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United States Medicine IT

Lessons From the Healthcare.gov Fiasco 501

Posted by samzenpus
from the better-luck-next-time dept.
Nerval's Lobster writes "In theory, the federal government's Health Insurance Marketplace was supposed to make things easy for anyone in the market for health insurance. But fourteen days after the Website made its debut, the online initiative—an integral part of the Obama administration's Affordable Care Act—has metastasized into a disaster. Despite costing $400 million (so far) and employing an army of experienced IT contractors (such as Booz Allen Hamilton and CGI Group), the Website is prone to glitches and frequent crashes, frustrating many of those seeking to sign up for a health-insurance policy. Unless you're the head of a major federal agency or a huge company launching an online initiative targeted at millions of users, it's unlikely you'll be the one responsible for a project (and problems) on the scale of the Health Insurance Marketplace. Nonetheless, the debacle offers some handy lessons in project management for Websites and portals of any size: know your IT specifications (federal contractors reportedly didn't receive theirs until a few months ago), choose management capable of recognizing the problems that arise (management of Healthcare.gov was entrusted to the Medicare and Medicaid agency, which didn't have the technical chops), roll out small if possible, and test, test, test. The Health Insurance Marketplace fiasco speaks to an unfortunate truth about Web development: even when an entity (whether public or private, corporation or federal government) has keen minds and millions of dollars at its disposal, forgetting or mishandling the basics of successful Web construction can lead to embarrassing problems."
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Lessons From the Healthcare.gov Fiasco

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  • by khasim (1285) <brandioch.conner@gmail.com> on Monday October 14, 2013 @03:07PM (#45124455)

    And you have to realize that not everyone on the team has the same goals.

    How much do the contractor companies get paid for overtime or change requests?

    When I'm a contractor I will tell you what problems there could be that I can see. But if you tell me to do it your way I'll do it your way and collect my check.

  • Contractors (Score:5, Insightful)

    by Todd Knarr (15451) on Monday October 14, 2013 @03:12PM (#45124521) Homepage

    Part of the problem is the usual problems with large-scale IT projects: it's not until you're well into it that you really get a grasp of what's involved. Nothing government-specific there, that plagues all large IT projects in private industry. Part of the problem, though, lies exactly in the fact that contractors were used. Contractors are mercenaries. They're here to deliver this project, and once they get their paycheck they're on to other work. They won't be around to deal with the fall-out and maintenance headaches from their work, and they don't have any vested interest in the quality of their work as long as it's good enough to pass review and get their payment check cut. In fact, poor quality is actually an opportunity to get paid twice since fixing the problems is a new project. Full-time permanent employees may not be as efficient as contractors, but on the other hand they've got a vested interest in making sure the system doesn't create any more problems than necessary because they know they're the ones who're going to have to clean up the messes. Long-term employees also have a better grasp of what's already involved in the current system, which translates directly into a better grasp of what the new system will need to do. They're less likely to miss major complications because they already have to deal with them.

    Part of the problem with contractors is also the fact that large organizations like governments limit themselves to Tier 1 contractors. And there aren't a lot of those. So it rapidly becomes a situation where the Tier 1 contractors aren't really concerned about quality and results, because they know their customers will by policy refuse to consider any alternatives outside a small set and those others aren't any better about quality. If the government switches from contractor A to B, that means B can't take on another customer who takes their business to A (because A and B are the only Tier 1 firms and the customer can't consider anyone who isn't a Tier 1 firm) and it's a net wash for A.

  • by jedidiah (1196) on Monday October 14, 2013 @03:18PM (#45124579) Homepage

    The political rhetoric is irrelevant. The point is that states implemented their own systems and none of them have been declared a disaster. You don't hear about any of them because they are working as intended. All of these other systems are just too boring to make the news.

    Each of them stands as an example of why the problem is not an insurmountable one and perhaps not even a terribly difficult one.

    Each one of them shames the federal government.

  • by jedidiah (1196) on Monday October 14, 2013 @03:22PM (#45124633) Homepage

    It's essentially an e-commerce site with a government subsidy element added to it. There are any number of similar sites that already existed. They were created to fill the same basic market need by people interested in making a buck.

    Since this whole thing was a gift to the insurance industry, perhaps the feds should have considered that the industry may have made a useful partner. Let all of the insurance sales men out there be honorary do-gooders helping themselves while helping Obama's agenda.

  • Campaign team (Score:4, Insightful)

    by curunir (98273) * on Monday October 14, 2013 @03:22PM (#45124635) Homepage Journal

    I find it interesting that the team behind the technical aspects of Obama's presidential campaign were so capable (more here [theatlantic.com]...it's a great read) and yet he still chose the tried and false alternate model of outsourced government contractors to handle this.

    A methodology more similar to what was used on his campaign would have been far more successful and cost significantly less.

  • by ebno-10db (1459097) on Monday October 14, 2013 @03:25PM (#45124675)

    Facebook and Twitter started out small and grew. That's also true of Google, Amazon, and just about any other very high volume site. This is different because they had to build a site and then, on the first day, turn on the fire hydrant all the way. I'm sure there are plenty of things they did wrong, and it was probably very badly organized. Nevertheless I'm curious what the best way to handle something like this would be. How many people have worked on a project where they had to go from zero to millions of users one day? Obviously massive test capability would be part of doing it right, but often that doesn't wring out all the unforeseen cases.

  • by NoNonAlphaCharsHere (2201864) on Monday October 14, 2013 @03:28PM (#45124713)
    So ~30 hostage-takers get to override the other 500 House and Senate members? We have a first-past-the-post system, which guarantees a 2-party system. If we had a proportional system, we could have these kind of splinter groups in a coalition government, much the way Israel runs. But when one faction holds its breath until it turns blue, the whole government can fall. We HAD a national referendum on Obamacare, i.e. the last presidential election, where the Republicans were the ones who wanted to make the election about it - AND THEY LOST.
  • by rbrander (73222) on Monday October 14, 2013 @03:43PM (#45124857) Homepage

    It's pushing 20 years since I first saw an academic study showing that IT project failure probability increases dramatically - the latest was 2005:

    The Challenges of Large-Scale IT Projects [waset.org]

    You're darn right I won't be put in charge of such - not without a gun to my head. I'd want to de-scale anything down to a size where you could reasonably spec and test it. As the article says, "test, test, test". A formative experience in my programming was FORTH, a language that strongly rewards small incremental experiments, compiling as you go, building from small functions up to large ones. I'm not saying use FORTH, but the philosophy of getting the basics working and building up has really worked for me for a whole career.

    By contrast, all the large-scale projects I've worked on have all taken a philosophy like building a skyscraper or 747 - no one person can comprehend it, design everything before the first screwdriver is picked up, so the design process goes on for months and years, etc. And then you have "crunch time" from then on as the fond beliefs of the design team smack into reality, and the specs are proven to not match needs. Incremental building and testing tends to reveal these problems.

    The fear that drives these philosophies is that you'll have the thing mostly built...and discover it doesn't meet every need and can't without some huge rebuild, because you didn't think of everything up front. Rather like an old system that's been patched to death and has to be tossed because it just can't keep up with changes. I think the fear exaggerated, particularly if the design-build team is at least roughly aware of the whole project dimensions.

    The advantage of more-incremental projects that are never large because you take one part at a time is you develop in priority order. The 80/20 rule suggests that 80% of the clients will want about 20% of the options available - so get 20% of the offering working, and working well, first.

    Canada has this story of medical records: http://news.slashdot.org/story/09/10/10/0124227/open-source-could-have-saved-ontario-hundreds-of-millions [slashdot.org]
    As /. covered it, "open source" would have saved 95% of project costs, but I think it was also about the open-source development was in small increments, no large projects.

  • Re:I wonder if (Score:3, Insightful)

    by alexander_686 (957440) on Monday October 14, 2013 @03:44PM (#45124883)

    What hostile minority? It is the executive branch that was âoeexecutingâ the plan. Considering that this is seen as Obama's greatest achievement and Obama gets the pick the staff I can't think of a minority opposed.

    If you are talking about the backseat drivers - the Republicans - well congress has oversight but no powers in this case. Sigh. No. This falls squarely on the shoulders of Obama.

  • Re:I wonder if (Score:3, Insightful)

    by GodfatherofSoul (174979) on Monday October 14, 2013 @03:45PM (#45124887)

    You really think the President is going around shutting down just vet memorials to make some kind of a point? A shutdown means government services are shut down. Just because a handful of congressmen stand outside of the most controversial ones, doesn't mean that's all that our government has stopped doing. Pretty clueless for people to start taking a strategy one wing of the Republican House has bragged about for MONTHS now and blame it on the President.

  • by rbrander (73222) on Monday October 14, 2013 @03:47PM (#45124917) Homepage

    ...wasn't the whole "dot bomb" crash about doing stupid things (pets.com) in an expensive way (all those Aeron chairs) and throwing more money at the problem to fix it? The notion that "government" is a worse bureaucracy than other large bureaucracies like, oh, a healthcare insurer, say... has never clicked with me; I've tried to get service from (or worked in) too many large private bureaucracies.

  • by Austrian Anarchy (3010653) on Monday October 14, 2013 @03:53PM (#45125009) Homepage Journal
    Not to worry. It is not like the customers of Healthcare.Gov are going to go shopping anywhere else. They have captured 100% of the market at the barrel of a gun. It is like the old American Telephone & Telegraph phone service, except they can go into your checking account for a billing dispute, or take your tax refund if you refuse to do business with them.
  • Re:I wonder if (Score:5, Insightful)

    by dhanson865 (1134161) on Monday October 14, 2013 @03:54PM (#45125023)

    What production website do you know of where development stopped and the product had no issues?

    Development is an ongoing process that goes up to and beyond the day of product release. There will always be security holes to patch, bugs to fix, changes to be implemented, new features to be added.

    If you think you can release a product on day x and lay off / fire / furlough all the developers the same day and have a good product you are part of the problem not part of the solution.

  • by Anonymous Coward on Monday October 14, 2013 @03:54PM (#45125025)

    Obviously the math doesn't work out if your whole family racks up one doctor visit every three years; it's so that when you get cancer and run up bills in the six or seven figure range, you aren't completely boned.

    I mean, what do you think "insurance" means, anyway?

  • by Obfuscant (592200) on Monday October 14, 2013 @04:04PM (#45125167)

    So ~30 hostage-takers

    54 Democrats voted along party lines to "pass" a modified continuing resolution that they knew in advance would not pass the House. So no, not ~30, more like 54.

    We HAD a national referendum on Obamacare, i.e. the last presidential election,

    I voted in the last presidential election. I don't recall seeing any ballot entry for "support ACA". What "national referendum"? Trying to claim that every vote for Obama was a vote in favor of the ACA is as meaningless as trying to claim that every person who goes to McDonalds does so because they like the fine urban atmosphere and prompt friendly service.

    Those Republicans who added the amendment to the CR did so because THEIR referendum told them to. Either you claim that an elected official has a "referendum" on a specific item and has to follow that and accept that the Republicans are doing what they promised they'd do, or stop pretending.

    If you really want to talk "national referenda", let's talk Gitmo (still open). Iraq. Afghanistan. Open and transparent government (one way mirror -- NSA sees us, we don't see them). Hope AND Change (not "Hope FOR a change".) There certainly must have been an overwhelming mandate in the national referendum, and yet these are delayed or forgotten.

    As for the ACA itself, and delaying the individual mandate. Keep very centered in your mind that Obama has delayed the mandate for corporate compliance by a year on his sayso alone. People who donate money got a delay. People who vote don't deserve a delay. Why is this corporate voice in the process now irrelevant, when it is so unethical in everything else?

  • Re:I wonder if (Score:0, Insightful)

    by Anonymous Coward on Monday October 14, 2013 @04:16PM (#45125303)

    No security present. Use at your own risk.

    Agreed, as a mugger and occasional rapist, I feel I have been deprived this opportunity. Stupid Obama administration.

  • Re:I wonder if (Score:4, Insightful)

    by I'm New Around Here (1154723) on Monday October 14, 2013 @04:34PM (#45125529)

    So the logical thing would have been to install those fences and station armed guards every evening after the memorial was vandalized. Not all day a couple months later to keep daily visitors out.

    Keep defending it if you want, but the people of this country know when someone is acting like a spoiled child, taking his toys and pouting in the corner. This has nothing at all to do with the shutdown, and everything to do with an ego.

  • by alexander_686 (957440) on Monday October 14, 2013 @04:53PM (#45125745)

    Well, no. The Dot Bomb was caused by wild irrational exuberance. I have yet to meet a government bureaucracy that was characterized as having âoewild irrational exuberanceâ.

    And I think there is an important difference. If a company has poor customer relations people will go elsewhere or start up their company. The old companies will go bankrupt. The amount of damage is limited.

    Government bureaucracies are different. If they fail they don't go out of business. Often another layer of regulation and bureaucracy are laid on top of the old so the whole thing grows. (I also think it ties to incentives and who chooses to work for government. In business risk generally have huge upsides with limited downsides. In government that is reversed. Risk taking is meet with limited upsides and serious downsides.)

  • by Tassach (137772) on Monday October 14, 2013 @06:11PM (#45126577)

    You have to remember that, prior to Nixon's Southern Strategy, southern Democrats (AKA Dixiecrats) were the Tea Party of their day: racist, xenophobic, religious fundamentalists bent on socially regressive and theocratic policies.

    The south remained solidly Democratic from 1865 to 1965, a legacy of the Civil War and Reconstruction. The only thing that got them to switch sides was because the butthurt of a Yankee Catholic giving civil rights to the n*****s was greater than the butthurt of a Republican giving them freedom in the first place.

    Most people tend to forget that, from Lincoln to Teddy Roosevelt, the Republicans were the progressive party, and the Democrats were the Conservatives. It wasn't until after the Taft-Roosevelt split at the 1912 Republican National Convention in that the GOP started becoming the party of big business and fiscal conservatism. The progressives eventually migrated to the Democratic party, but this just exacerbated the existing split between the northern Democrats and the Dixiecrat faction. For much of it's history the Democratic party was as dysfunctional and fractious as the GOP is today - unsurprising, considering that the Tea Party, the Dixiecrats, and the Civil War era Know Nothings are basically different manifestations of the same ideology and encompass the same demographic.

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