Contractors See Weeks of Work on Health Site

Yes, we've burned at least $400 mil. Last week, everyone insisted it only cost $55 million, and the $768 million figure was misreported. I can only speculate what the final cost will be after victory is declared over these bugs.

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.

Here's a fascinating visio diagram that shows just how much government has grown under the ACA. Anything red indicates new or expanded government:

http://www.jec.senate.gov/republicans/public/index.cfm?a=Fil...

Seems like the ACA created very painful integrations between federal systems and insurers, asking them to do many new things. Not a big surprise they're having problems. Some federal IT systems are archaic and integrations/change are costly and fraught with danger. The insider stories I've read about the Soc Security mainframe-based system are frightening!

> It is hard to argue with what is unfolding before our very eyes

What we are seeing right now (~.5B waste) is a drop in the bucket compared to waste in the US system as compared to socialized systems. We pay ~2x as much for comparable health care (per person per mean PPP-adjusted GDP/capita) [1]. That is about 250b/yr we are spending on a (more closely) free market system that keeps promising to be more efficient than its social counterparts and keeps failing to deliver, or even deliver in the same ballpark. I realize that HN is a site about code, but it's important to keep some perspective here. $500M (itself an inflated figure) is 0.2% of $250b. If it is hard to ague against $500M of waste, it surely must be nearly impossible to argue against $250b of yearly, recurring waste, no? How do you ignore these figures?!

If you're going to argue that our system makes up the difference with better outcomes, I want to see numbers. I happen to know that they don't support this argument, but I want you to do the search so that you can't dismiss my sources by assuming they were cherry-picked.

> I happen to think ... Free market decentralized healthcare ... would have been a far better approach

Of course, $250b/yr includes the cost of providing care as well as administration. Perhaps administration of a free market system is more efficient? Not when you compare the US (31% administrative overhead) to Canada (16.7%) or the UK (6%) [2], [3]. This isn't a surprising result, either: I recently listed 7 reasons why exchanges should be more efficient than current individual plans [4] and you can add the profit margin and advertising costs to that list to come up with 9 advantages a single-payer system would have over a free market health care system.

Markets are good at optimizing things that can be quantified, so perhaps a better comparison would be between medicare and private insurance (not overall administration, just the insurance part). Again, the government systems come out ahead: Medicare overhead is 3.6%, Canada's insurance-related overhead is 1.3%, and overhead among private US insurers is 11.7% [2].

> Cheaper, faster, better. All three.

[citation needed]

See [5] for a more complete overview of the pro-single-payer argument and a truckload of reputably-sourced studies and comparisons (as opposed to hand-wavey promises) to back it up.

[1] http://en.wikipedia.org/wiki/List_of_countries_by_total_heal...

[2] http://www.pnhp.org/single_payer_resources/administrative_wa...

[3] http://nhsrationing.org/tag/administrative-costs/

[4] https://news.ycombinator.com/item?id=6582753

[5] http://www.pnhp.org/facts/single-payer-resources

Thanks for saying this... it needs to be said far more often.

I wish there were a book about how to READ software. (If anyone knows of one, please speak up.)

One tip I picked up on my own over time is when you're looking at an unfamiliar project, don't read the code like a book, read it like a program. In other words, try to find main() and trace how things work from the bottom up, rather than trying to understand it based on how the authors have broken up the code into directories. I don't know yet whether this is truly good advice.

Here's the frightening story I recalled on Social Security from 2011. http://www.informationweek.com/government/enterprise-archite...

Woe be to the phalanx of ACA consultants that has to integrate with those systems... :/

One specialist said that as many as five million lines of software code may need to be rewritten before the Web site runs properly.

In comparison:

  Windows 95 had 15 million lines of code.
  Windows 98, 18 million
  Windows XP, 35 million

http://www.nytimes.com/2006/03/27/technology/27soft.html?pag...

Luckily they have about 8 weeks.