Nov 13 2013
This is one of many “I told you so” posts I expect to write on Obamacare and the launch of Healthcare.gov. As of this week the picture I predicted would come true is coming true – with force. Healthcare.gov was the first big deployment of Obamacare, the flagship of what was to come in government run healthcare. And it has more than demonstrated the quality of what government-run, risky schemes can produce.
The launch of the website was allowed to go through even though there was clear evidence of insurmountable problems. Problems that literally make Healthcare.gov the worst government run program I have seen in over a decade (as one who comes to the rescue to government programs in trouble and in the ditch)
Basically, Healthcare.gov is so broken it cannot be fixed in its current form. Evidence for this conclusion lies in the fact that there are 100’s of problems (a.k.a. glitches) in the system:
Health and Human Services Secretary Kathleen Sebelius offered a sobering picture Wednesday of the challenges in fixing the government’s health-insurance website, saying contractors need to fix a couple of hundred problems and “we’re not where we need to be.”
Emphasis mine of course. With this many big issues to tackle, we can conclude the system design is a complete mess. And if it is a complete mess, the system will not be up and running in weeks or months. As people are now confirming behind the scenes:
The insurance exchange is balking when more than 20,000 to 30,000 people attempt to use it at the same time — about half its intended capacity, said the official, who spoke on the condition of anonymity to disclose internal information. And CGI Federal, the main contractor that built the site, has succeeded in repairing only about six of every 10 of the defects it has addressed so far.
Government workers and technical contractors racing to repair the Web site have concluded, the official said, that the only way for large numbers of Americans to enroll in the health-care plans soon is by using other means so that the online system isn’t overburdened.
Julie Bataille, director of communications at the Centers for Medicare and Medicaid Services (CMS), which is part of the Department of Health and Human Services, said: “We are working 24/7 to make improvements so that by the end of the month the site is working smoothly for the vast majority of users. We are making progress, including fixes to reduce error rates and get the site moving faster.
H/T Erika Johnson at Hot Air. Reducing error rates are they! How long will this take?
Chao said he was unaware of a Sept. 3 government memo written by another senior official at CMS. It found two high-risk issues, which are redacted for security reasons. The memo said “the threat and risk potential (to the system) is limitless.” The memo shows CMS gave deadlines of mid-2014 and early 2015 to address them…
No surprise. HHS/CMS was in over their head. Their arrogance was taking on a huge system integration without the schedule, budget and technical program expertise to even come close. I have posted many times on the evidence of their ignorance (see here, here, here). Some of the more interesting bits of evidence that have come out since the failed launch of Obamacare are (snipped from the above posts):
On the backdoor, the 834 connections, I had one client tell me they saw some improvement in the error rate, so I checked with three other clients, and they said they hadn’t seen any improvement.
EK: Let’s go back to the 834s for a minute. This sounds like it should be an easy problem to solve. The 834 standard is widely used. It’s not particularly complicated. What’s going wrong?
BL: I don’t know. This process is decades old. Every union and every self-insured employer who contracts with an insurance company uses it. It’s like a 74 Ford pick-up truck. There’s nothing complicated about it.
834s are the way insurers receive requests for enrollment. This should not have been rocket science, but…
It get’s worse if we look at the details of the reporting from the very first morning, were we find major elements of Healthcare.gov just not functioning as they should:
- VA [Veterans Administration] system not connecting
- Experian creating confusion with credit check information
- residency issue has a script being developed for the 900 issues that occurred
- many agent-brokers have not signed up on the EIDM
The ‘residency issue’ is huge. 900 problems identified! A properly designed and tested system would not be this bug-ridden at launch.
So how did they come to this disaster? HHS/CMS cut corners on the technical documentation:
Worse than that, as I noted in my previous post, HHS/CMS decided that this huge, complex effort would best be served by skimping on the required technical design documents – a process called “tailoring”:
First and foremost you need to define all interfaces and get them on a coherent schedule. Then you have to model all state and federal sources of data (i.e., define how each one labels common information and create a Rosetta stone to relate each existing label in those data sources to a common definition, like “first name”) and then you need to model all data products (each state and each insurer in the state has unique definitions for data as well).
And of course, data modeling and translation is one of those things HHS/CMS tailored out to save time. [In the above diagram] R = Recommended, which in tight programs means it won’t get done.
Afterwards. the President lost his nerve and compounded the problem by further cutting out critical technical guidance that would coordinate federal and state efforts to come to “Go Live” day as coherent program:
“According to two former officials,” they write, “CMS staff members struggled at ‘multiple meetings’ during the spring of 2011 to persuade White House officials for permission to publish diagrams known as ‘concepts of operation,’ which they believed were necessary to show states what a federal exchange would look like. The two officials said the White House was reluctant because the diagrams were complex, and they feared that the Republicans might reprise a tactic from the 1990s of then Sen. Bob Dole (R., Kan.), who mockingly brandished intricate charts created by a task force led by first lady Hillary Clinton.”
“In the end…the White House quashed the diagrams,” which prevented states from learning about how the administration wanted the insurance exchanges to be designed.
No detailed data model, no concept of operations and a late effort to slap on IT Security features (which need to be designed in from the beginning). Plus a fractured contracting mechanism and government civil servants attempting to be system integrator. How could this have ever succeeded?
For those not use to these kinds of programs, we are at the “start over” stage. The effort to rebuild from scratch (and doing it right) will be less time and money than trying to salvage this mess. This has happened to many programs who are so far off the rails you cannot recover.
According to tech experts, the sorry state of the current website does little to inspire confidence that it can be fixed and functional in less than three weeks.
“When I visited healthcare.gov on October first 1, that was the worst piece of software I’ve ever experienced in my life,” said Luke Chung, founder and CEO of the software company FMS. “It had nothing to do with too many users. It couldn’t serve one user.”
According to Sumit Nijhawan, CEO of Infogix, a data security firm working with private insurers, even if the White House can fix the problems associated with the site, they’re going to find new ones immediately. Nijhawan also warned that the systems that allow CMS and health insurance companies to exchange information are no where close to being ready, meaning tech problems could last years.