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Contractors See Weeks of Work on Health Site

nytimes.com

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Re: Contractors See Weeks of Work on Health Site

#91

I've said this before. The fact that these people (government and it's contractors) are going to have and handle our most intimate information AND that the IRS is also in the loop scares the living daylights out of me. The level of incompetence being revealed here is almost without description. To go all the way up to opening day, have these problems and then offer that five million lines of code need to be redone is…

> 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 th…

>> Cheaper, faster, better. All three. > [citation needed]

Lookup the history of laser eye surgery over the last, say, ten years.

Free markets work. That's irrefutable. The problem is we've never had a free market system when it comes to medicine.

Re: Contractors See Weeks of Work on Health Site

#92

Earlier quoted context omitted.

> 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 th…

>> Cheaper, faster, better. All three. > [citation needed] Lookup the history of laser eye surgery over the last, say, ten years. Free markets work. That's irrefutable. The problem is we've never had a free market system when it comes to medicine.

You're cherry picking: laser eye surgery has effective competition, elastic demand, no information asymmetry, and it is priced well within the annual (even monthly) earning potential of most Americans. It's a service that I would expect the free market to be able to provide efficiently and it does not surprise me that it succeeds. The free market is very good at optimizing value creation under certain circumstances and it's great that laser eye surgery matches up with those requirements.

Unfortunately, when it comes to policy we do not get to cherry-pick the conditions under which the rest of the system operates, and the other parts of the health care market run under conditions that demonstrably throw the free market for a loop (hence the system-level failures vs socialized systems I pointed out above). Cancer treatments cannot be paid for out of most people's savings. "Customers" do not always have the chance to shop around between providers (w/o insurance) and those that do use insurance experience a 99% deleveraging effect because only the 1% that have extraordinary costs are in a position to examine the value of what they bought. Do you have a proposed mechanism of breaking information asymmetries, re-leveraging disproportionately expensive consumers, and standardizing the coverage provided by free market plans? Do you have a way of pricing the 5 externalities I listed into the insurance providers' budgets? Has your proposal been implemented in a dozen other countries and proven to be comparatively cost effective for decades?

What is your answer to the figures that show that our system in aggregate is 2-10x less efficient than comparable social systems?

Anybody can cherry pick a counterexample. Anybody can speculatively extrapolate it out to a convenient conclusion. But the single-payer advocates can point to a mountain of directly relevant apples-to-apples evidence regarding the industry as a whole that does not require extrapolating across markets or cherry picking conditions / good years. To me, it appears to be a mountain of evidence vs a pebble. Do you really think the the implicit strength of extrapolation from the (very) special case of laser eye surgery carries weight against these empirical apples-to-apples comparisons?

Re: Contractors See Weeks of Work on Health Site

#93

Earlier quoted context omitted.

>> Cheaper, faster, better. All three. > [citation needed] Lookup the history of laser eye surgery over the last, say, ten years. Free markets work. That's irrefutable. The problem is we've never had a free market system when it comes to medicine.

You're cherry picking: laser eye surgery has effective competition, elastic demand, no information asymmetry, and it is priced well within the annual (even monthly) earning potential of most Americans. It's a service that I would expect the free market to be able to provide efficiently and it does not surprise me that it succeeds. The free market is very good at optimizing value creation under certain circumstances a…

In abstract terms, I would say single payer systems could (and should) work well. It sounds nice to me on paper.

I think an issue is that America has a system of government that lacks a long-term focus. Every 4 to 8 years, we get a new 40-100 year agenda. This leads to tinkering with these social programs and the original goals can get lost, muddled.

That, and our government is not structured very well to deliver services with a largely unaccountable bureaucracy overseen by a divided and paralyzed government. Our government in the process of failing to deliver a service right here (with the exchanges at healthcare.gov).

I could see single payer systems working well elsewhere. In the states, I think it would be implemented badly at 10x the cost. Just my opinion, but I think we should try developing a competitive market for healthcare and reduce government regulation in it and see how that goes. Then, when that flops, we can try out socialized medicine.

Re: Contractors See Weeks of Work on Health Site

#94
post #81

Earlier quoted context omitted.

$800 pays for roughly one day's worth of work for a senior developer in the US. One thousand lines of working, debugged code (which is presumably what's being paid for) sounds like an awful lot of code for one person to write in a day, if the problem domain has any degree of complexity. Some parts of healthcare.gov could be quite complex, e.g., interfacing to other government systems whose APIs are not well documente…

It costs ~$300K for a senior web developer in the US currently?

The per-day rate that a company charges is not the same as the salary that person makes. So yes, it costs 300K to hire a contractor full time. Not only in the US, but on most parts of Europe too.

I feel a bit dirty for having to explain such simple things. All the armchair pundits here are declaring 'how can they screw up a simple website'. Nobody here (except if there are people reading this who actually worked on this project) knows how hard this project is, and how much integration is required. Personally, if somebody had asked me to make a quote for a project this size a year ago, and going on the information we have now, I would have said that it's impossible to build something this big and this complex within a year. Can't be done. IT systems of tax administrations of small countries that do less than this system have cost 10 years to get to a stable, workable state. How can anyone build this within a year?

Re: Contractors See Weeks of Work on Health Site

#95

> According to one specialist, the Web site contains about 500 million lines of software code. > One specialist said that as many as five million lines of software code may need to be rewritten before the Web site runs properly. Oh, so only 1%! Tangentially, why are so few quotes in this article sourced? I see no reason why they shouldn't be. It's all throughout the article... They keep quoting "specialists."

In something this loaded with politics, I wouldn't imagine anyone involved would think it a good career move to have their names attached to bad news quoted in the press?

The only people I've seen willing to go on the record have been:

"Stan Z. Soloway, president and CEO of the trade association that represents hundreds of government service companies" who parsed the contracts and independently confirmed that there's no prime integrator (i.e. the HHS CMMS is doing/failing that job, https://news.ycombinator.com/item?id=6569042).

One or more big insurance company CEOs; they're the ones who have to deal with the gubble the backend is delivering to them.

Various mostly bloviating politicians like John McCain.

Even yesterday's HHS blog posting (http://www.hhs.gov/digitalstrategy/blog/2013/10/making-healt...) is unsigned.

Re: Contractors See Weeks of Work on Health Site

#96
post #31

Earlier quoted context omitted.

Don't forget to add in the lines of code for the Linux kernel on which they are running and the MySQL database etc etc. I kept reading the article and on the last you find this gem: According to one specialist, the Web site contains about 500 million lines of software code. By comparison, a large bank’s computer system is typically about one-fifth that size. That to me suggests the number is bogus, because it is so o…

Simply measuring the web site in 'lines of code' as if that's meaningful indicates that it's a quote by someone who is not aware of how modern programming works.

Disagree, perhaps. If you were talking to a New York Times reporter, with an intended lay audience, how would you describe scope issues like this?

And while it's a poor metric, lines of code is not completely useless.

Re: Contractors See Weeks of Work on Health Site

#97

Sounds like a load of crap to me. Seriously, 500 million lines of code? I bet not even mission-critical code written to power NASA spacecraft and satellites are anywhere near that length. I propose they give the project to the HN community, divide up the $400 million figure amongst the participants and give us a weekend and I bet we'll have more to show than that of the so-called developers the government hired. I am…

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 fas…

"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....

Re: Contractors See Weeks of Work on Health Site

#98

I wonder what languages it focuses on. I haven't heard. I find some of it amusing - I've worked on some enterprise-level projects with business systems talking to other business systems, and I can only imagine how much eye-rolling is going on among the programmers that are actually trying to do the work. This is a project where some very visible, loud people have a vested interest in it looking bad even if it were fl…

"This is a project where some very visible, loud people have a vested interest in it looking bad even if it were flawless."

Are any of the managers in the White House, HHS and CMMS in that category? Certainly not loud (nobody is speaking on the record: https://news.ycombinator.com/item?id=6586119), but perhaps anti-Obamacare moles?

Because the people running this show every sign of being true believers, and I seriously doubt they're playing much attention to the "waco birds" who are totally against it.

Re: Contractors See Weeks of Work on Health Site

#99

I wonder what languages it focuses on. I haven't heard. I find some of it amusing - I've worked on some enterprise-level projects with business systems talking to other business systems, and I can only imagine how much eye-rolling is going on among the programmers that are actually trying to do the work. This is a project where some very visible, loud people have a vested interest in it looking bad even if it were fl…

The sad thing is that the site being bad should be really tangential to the politics. I personally would love to see outright socialized healthcare, where everyone was mandatorally enrolled in a government created program. I feel like we'd have the most leverage to bring costs down under a centralized and non-profit system. However, this system being as broken as it is - and costing as much as it has - did nothing to…

I guess you can't see how giving the government even more power of life and death over its subjects can be anything but political?

Certainly the U.K. NHS experience shows the running of such a system is political. I don't watch it closely, but as I understand it Tony Blair/New Labour doubled spending, but somehow functionaries and bureaucrats got the new money, not the front line people and institutions.

You think we can have anything less than a totally political discussion about euthanasia, most recently known as the Liverpool Care Pathway in the NHS?

Re: Contractors See Weeks of Work on Health Site

#100
post #38

"One specialist said that as many as five million lines of software code may need to be rewritten before the Web site runs properly." Yikes! I don't think these "experts" are going to be fixing this anytime soon.

The sad part is that it sounds like they're already being paid to do so - they were quoted as being Federal Contractors. We really need a public peer review system for technical contracting of government projects. This is getting insane. These schmucks fleeced 500 million from our government ( us ) for a barely functioning website, and now some snake oil contractors are going to come in to "fix it" and fleece us for…

Given the obviously appalling management "these schmucks" were subjected to, per the article "In the last 10 months alone, government documents show, officials modified hardware and software requirements for the exchange seven times.", plus our hearing from multiple sources that there were getting change orders through the beginning of the week per launch, can you honestly say they fleeced us?

I can't imagine any way the contractors could have delivered a working system under the constraints we've been hearing, including most especially the unqualified Federal HHS CMMS government bureaucrats taking upon themselves the role of integrator of the 50+ parts of this system.

For that matter many people at all levels of this have been waving red flags, which the people running the show have studiously ignored. I mean, you know someone told them "you've got to freeze the requirements and give the programmers some time to get the job finished", not to mention "it needs more than one week of testing"....

Some of the remedial steps we're hearing about, like monitors for system bottlenecks, sound to me like things the integrator should have made part of the system from the beginning....

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