Dec 22 2013

Obamacare: Crash Of The Arrogant Amateurs

Published by under All General Discussions

Sorry for the light posting. ‘Tis the season to be way too busy.

Besides, I have been quietly watching the disaster that is “Obamacare” unfold over the last month. Watching as I see the collapse of a program so screwed up it boggles the imagination. So screwed up, because it is the nexus of shallow, liberal thinking.

As I posted here a while back, Obamacare was implemented by amateurs who had no experience in how to run a large federal IT contract. It was run by a Civil Servant cadre who allowed the White House to delete the very programmatic tools needed to have ANY chance to succeed. Led by a SW System neophyte, the Healthcare.gov program suffered:

  • Endlessly changing requirements
  • The deletion of its Concept of Operations document (vacated because it laid out the true challenges of ObamaCare – thus depriving the developers and stakeholders any agreed upon baseline to work against)
  • A test program that was a joke because it never happened
  • Serious and criminal security lapses, etc

I think the amateurs at HHS pretty much nailed every thing you should NEVER do on any computer based development effort.

This debacle is a great example of liberal thinking. You know the kind. Where a cursory assessment by a self-proclaimed genius decides the entire human race had missed the obvious. That a simple fix could right an infinite number of wrongs in a very complex environment covering 100′s of millions of patients and tens of millions of care givers would fix wrongs introduced by reality. Like the “wrong” of having genes that predispose some to illnesses and not others.

Some things cannot be fixed via policy. Liberals have yet to become enlightened enough to grasp this fact.

The fact is: life is diverse. Therefore life creates diverse strengths and weaknesses. Instead of trying to level the playing field, humanity should be leveling the opportunities, and expanding the resources that lift those up who need a bit of a hand. Not tear everyone down to a lesser state.

Right now, Obamacare is creating more uninsured. It is doing this by dramatically RAISING the cost of health care (premiums and deductibles). The administration is doing this to cover a few people who did not have the financial resources or support to deal with serious illnesses and conditions. Is this a good trade? Obviously not.

Worse yet, Obamacare attempts to cover the elderly and sick by sticking the bill to the young and the healthy. The big problem with this liberal brain-fart is the elderly tend to be much better off financially, and the Obama Economy has ruined the career opportunities of everyone between 20 and 30 years old!

The demographic least capable of affording a huge spike in their basic cost of living is the one shouldering the burden of Obamacare!

Pure genius!

So here we are, just a few days before Christmas watching the ObamaCare House of Cards crumble. Megan McArdle probably has the best run down of what has happened this week. Basically, the neophytes are in full-panic mode (though I am 100% sure they think they are in crisis-management mode). They are making rash decisions without any thought of the ramifications. A sampling:

As Avik Roy points out, catastrophic plans aren’t that much cheaper than the so-called bronze plans. They’re also not eligible for subsidies. This is unlikely to be much help to folks who lost insurance; all it does is introduce some much-unneeded complexity to Healthcare.gov.

As Aaron Carroll points out, insurers calculated their premiums for this year on the expectation that the relatively healthy folks who were already buying insurance would be buying policies on the exchange. The insurers are not happy about this latest change, and Carroll predicts that they will ask the administration to push more money to them through the “risk corridors.” I think he’s right.

As Ezra Klein points out, this seriously undermines the political viability of the individual mandate: “But this puts the administration on some very difficult-to-defend ground. Normally, the individual mandate applies to anyone who can purchase qualifying insurance for less than 8 percent of their income. Either that threshold is right or it’s wrong. But it’s hard to argue that it’s right for the currently uninsured but wrong for people whose plans were canceled

When President Obama released the previously insured from the rules of Obamacare, specifically due to the “hardship” of Obamacare, the dam basically broke. Legally, Obamacare just became a litigator’s dream! Why some and not others? Why the insured and not the uninsured? Heck, why individuals and not small companies? We small companies have been nailed by the cost of ObamaCare – can I now get my old plan back due to financial “hardship”? The lawsuit possibilities are endless – and highly lucrative. The need to limit legal exposure in the health care arena will come front and center for quickly.

The Weekly Standard posts another insightful item, because many people DO consider the implications of an act before taking it and can predict what could easily happen:

In addition, what’s to stop those with canceled policies who fought their way through healthcare.gov from now changing their mind and dropping their plans in light of the administration’s announcement?  These families would need only to file a form indicating that the premiums they were facing in the exchanges are unaffordable. As matters stand, the administration would have no basis for denying an exemption to such households.

The upshot is that the administration has voluntarily opened another very big escape route out of Obamacare, and the most likely escapees will be young and healthy Americans who don’t want to pay high premiums for Obamacare’s expensive benefit plans.

Here is something for the backers of ObamaCare to carefully consider.

While ObamaCare sounded like a nice, painless way to help people in need (you can keep your plan and your doctor), the truth is much worse. ObamaCare is not painless, and is not helping as many people as it is hurting. And that is the equation that maters:

Where you better off before or after ObamaCare kicked in?

If the answer is “before” to a majority of voters – watch out Democrats!

The second aspect of this is something that never occurred to the liberals who thought up this Rube Goldberg fiasco. What happens if the uninsured were mostly uninsured because they chose to be? No one knows for sure what fraction were in need of health care, or were in need of health care but could not afford it, OR decided to self fund their health care!

What happens if the majority of the uninsured fell into the last category? That means these people will stay out of ObamaCare, stay uninsured, stay independent. And likely not even face a fine this year given the disaster that is ObamaCare.

If that is true, ObamaCare just established the beginning of the death spiral. People will opt out as best they can to save money. Leaving the insurance pool full of the most expensive cases.

And don’t be suckered into thinking ObamaCare is over the tough technical issues. Not even close. I also predicted the ‘fix’ to the technology underpinning ObamaCare would take months. So far, that prediction is also holding.

Case 1:

In spite of the recent improvements in the HealthCare.gov website, the co-chair of the Wisconsin Hospital Association’s task force on Affordable Care Act enrollment said the sign-up process remains time-consuming and confusing.

Therese Pandl, president and CEO of the Hospital Sisters Health System eastern Wisconsin division in Sheboygan, said the situation continues to baffle both consumers and hospital staff, according to the hospital association’s Dec. 13 newsletter.

“Our enrollment counselors say the process takes an hour or two per person, so they are only able to enroll maybe five to seven people per day,” Pandl said.

Case 2:

Private health insurance exchanges still are not able to directly enroll consumers in subsidized health plans offered through Obamacare even though the government has said problems doing so should have been cleared up weeks ago.

Executives from three online health exchanges that contract with both insurance companies and government agencies to enroll consumers eligible for federal subsidies in marketplace plans say the process still isn’t ready to go and that more work remains.

“We’re not going to launch anything that doesn’t work, but we can’t even start testing for a while yet,” said eHealth.com CEO Gary Lauer, weeks after the first round of fixes were announced in mid-November.

“We’re still going through all of this. The stuff we’ve had up to this point has been junk, and that’s why I’m so concerned about this. It may not work,” he said.

But weeks later, company spokeswoman Andrea Riggs said the direct enrollment process is still not ready for public use even though her company has been in near-daily contact with CMS.

“We’re not going to put it in front of the consumer and make noise about it until it’s a great experience,” Riggs said.

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Dec 02 2013

Obama Administration Trying To BS Country On Obamacare’s Pending Failure

Watching the Sunday talk shows I realized the country would be better off if they all were cancelled, since they are all about partisan (read Democrat/Liberal) fiction and NOT about objective news and information to the voters.

The topic of the Healthcare.gov site status and its imaginary fixes was most amusing. All the leftist media types were in full CYA mode, trying to apply lipstick to the pig that ObamaCare has become.

While the technology ignorant may be fooled by load times and error rates on a web pages, the truth is ObamaCare will leave 5+ million Americans who HAD good healthcare insurance uninsured come January 1, 2014. And this is not speculation – according to the New York Times:

The problem is that so-called back end systems, which are supposed to deliver consumer information to insurers, still have not been fixed. And with coverage for many people scheduled to begin in just 30 days, insurers are worried the repairs may not be completed in time.

Emphasis mine. Notice the liberal spin in the ‘hide the truth’ verbiage? The problem is most people who lost their coverage ARE NOTscheduled” to be covered in 30 days. They cannot enroll! SO how can they be “schedule“?

“Until the enrollment process is working from end to end, many consumers will not be able to enroll in coverage,” said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group.

And here is how bad it is going to be:

About 100,000 people signed up for health insurance through the online federal exchange last month, a roughly four-fold increase from October even as a team of U.S. government and contractor programmers was fixing the troubled Affordable Care Act website, said a person familiar with program’s progress.

For those not wanting to do the math, that is around 125,000 ‘signed up’ so far, though 5+ million were sent notices of cancelled polices. But wait, there is more:

The preliminary November numbers reflect individuals who successfully selected a plan.

Hmm, that wording seems a bit weasel-ish. Let’s go back to the New York Times piece for a possible explanation:

Some insurers say they have been deluged with phone calls from people who believe they have signed up for a particular health plan, only to find that the company has no record of the enrollment. Others say information they received about new enrollees was inaccurate or incomplete, so they had to track down additional data — a laborious task that would not be feasible if data is missing for tens of thousands of consumers.

In still other cases, insurers said, they have not been told how much of a customer’s premium will be subsidized by the government, so they do not know how much to charge the policyholder.

So, the website (the “pig’s face”) is now the diversionary focus. But the real test – will people who had valid and working insurance be insured come Jan 1, 2014 – is still to come. The numbers above show nearly all those who had terminated policies will not be enrolled.

That means every, single, horrific story of a sick person fighting a preexisting condition (e.g., cancer, pregnancy) now without insurance will be fair game. Because it will be the sheer ineptitude and negligence of Obama and the Democrats who risked each and every human life. What a political PR disaster – and deservedly so.

There is no excuse that will fly come Jan 1, especially something along the lines “we had to take that child’s cancer treatment away so the young, elderly and immigrant uninsured could become insured”.  The Dems tried this all weekend. I dare them to try it again come January 1.

Update: At least one Democrat insider is beginning to wonder how long Obama and the Dems can keep up the charade:

“Again, I think the pressure now will be on the administration to be more forthcoming about what’s happening on the back-end and whether insurance companies are getting the information.”

Well, we know the answer to that already.  Just not exactly how bad it will be? Will it be 5 million who lost coverage and could not enroll? Will it be 4.5 million?

With that many horror stories out there will it really matter>

14 responses so far

Nov 27 2013

ObamaCare Will Uninsure More People, Not Insure More People

Major Update At End

It’s becoming a sad, laughable fact.

DC Political Spin (aka, lying to the naive masses) has hit an all time new level dishonesty under the Democrats and President Obama.

  • If you like your insurance, you can keep it
  • If you like your doctor(s), you can keep them
  • Obamacare makes insurance affordable (after all, it is called the “Affordable Care Act”)
  • Obamacare will expand the pool of insured in America
  • Healthcare.gov is on track for an October 1, 2013  “Go Live” launch
  • Healthcare.gov is secure and protects personal identifiable information (PII)
  • Healthcare.gov will be fully working on December 1, 2013

The BS is meter is pegged with this administration [H/T Ed Morrissey at Hot Air]:

CMS spokeswoman Julie Bataille said errors that persist past this weekend would be “intermittent” and, in line with a promise made by the White House, would not affect the vast majority of the site’s users.

But Bataille acknowledged that some would still experience “periods of suboptimal performance” by the system due to either heavy traffic or technical issues that are still being addressed.

The system will not work perfectly on Dec. 1, but it will work much better than it did in October,” Bataille said.

But according to an insurance industry source, though the 834 problems are getting better, there is still a long way to go. Insurers still haven’t reached the point where they can feel confident that the data is reliable.

As a result, though they have been able to process some payments from individuals, they’ve only been able to do so on piecemeal basis in cases where they are fully confident in the data, often because it’s been verified by hand.

The second quote is from this piece, which confirms what I was predicting for weeks now:

Though insurers traditionally haven’t counted individuals as enrolled until they’ve paid their first month’s premiums, the HHS report declared, “Enrollment figures include those who have selected a plan and have or have not yet paid the first month’s premium.”

HHS did not provide a number for those who have paid.

Behind the scenes, when an individual selects a plan, the federal system transmits a file, known as an “834,” with all of the relevant information about that individual and his or her plan selection.

These files have been plagued by errors, from spouses and children being mixed up to enrollments being duplicated or inadvertently cancelled. According to HHS, they have “completed fixes for two-thirds of the high-priority bugs that our tech team working with issuers identified as being responsible for the issues with 834 transactions and other issuer priorities.”

Continue Reading »

5 responses so far

Nov 24 2013

ObamaCare’s Failure Inevitable: The Big List Of Screw Ups

Update: Add to all the big screw ups listed below this doozy:

HHS had forty-two months to build this system after the passage of the Affordable Care Act in March 2010 to hit the October 1 deadline.  Why did they wait more than forty months to begin building the payment system that is absolutely critical to the system’s potential operation? And what can we expect to see from a massive, $12 million system that has to be delivered in less than four months, which to this day is still not complete?

… Now we find out that 40% of the system slipped through the cracks until well past the last moment, and CMS was forced to do a no-bid award to catch up.

The incompetence exposed by this disaster almost escapes the ability of adjectives to adequately describe it.

CMS/HHS did not realize for 3 and 1/2 YEARS they were not going to get done on time? As I illustrate below, this whole government take over of America’s health care services was amateur hour on steroids. - end update

ObamaCare was doomed to extended failure years ago. What we see now is just the initial shudders of a government program so damaged, so poorly thought out, it cannot succeed. It will produce massive insurance loss come January 1, 2014 because the ‘system’ is so broke it cannot recover.

The evidence for this conclusion/prediction is all around, especially to the trained eye of people who have made a career out of federal contracting on large, complex, computer-based programs. I remind people that not just anyone in the government or industry can stand up a large system with lots of interfaces and lots of human users. Private industry is better at popular websites, but websites are not all that are needed for large systems. In fact, in the world of large federal programs, the website is usually an abstracted window through which filtered information can be exposed and limited requests can be made.

The systems behind many websites are enormous, and require thousands of engineers and technical managers (as opposed to financial managers, policy managers, communications managers, etc) to make work. While a diverse management team is required on all programs, large computer-based programs require a strong technical manager and team.

This skill set is rare even today, both in and out of government, 40 years into the computer age. So when the country embark son these challenges, we HAVE to have the right team in place. ObamaCare was an enormous challenge in both the  computer system world and the website world. So it needed special skills to pull off.

What is astounding is how the Democrats’ signature government program of the last half century was so badly botched, and how it all starts with inexperienced leadership. From the White House to CMS, the organization in HHS designated to lead the development and deployment of ObamaCare, for some reason getting the right team to run this was a non-starter.

I predicted back in one of my first posts on this debacle the main culprit was inexperienced bureaucrats pretending to know how to run a large computer-based program:

If you try and jump from managing some health care technology to deploying a system like ObamaCare – you will fall on your face.

NASA, DoD and DoT have the necessary government infrastructure to accurately define, procure and monitor something like ObamaCare. They have this capability because the built up a contractor and civil servant base able to take on the challenge over many decades. HHS and other government entities usually do not.

This suspicion was just confirmed by the New York Times:

… over the past three years five different lower-level managers held posts overseeing the development of HealthCare.gov, none of whom had the kind of authority to reach across the administration to ensure the project stayed on schedule.

As a result, the president’s signature initiative was effectively left under the day-to-day management of Henry Chao, a 19-year veteran of the Medicare agency with little clout and little formal background in computer science.

Emphasis mine. This is like asking a 20-year veteran car service mechanic to perform complicated surgery. Just ridiculous. And criminal in the private sector. We in the private sector would be barred from contracting if we put someone in a lead position without the experience and expertise required.  Sadly, the government does it more and more these days as it takes on more and more large projects without increasing its pool of expertise.

Continue Reading »

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Nov 23 2013

Arrogant & Stupid – Not A Good Combination

Published by under All General Discussions

This story is just one more example of why government is running out ideas, gas and just plain brains:

Refusal will result in a Racial Discrimination note being attached to your child’s educational record…’

Of course this idiotic attempt at oppression is laughable on so many levels.  This note went out to parents of children who were not going to attend a field trip to an Islamic Center.

Islam is a religion, not a race. So you wonder about the fool behind this?

What is the single most depressing aspect of this letter? Is it the idea of labelling eight-year-olds racists? Is it the moronic conflation of religion and ethnicity? Is it the ugly grammar (“As such our expectations are that all children in years 4 to 6 attend school on Wednesday…”)? Is it the bullying tone? Is it the unconscionable choice of font? Is it that someone can write that way and yet hold a position of authority in a school?

Tax dollars ‘at work’.

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Nov 18 2013

Obamacare Cannot Enroll Enough People By January 2014 To Salvage Democrats

Update: The Impossible just became Fictional:

TWS: If I don’t pick a plan until 12/15, won’t it be too late for my info to go to the insurance company, them to bill me, and me to make a payment by 12/21? Seems pretty tight.

[Healthcare.gov] Rep: You must make your first premium payment by 12/15/13 for your coverage to begin January 1, 2014. If you make your payment by the 21st, your coverage will begin in February 1, 2014.

Of course, if your not enrolled by 12/15 you will not be able to make a payment, so the real window here is  now around 4 weeks, Which as we see below, about enough time to get 30,000 more people enrolled. Which equals an epic fail with a double face plant - end update

The reason Healthcare.gov will not get well in time to avoid catastrophe is because right now, due to massive errors in the information gathered from enrollees, and errors introduced by the HHS SW, the process of enrolling people is pretty much manual.  And will remain manual well into December 2013.

So while millions of cancellation notices are going out to Americans who are losing their insurance come January 1, Obamacare cannot physically enroll them into new plans even. Which means most people tossed off their insurance by Obamacare will come out of this without coverage come January 2014.

The evidence and underlying numbers are brutal.

It starts with the errors being generated by Healthcare.gov. Errors so extensive the process of cleaning them up so people can safely be enrolled is running at a fraction of the production level needed to keep up.

Let’s begin with the errors:

By October 16, some 3,000 paper applications were in the processing center but only “81 have been successfully entered.”

In a document full of figures and consultant-speak, one number stands out: 834. That’s the code for the final step in the HealthCare.gov process, when all the data entered is sent to the insurance company a user has chosen. It sets up the actual insurance policy and hands off responsibility to the company or organization running that plan.

But from the start, that data was not transferring correctly. “834 issue – Raised here as well – issuers not receiving 834s that they should be getting,” a contractor wrote on October 3. At one point no one could track whether the final 834 data entered by individuals was actually the same as the 834 data going out to insurers.

October 9: “A new problem in the system has been identified: for about 30% of the 70,000 applicants, the system has skipped applicants through ‘events’ that are required to complete the application.” In other words, nearly a third of applicants couldn’t fill out the form, because the website was skipping “events” or entries they needed to make.

3,000 submitted, 81 complete? Let’s connect some other dots here.  How many people were actually enrolled in the first 4-6 weeks of Obamacare?

Fewer than 27,000 Americans selected an insurance plan through the federal HealthCare.gov site, which is handling enrollment for 36 states.

So what was the applicant po0l if the 3,000:81 factor is even marginally close?

This is a very strange number based on the supposed daily capacity for the website.  When we look at capacity verses production there is an obvious gap:

Zients said his next priority is adding capacity to the system, which is currently handling 20,000 to 25,000 users at one time.

He noted that there were no unscheduled outages on the site in the past week, a positive sign, and that more than 60 bugs were recently fixed.

The call was not fully positive, however, as Centers for Medicare and Medicaid Services spokeswoman Julie Bataille acknowledged that some insurers are still receiving flawed application data.

“We are actively working on with issuers … to put that fix in place as soon as possible,” Bataille said.

So how is it the site can handle 25,000 people at ant given moment on any given day, but only 27,000 people are enrolled after 4-6 weeks? What is the bottle neck?

Simple, the only way for applicants to become enrolled (and covered) is for the insurance companies to manually correct the data (I presume via some form of contact):

An 834 transmission contains enrollment data like an individual’s social security number, their dependents and the plan that they picked. That data is, obviously, critical: If it comes in wrong, an applicant may not get the right plan, or family members may not be covered, or identity may not be verifiable.

The 834 transmissions have begun filtering out to health insurance plans. The only problem? A lot of them are wrong.

The Wall Street Journal reported that one insurance plan got an 834 for a subscriber who, according to the data, had three spouses. This was surprising because the individual was not a polygamist. Two dependents had been incorrectly coded as spouses.

Others have gotten reports for people joining the plan, unenrolling and re-enrolling multiple times in the course of a week — or even the same day.

Right now, health-insurance plans say they can manage these problems. Few enough enrollment forms are coming in that they’re able to hand-check each one. ”What our company, and I’m assuming others, are doing is throwing people at it,” one insurer told Wonkblog. “We’re overcoming the tech flaws with manual reviews and manual rigor and manual processes.

So what is happening? We are seeing an enormous backlog of applications and their respective 834s because of errors.  And if, as the reporting indicates, each applicant has 3-4 erroneous 834s attached to them, then the effort to manually work through all this is more than can be performed between now and the new year.

The gap here is mind boggling. 27,000 enrollees from a pool of applications that is probably more than 10 times that number.  H0w do I know the backlog is more than 10 times those manually processed? Simple, look at how many people HHS asked to reapply – probably to simply throw out that backlog of erroneous 834s and get some good information into the pipeline:

“Today, we’re beginning to send messages to those consumers who had account creation issues to let them know they can try again,” said Centers for Medicare and Medicaid Services Communications Director Julie Bataille. The agency, which will make the outreach to frustrated shoppers in waves, plans to send emails to about 270,000 people this week, she said.

So, 270,000 who had attempted to apply are being asked to come back and do it again. At a pace of 27,000 a month processed manually, you can see that would require 10+ months to work off just these people.

And that is even without new applicants adding to the backlog. As noted above:

Centers for Medicare and Medicaid Services spokeswoman Julie Bataille acknowledged that some insurers are still receiving flawed application data.

Just wait until the 90% of Americans on company plans lose their coverage in 2014! This backlog will look like paradise.

What is ridiculously impossible now will become tragically impossible next year.

And the Democrats, who own Obamacare from end to end, will reap the rewards.

 

4 responses so far

Nov 16 2013

Obama Makes Another False Promise On Less Affordable, Less Care, Act

Published by under Obamacare

You have to wonder if the Commander-in-Chief is in full command of his faculties after this week. I have no idea what President Obama thought he would accomplish with his Mea Culpa press conference, but it boiled down to apologizing for his huge lies 0n keeping current health plans (and prices) by announcing another false promise to keep cancelled plans available.

Mark Steyn skewered the President best on this mind boggling political ‘move’:

On Thursday, he passed a new law at a press conference. George III never did that. But, having ordered America’s insurance companies to comply with Obamacare, the president announced that he is now ordering them not to comply with Obamacare. The legislative branch (as it’s still quaintly known) passed a law purporting to grandfather your existing health plan. The regulatory bureaucracy then interpreted the law so as to un-grandfather your health plan. So His Most Excellent Majesty has commanded that your health plan be de-un-grandfathered.

After which, the President threatened to veto any bill that would make his illegal decree … legal!

The same president who had unilaterally commanded that people be allowed to keep their health plans indignantly threatened to veto any such law to that effect: It only counts if he does it — geddit? As his court eunuchs at the Associated Press obligingly put it: “Obama Will Allow Old Plans.” It’s Barry’s world; we just live in it.

The Democrats are now rightfully in full panic. Their leader is off the rails, along with the health plans of millions of people.  John Hindraker nailed it when he pointed the problem with Obamacare on ignorant do-gooders on the left:

One obvious lesson is that liberalism fails to appreciate the complexity of the world. The hubris required by the Democrats’ attempt to reorder not just a large sector of the economy, but an important part of the lives of millions of strangers, is breathtaking. Recognizing, at least dimly, the difficulty of the task, the Democrats responded by trying to draft a law whose complexity would match that of the reality that it tried to control. That made the situation worse, not better: the more convoluted the statute became, the more unworkable it was. Friedrich Hayek, call your office!

Obamacare also illustrates the inordinate faith that many liberals have in the power of words. Various aspects of reality are not as liberals would like them to be. What is the solution? The magical power of words: reams and reams of paper covered with sections and subsections, commands and requirements. If they can only get the words right, reality will certainly fall into line, just as liberals want it to be!

Obamacare was a Herculean task. I have concluded the entire disaster has shown how what Hindraker calls hubris (and I call the nexus of ignorance and arrogance) has finally plumbed the depths of Big Government Limitations. We have seen the enemy and it is busy-body, do-good liberals who don’t understand the complexity of what they want to try and fix.

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Nov 13 2013

When Arrogance Meets Ignorance: You Get Obamacare

Published by under Obamacare

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?

Years:

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.

Update: This came out as I wrote the above this morning:

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.

A consensus is forming among the experts in this field.  The death spiral is in full force

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Nov 05 2013

GOP Surprise In VA?

Published by under All General Discussions

I have been quietly optimistic Ken Cuccinelli would pull an upset today. McCauliffe is too much the political hack for most people’s taste. Even in Northern Virginia. And Virginia is purple, it stays out of the fringes (e.g., When Dem Chuck Robb beat GOP candidate Olly North).

Some good and bad signs already are appearing in the voting. There are voting machine issues in Loudon County – an area that should swing towards Cuccinelli. At first blush one would assume this bodes badly for the GOP.

But there are long lines in the county as well, and people seem to be pushing through the problem and voting.

Warner from Lovettsville said, “I got to the polls about 6:15 and the parking lot was packed and I go in and there are about hundred people in line and come to find out that the electronic system to validate voters is down.

Paul from Lovettsville agreed telling WMAL, “I’m experiencing the exact same thing he did. I  arrived just before six ‘o’ clock. The great news was that in Loudoun County the lines were packed. People were definitely showing up, but once you got in, there was a connectivity problem.

Contrast that with absentee voting trends:

It’s a tale told by absentee ballots, which can be a good indicator of turnout on Election Day. In Charlottesville, those ballots are pouring in. But in Richmond, a city steeped in politics, things are a bit slower.

“Traditionally the city of Richmond votes heavily in these sorts of things. So far, we are not seeing it,” said Kirk Showalter, Richmond’s voter registrar.

Intensity and determination. If this is on Cucinnelli’s side, then we may be in for a big surprise today.

And I would not be surprised of the ObamaCare debacle is fulling a lot of that intensity.

 

15 responses so far

Nov 05 2013

ObamaCare Implosion: Pay Much More, Get Much Less

Published by under Obamacare

Alternate Title: There Always Was Going To Be Death Panels

Watching liberal, activist government crash and burn on Obamacare is both laughable and sad. Laughable because of all the snake oil people fell for because they want hand outs. Sad, because the lesson to be learned here will be painful, and may even be deadly.

Seriously did you really believe that to cover the chronically uninsured, the rest of us could:

  • Keep our health insurance premium?
  • Keep our health insurance deductible?
  • Keep our health insurance plan?
  • Keep our doctor?
  • Preexisting conditions had to be covered?
  • ObamaCare was on track for a successful launch?
  • Healthcare.gov is a secure system and won’t expose our personal information?

Really? Who but the most delusional still buy this?

To cover the cost of 15 million hard to insure people, everyone was going to get hit. Even seniors.

Obamacare has a new message to seniors: Take two aspirins and find yourself a new doctor in the morning.

And why is this deadly? Check out what happened to Edie Sundbury, who is in the fight of her life against cancer:

… all my energies are directed to enjoying life and staying alive, and I have no time for politics. For almost seven years I have fought and survived stage-4 gallbladder cancer, with a five-year survival rate of less than 2% after diagnosis. I am a determined fighter and extremely lucky. But this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31.

Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team.

You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan—a very restrictive Anthem EPO Plan. EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).

Here is someone who had an affordable plan that was doing everything possible to save her life. Her preexisting condition was not an issue.

But now, thanks to cost cutting measures, she is being DENIED access to the very doctors she’s had by Obamacare. Nothing in that list above is true.

We are all paying a lot more than we were and getting a lot less in return.

So given all the other BS the Obama administration lied about, anyone still want to bet there are no death panels?

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