settings file entries seems tedious but if anyone else wants to take this on, let me know and I’ll forward them and you can knock yourself out.  But the reason I bring this up is that I’ve been to the NYTimes comments section on the article listed above and it seems like there are an awful lot of “I logged into the exchange the first day and got a great deal on an insurance policy so quicherbitchin” type comments there.  They may be genuine, if so they are among the tiny few that got on the exchanges and purchased successfully (I think the number is something like 51,000 successful logins and fewer successful purchases).

But if they’re not, I’d like to know who or what is paying for the online astroturf.

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12 Responses

  1. “…social security system, IRS and Medicare…” are not trying to sign up 40 million people.

    I’m sick and tired of your relentless negativism toward TehLightbringer. I didn’t vote for him either time and think that he’s been an overall failure, however I have a hard time differentiating between you and the Teabaggers.

    Goodbye. It was fun while it lasted, but you’ve lost touch with reality just as surely as Ted Cruz et. al.

    • Hey, thanks for playing. As a matter of fact, I think the Tea Party is off its rocker but that doesn’t mean we should give Obama a pass on this.
      Health care is a real issue affecting real people. I personally have experienced the worst of what it’s like to be dumped on the market in the middle of a severe health crisis. For millions of people, this is not theoretical and it deserved a better solution than this that creates a two tier system of Americans. We ALL deserve to be treated with dignity and respect and that is not what we are getting with Obamacare.
      As for medicare, social security etc, the problem is not the number of people signing up. BTW, when social security was implemented, we didn’t have a computer system and it *still* worked.
      The problem is that we have private industry that thought it could cash in and the way it does that, from observation of what happened to pharma companies that needed integration of their databases, is by deliberately downplaying some of the better in-house solutions. In house solutions means putting people on your payroll full time. There’s always a subtext behind these decisions. What you are getting for your money is very low cost employees on a tight budget and very quickly, you lose sight of what you are trying to accomplish.
      I’m very surprised that you are not seeing what’s going on. It’s not my fault that we got stuck with a weak, unprepared, finance and MBA loving president at the worst possible moment in our nation’s history. But I think it would be a very big disservice to the country if we all decided to just lie about it because the truth made us feel bad about the decisions our own side has made.

    • Just because Riverdaughter and the Tea Party actually both agree that something is not right, it does not mean they’re aligned in core beliefs.

      The problem with this country is that people need to label other people. And the Powers That Be use this natural need to label to their advantage. The Tea Party says the servers aren’t working, so therefore it must be right win spin. And anybody who says the same is also a right winger. (FALSE).

      The FACTS don’t have a party affiliation, and the whole purpose of trying to apply one to them is to obfuscate, divide and conquer. Our lousy two-party system is dependent on you not recognizing this.

      Until we realize that we’ve let our two-party government pit us against each other we will never win. The real split is the citizens versus the corporate government.

      I wish we would just give up on these farcical elections. Instead of Democrat versus Republican candidates, we should run say, Big Oil against say, Big Insurance. Because the reality is those are the kinds of parties who are really running for office, really winning and really raking in the money.

      • The thing is you are never going to get the tea party to help you out on anything. I live amongst many of these types and they are odious. Yes, the servers have problems but the tea party is rejoicing in that fact.

        • That makes no difference to the facts at all. The administration was incompetent in the matter.

          And as lousy as the plans are, maybe we should all be rejoicing.

        • If the Tea Party’s rejoicing in the matter steers you to sympathize with the Democrats, then you’re letting your emotions define your reaction. And you are ultimately siding with people who are in the wrong.

          As I’ve said, the fact is the implementation has been awful. Widespread failures. That isn’t a partisan idea, it’s the reality.

          • You know? The truth of the matter is the tea party is driving people to Obama and the dems because him and the senate are the only thing that is keeping the country from blowing up right now. Whenever he has whined about the tea party in the past i have thought he was stupid because things would be a lot worse for him without the tea party. I mean look at the favors they are doing for him with regards to the shut down. The thing is they are not smart enough to realize how much they are helping him because they reside in a bubble.

  2. Well, I really don’t think Obama is in love with the captains of finance. I really don’t think Obama is in love with anyone but himself. He has no ideological grounding in any of the Democratic party ideas and just floats with the wind.

    • He’s definitely one of them. It’s his tribe. In general, they think they’re the pink of perfection. You should read that article they NYTimes did on Harvard Business School to get an idea of who his peeps are. They look for businesses to run. What those businesses produce and the people that work for them seem almost irrelevant. So it is with Obama. He got his business to run. Now, what does he do with it? Without a political or economic philosophy and with “everything on the table” to negotiate away, we should not be surprised that his signature policy initiative is having problems.
      These have been the longest 13 years of my life and they came it what should have been my prime earning years. It will be very hard for me to forgive the Democratic party for doing this to us.

      • Well, I disagree. I think the fact that he has no ideological compass is what was appealing to his backers. I think the fact that he has no ideological compass makes it easy for them to get him to do their bidding. I’m sorry you have been having such a hard time. You are not alone. They have been very hard for my family too and I understand your frustration.

  3. […] And I’m not going near it until the last minute, because I suspect it’s going to fuck up all the information I input. I’d advise you to do the same. Here’s Riverdaughter with her own observations: […]

  4. A friend of mine is the Finance Administrator for a group surgical practice. She is in charge of Finance, Billing, and computers. A small amount of the programming work is sub-contracted to India. She will not assign any tasks that are time-sensitive to the Indian programmer (a man named Vykas).

    Anyone in the medical or pharma business knows that sub-contracting large projects that are time sensitive to India is a disaster. Between the time differences and the cultural missing data, everything is slow and discombobulated.

    It turns out that “everybody” does not include the decision maker(s) in the Obama administration. I guess they are too far “above it all” to notice the practicalities of daily life.

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