• Tips gratefully accepted here. Thanks!:

  • Recent Comments

    MsMass on He knew he was a looooose…
    riverdaughter on He knew he was a looooose…
    jmac on He knew he was a looooose…
    Propertius on He knew he was a looooose…
    Propertius on He knew he was a looooose…
    William on Thanksgiving Week Wordles
    William on He knew he was a looooose…
    Ivory Bill Woodpecke… on He knew he was a looooose…
    riverdaughter on He knew he was a looooose…
    riverdaughter on He knew he was a looooose…
    Propertius on He knew he was a looooose…
    Ivory Bill Woodpecke… on He knew he was a looooose…
    Ivory Bill Woodpecke… on He knew he was a looooose…
    Beata on Thanksgiving Week Wordles
    William on Thanksgiving Week Wordles
  • Categories

  • Tags

    abortion Add new tag Afghanistan Al Franken Anglachel Atrios bankers Barack Obama Bernie Sanders big pharma Bill Clinton cocktails Conflucians Say Dailykos Democratic Party Democrats Digby DNC Donald Trump Donna Brazile Economy Elizabeth Warren feminism Florida Fox News General Glenn Beck Glenn Greenwald Goldman Sachs health care Health Care Reform Hillary Clinton Howard Dean John Edwards John McCain Jon Corzine Karl Rove Matt Taibbi Media medicare Michelle Obama Michigan misogyny Mitt Romney Morning Edition Morning News Links Nancy Pelosi New Jersey news NO WE WON'T Obama Obamacare OccupyWallStreet occupy wall street Open thread Paul Krugman Politics Presidential Election 2008 PUMA racism Republicans research Sarah Palin sexism Single Payer snark Social Security Supreme Court Terry Gross Texas Tim Geithner unemployment Wall Street WikiLeaks women
  • Archives

  • History

    November 2022
    S M T W T F S
  • RSS Paul Krugman: Conscience of a Liberal

    • An error has occurred; the feed is probably down. Try again later.
  • The Confluence

    The Confluence

  • RSS Suburban Guerrilla

  • RSS Ian Welsh

  • Top Posts

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.