"It is too late to get mad about any new/rising costs related to the ACA. It is here to stay and might as well be Medicare 2. "Law of the land" as the president is fond of saying."
Reading this article, which at the highest level tells us the people in charge, the White House and HSS's CMMS (all government workers, the latter the integrator of the project) are still discussing how to fix this mess, hoping to have a plan by Thursday, combined with e.g. CMMS delivering changes to the contractors through the week before launch, and per this article "In the last 10 months alone, government documents show, officials modified hardware and software requirements for the exchange seven times.", suggests to me it could easily be years before the exchange works, and possibly never. We've seen this before (FAA, FBI, IRS, etc.).
All depends on CMMS (non-specialist civil servants and perhaps political appointees) learning big project management "on the job" or the vast majority of them getting replaced by an integrator who has a clue, either of which will take months.
That's just what's required to get sane high level management of the project.
In the meanwhile, can the individual parts done by different contractors get some serious progress? Well, first it depends on CMMS freezing requirements, and doing a good enough job of deciding what requires a total rewrite. Per this article:
"Quality Software Services Inc., or Q.S.S.I., a unit of the UnitedHealth Group, developed the identity management system, another major component that allowed consumers to register and establish accounts.
The identity management system from Q.S.S.I., which also taps into government databases to retrieve users’ personal information, was a particular source of trouble when the exchange opened. Change orders show that on Oct. 4 — after millions of people had been trapped in technological loops trying merely to log in — the government asked CGI to help it devise a new identity management system to replace the one provided by Q.S.S.I. But specialists said that approach was abandoned as too risky. Ultimately it was decided to fix the current identity system."
And we've heard from a HN member who was involved in a big university project that Oracle's identity software is fairly gnarly to get working. Which I have absolutely no trouble believing, because the underlying problem is gnarly.
But one wonders just how much panic was behind CMMS's idea of punting the existing one 3 days after launch. And you know the managers of both contractors had to spend a lot of time working with CMMS on just this detail ... working with people who are simply not (very) experienced in software development and management.
(Ask for my worst experience working for a government for the level of cluelessness that's likely involved here.)
So, getting to my point, you may say "It is here to stay", but "You Can't Fight Mother Nature" or the hard reality that computers do exactly what you tell them to do, not what you want them to do. How many months or years do you think people will stand for being fined by the IRS for not enrolling when they can't? How many will die because they've lost their existing coverage due to the ACA changes but can't sign up for anything, or anything they can afford without the subsidies which only the exchanges can (now) deliver? What happens if this not entirely nonfunctional system develops an adverse selection death spiral?
That's where only the very dedicated, the ones who really need a lot of healthcare, jump through the hoops, whereas the healthy 20 somethings and beyond, who are asked to do a 30 step (!) application on an unreliable system, punt, pay the fine but not the much larger sums needed to subsidize the 50-64 age bracket. Which raises the prices of the policies offered, which further decreases enrollment....
It does seem that dismal failure is the most likely outcome.
I just read between the lines when I hear "law of the land" and I think there's NO way the administration is going to back down here. It is going to be interesting to see how things go down. Perhaps they'll just hire human agents to take the place of the broken site?
Can human agents handle the 7 million applicants needed to make it work (at least early on)? And they'll still need computer support, I presume you're only talking about taking the place of the front end web site.
Trying to do 7 million identity checks manually? Well, maybe something can be kludged to speed that up. On the other hand subsidy calculations had better be done by computer, and that's not working reliably right now; it could probably be Tiger Teamed into something that works and at scale, a simple calculator (heck, I bet it could be done in Javascript).
But again I get to the biggest problem of management. Starting at the very top, the CEO of this organization (Obama, per his Rose Garden event earlier today), they're in (public) denial of how bad the problem. In part they can't help it, they aren't experienced IT people, they aren't like us who can look at less than 1,000 words of clues and know "it's fucked".
Really salvaging anything out of this needs decisiveness. E.g. to get your kludge working for 2014---and again I note the critical detail of subsidies, especially since the only plan that can now be offered is gold-plated (e.g. coverage of your children through age 26) and inherently very expensive even before you get to community rating (everyone under 50 is to pay a bundle to cover the 50-64 set)---someone would have to decide to start it now. "Wastefully", in parallel with trying to get the site to work. As it is, millions are losing their old-fashioned high deductible major medical polices as of Jan 1st, things start getting really bad for a lot of people really soon.
If this nightmare drags out to 2016 (which today we can't discount, and that's even counting the website or its substitutes vaguely working), do you really expect it to be the law of the land by 2018?
Comments
"It is too late to get mad about any new/rising costs related to the ACA. It is here to stay and might as well be Medicare 2. "Law of the land" as the president is fond of saying."
Reading this article, which at the highest level tells us the people in charge, the White House and HSS's CMMS (all government workers, the latter the integrator of the project) are still discussing how to fix this mess, hoping to have a plan by Thursday, combined with e.g. CMMS delivering changes to the contractors through the week before launch, and per this article "In the last 10 months alone, government documents show, officials modified hardware and software requirements for the exchange seven times.", suggests to me it could easily be years before the exchange works, and possibly never. We've seen this before (FAA, FBI, IRS, etc.).
All depends on CMMS (non-specialist civil servants and perhaps political appointees) learning big project management "on the job" or the vast majority of them getting replaced by an integrator who has a clue, either of which will take months.
That's just what's required to get sane high level management of the project.
In the meanwhile, can the individual parts done by different contractors get some serious progress? Well, first it depends on CMMS freezing requirements, and doing a good enough job of deciding what requires a total rewrite. Per this article:
"Quality Software Services Inc., or Q.S.S.I., a unit of the UnitedHealth Group, developed the identity management system, another major component that allowed consumers to register and establish accounts.
The identity management system from Q.S.S.I., which also taps into government databases to retrieve users’ personal information, was a particular source of trouble when the exchange opened. Change orders show that on Oct. 4 — after millions of people had been trapped in technological loops trying merely to log in — the government asked CGI to help it devise a new identity management system to replace the one provided by Q.S.S.I. But specialists said that approach was abandoned as too risky. Ultimately it was decided to fix the current identity system."
And we've heard from a HN member who was involved in a big university project that Oracle's identity software is fairly gnarly to get working. Which I have absolutely no trouble believing, because the underlying problem is gnarly.
But one wonders just how much panic was behind CMMS's idea of punting the existing one 3 days after launch. And you know the managers of both contractors had to spend a lot of time working with CMMS on just this detail ... working with people who are simply not (very) experienced in software development and management.
(Ask for my worst experience working for a government for the level of cluelessness that's likely involved here.)
So, getting to my point, you may say "It is here to stay", but "You Can't Fight Mother Nature" or the hard reality that computers do exactly what you tell them to do, not what you want them to do. How many months or years do you think people will stand for being fined by the IRS for not enrolling when they can't? How many will die because they've lost their existing coverage due to the ACA changes but can't sign up for anything, or anything they can afford without the subsidies which only the exchanges can (now) deliver? What happens if this not entirely nonfunctional system develops an adverse selection death spiral?
That's where only the very dedicated, the ones who really need a lot of healthcare, jump through the hoops, whereas the healthy 20 somethings and beyond, who are asked to do a 30 step (!) application on an unreliable system, punt, pay the fine but not the much larger sums needed to subsidize the 50-64 age bracket. Which raises the prices of the policies offered, which further decreases enrollment....
It does seem that dismal failure is the most likely outcome.
I just read between the lines when I hear "law of the land" and I think there's NO way the administration is going to back down here. It is going to be interesting to see how things go down. Perhaps they'll just hire human agents to take the place of the broken site?
Can human agents handle the 7 million applicants needed to make it work (at least early on)? And they'll still need computer support, I presume you're only talking about taking the place of the front end web site.
Trying to do 7 million identity checks manually? Well, maybe something can be kludged to speed that up. On the other hand subsidy calculations had better be done by computer, and that's not working reliably right now; it could probably be Tiger Teamed into something that works and at scale, a simple calculator (heck, I bet it could be done in Javascript).
But again I get to the biggest problem of management. Starting at the very top, the CEO of this organization (Obama, per his Rose Garden event earlier today), they're in (public) denial of how bad the problem. In part they can't help it, they aren't experienced IT people, they aren't like us who can look at less than 1,000 words of clues and know "it's fucked".
Really salvaging anything out of this needs decisiveness. E.g. to get your kludge working for 2014---and again I note the critical detail of subsidies, especially since the only plan that can now be offered is gold-plated (e.g. coverage of your children through age 26) and inherently very expensive even before you get to community rating (everyone under 50 is to pay a bundle to cover the 50-64 set)---someone would have to decide to start it now. "Wastefully", in parallel with trying to get the site to work. As it is, millions are losing their old-fashioned high deductible major medical polices as of Jan 1st, things start getting really bad for a lot of people really soon.
If this nightmare drags out to 2016 (which today we can't discount, and that's even counting the website or its substitutes vaguely working), do you really expect it to be the law of the land by 2018?