More than three weeks into the official roll-out of ObamaCare, I haven’t written a word in defense or as criticism of the website Healthcare.gov. The reason is pretty simple. I am perfectly content to have the Republicans pushing to make the website, and therefore the law, work better. I know that the administration is mortified about the problems they’ve encountered and totally motivated to fix them as soon as possible. They don’t need scolding from me.
I’m not in the camp that thinks there is some moral duty not to criticize the administration over these problems, but I definitely don’t see why anyone should feel obligated to pile on. The problems will get fixed and we’ll all move on.
In the meantime, every time the Republicans criticize the website they are defending the law, and I think that is great. I’ll be happy to give them credit for speeding up the fixes and helping to make sure the law is implemented correctly. Good job, morons.
Too much traffic to your website doesn’t seem like the worst problem one could have. They will get it ironed out soon enough. It does give you an idea how strong demand is although.
“My expectation is that once the ACA is successfully and fully implemented early next year, most opposition will melt away. Beginning in 2015, Congress will resume its customary and necessary role of providing vigorous oversight and reforms to the ACA.” http://cognoscenti.wbur.org/2013/10/09/series-policy-affordable-care-act-john-mcdonough
That’s a prediction made earlier this fall by John McDonough who was an architect of Romneycare in Massachusetts, and who Ted Kennedy hired to help the Senate write the ACA.
At the time McDonough thought it would take until after the 2014 elections for congressional Republicans to start treating the ACA like any other law. It’ll be interesting to see if the tech issues associated with the exchanges actually has the effect of speeding up the process.
McDonough’s book is worth a mention:
http://www.amazon.com/Inside-National-Health-California-Milbank/dp/0520274520
Essential reading, IMHO.
Time to fix the responsibility where it actually lies. First of all with the GOP governors and legislatures who systematically worked to sabotage the federal exchange by delaying as long a possible declaring whether they were going to build their own exchange. For example, North Carolina canceled the building of an exchange in July and dumped the load of the 10th largest state in the nation on the federal exchange three months before the federal exchange was to open.
Then consider the interfacing with the insurance company computer systems that goes on the back end of the system. Which insurers you have to interface with depend on what states you are covering, regardless of whether that is done directly by states or through the back end of the federal exchange.
And there is this little interesting feature of the HIPAA data formats that HHS decided to use for enrollment. The data format and protocol at issue is what is called a HIPAA 834 benefit enrollment and maintenance document commonly used by employers, unions, government plan sponsors (Medicare Part D, for example), and insurance marketing organizations to enroll members in a health benefit plan.
Just What Is an 834 Transaction? Why Is It Holding Up Obamacare? How Long Will This Take to Fix?
Beginning in the Clinton administration, the Health Information Portability and Accountability Act specified data interchange stanadards that were to allow the use of a single common data transaction for all insurers. The industry after over a decade never implemented that common data transaction in a way that the HHS can send an enrollment to any insurer and expect a flawless reception of the data. No doubt the Bush administration did not push insurers to actually deliver a common implementation; so they never did, just working around the variations they had to. One wonders whether CGI or its subcontractors were aware of this variation problem before whatever caused them to scramble to specify a common format at the last minute. But the industry is putting the blame on the feds, not on their unwillingness to commonize their data transactions in practice.
So what we see here in this is multiple layers of foot-dragging and sabotage that have gone on in the industry and with the states in GOP control. And the federal government agency and even the contractor being expected to pick up the pieces and work them out at the last minute. And then complaining that there was inadequate testing.
Whatever the issue is, it is not the HIPAA law or the ACA law except in this sense. The neoliberal outlines that the Heritage Foundation in the 1990s wrote into its design of the exchange system were more complicated to implement with public-private partnership than would have a straightforward New Deal solution like Medicare-for-all or VA-for-all. And provided the opening for multiple points of failure or sabotage.
The neo-liberal outlines that the Heritage Foundation in the 1990s wrote into its design of the exchange system were more complicated to implement with public-private partnership than would have a straightforward New Deal solution like Medicare-for-all or VA-for-all. And provided the opening for multiple points of failure or sabotage.
As Atrios calls it, a Rube Goldberg system.
THIS.
There are simply too many ways the multiple systems can fail. And that says nothing about contractor incentives to muck things up and keep the paychecks coming.
Great post- the sanest take on the subject that I’ve seen anywhere.
Even the process of registering with an email address (which I could do even though not complete enrollment) gives the ACA administrators a lot of real information for the demand.
America has been waiting since the FDR Administration for this, a few more weeks or months will hardly make any difference.
I started programming in’79. In a system the size of this, there literally (actually, algebraically) must be errors the size of montana written into the code.
This thing is gargantuan. Of course there will be errors. Lots of them.
The last error found in IBM360/370 operating system was found approximately 22 years after its introduction.
Just more troglodyte tomfoolery. If this is the best they got, BRING IT ON!!!!!
Excellent post Booman. I agree completely. The pile on has gone past absurd and silly (even from the left) for several reasons:
All that said, I find myself drawn to the articles discussing IT project management, capacity planning and testing. There is a healthier (although not always) discussion going on on the IT issues. For example, the architects of the Kentucky system had the wisdom to apply the KISS principle:
I just read the latest Krugman article about people crying about the sky falling (for 3+ years now) without so much as a drop of rain, and it has me wondering: is the real reason for the deficit scolds’ angst the fear that some liberal is going to come into office and inflate the bankers’ ill-gotten gains away? If so then I earnestly hope that their fear becomes a reality, although I am not an economist and I didn’t stay at a Holiday Inn Express last night so I’m willing to listen to thoughts that such may not be a good idea.
Meanwhile, multiple spins continue to emerge.
The audacity of these people knows no bounds.
Congressman Camp is either lying or is misinformed. This from an IRS bulletin sated Jan. 8, 2013.
I started a reply to this post.
It grew.
Now a stand-alone piece.
A Non-Story, Booman? No. The REAL Story.
Long “real story,” short?
Sure.
The Healthcare.gov kerfuffle is not the real story, it is merely a symptom of the real story. The real disease.
Big Government.
It simply doesn’t work well.
What to do?
Take it down, one fool at a time.
How to do that?
I dunno for sure, but I have some ideas.
Read on.
AG
Big Government? Really, after 30 years of Reaganism, how did that happen? After Al Gore re-engineered government and reduced the size of the civil service, how did that happen? After two years of austerity and one year of a sequester, how did that happen?
What we have are big national security and intelligence institutions and a private contracting workforce that spins out costs and headcounts for both the military and non-military sides of the government.
What we have is private-public partnership in which the private is returning less value to the public than it is getting in contracts.
What we need to do is pull a lot of those functions back into the civil service–yes, increasing the size of the government. End a lot of contracts and the contract management, contract auditing, and program management overhead that goes with them. That means that a lot of folks will have to find jobs that actually serve consumers and businesses instead of playing government-to-contractor games.
But it is very curious to me that among my personal network, the folks messaging me most about the dangers of big government most all work for contractors at the federal government teat.
In this case, the failure in policy was in not letting the government take over the entire system as is done in other industrialized countries. Too many large corporations wanted to keep the golden handcuffs on their talent; too many employees love those golden handcuffs.
No, Tarheel.
What we have is a corporate-owned system, outside and inside of what used to be called “government.”
Now?
What we have now is a “government” that is used to (
rule)…errr, ahhh (control)…NO!!! I mean govern the poor and working classes (including the so-called “middle class” which is just another working class w/a slightly higher salary) and a “non-governmental” government that sells to the the official government at inflated prices…which is the reason that the corporations bought the political parties and politicians in the first place…and controls the non officially “governmental” institutions (the media, academia, etc.) by the sheer brute force of its wealth.The original concept of “fascism” included hand-in-glove cooperation between government and corporate interests. We have gone way, way past that state of affairs now. The great pianist, wit and self-hustler Oscar Levant once said “There is a thin line between genius and madness. I have erased that line.”
Well, the line between public and private enterprise has now been essentially erased in the modern developed world….the line between “government” and “business,” between public and private interests. Communism tried to make the government the boss and essentially control “business.” That didn’t work out so well, did it. We are trying the other routine. How’s that working out? Turns out not so well either.
Hmmm…
What to do, what to do?
Probably what we humans always do. What the people did in Communist Russia and China. Wait until it breaks and then muddle on through.
So it goes.
Get ready to hunker down.
I was in Russia just a couple of years after they had deposed Gorbachev. Food lines, desperate people, black market galore and the dollar was gold. Moscow was like a black and white photo. No color at all. Just varying shades of depressed grey. If you had told me that 20 years later it was going to be a bling-wearing, oil-rich kleptocracy that is successfully dictating policy to the U.S. (See “Syria” for all you really need to know about that), I would have laughed in your face.
This system is broken. It is not going to function even as well as it is functioning now for very much longer. One more solid blow and it will collapse into…and onto…itself. But the population will survive, and it will once again prosper. I really believe that. The U.S. has such a rich mix of cultures living in it now. Richer than Russia by far. It is the first truly multi-cultural, multi-racial major power that the world has ever seen and I believe that such multi-culturalism and multi-racialism is the next step in the evolution of humanity.
Watch.
These fools will go down of their own greed, and a new chapter will be written in human history when they do.
Will it be written in blood?
I am afraid that it will, initially. That’s why I suggest the hunkering down part. But afterwards comes the dawn.
Bet on it.
I am.
Later…
AG
Nobody could have thought that there would be Governors so fucking evil in half the country that they would:
a) Condemn the poorest people of their states to no healthcare by refusing to expand Medicaid.
b) Then would refuse to set up their OWN exchange
Now, we knew they were evil but did anyone actually think that HALF the country would refuse to do A&B?
I have as low opinion of them as possible, and I didn’t think half.
Good for you , Boo, And also, I don’t think Obama is particularly worried either. Concerned (to fix it), but not worried.