Contractors See Weeks of Work on Health Site

On an ipad so i can't even hope to author a lenghty reply.

>> I can't even attempt to understand where you might be coming from.

> MSCS student, ex-libertarian. I took a health care policy class in undergrad to satisfy a requirement and it changed my worldview.

Ah. OK. I get it now.

To be clear. I am not attacking you personally but rather making a comment on the frame of reference from which you are basing your views.

First. Academia is chock full of socialist extremists. Not sure how well you are/where able to see through this if present and filter it out.

Second. Don't think for a minute that a class such as that actually reflects reality without getting out to the real world. In other words, trust but verify.

Finally. You are wrong about such things as medicare being wonderful. My wife is a doctor. I won't go into some of what I've learned other than to say that people are suffering horribly due to the failings of that system.

In looking at our system versus other you seem to be ignoring the effects our litigious society has on the cost of, well, everything. I won't go into what we are paying for malpractice insurance (without even the semblance of a negative mark on her entire professional history).

At a very raw level, given how late in the game it was before the programmers were able to get started (obviously not their fault when CMS (sic, should be CMMS but isn't') took on the integrator role), obviously the project is going to copiously burn money. Pity the other constraints caused it burn quality (going by the old "pick two of time, money and quality").

"but thinking about it this morning I realized that they probably had to integrate with the systems of (every|many) major existing healthcare provider in the country to actually make this work as desired. I can see now where that wouldn't be cheap."

Actually, that's one part that shouldn't have been expensive for the government, except in support services. As in they should have standard, sane input formats for policy details and output for enrollees that any participating insurer could adapt their systems to. IT must be a core competency for a successful insurer, since everything? they do aside from marketing is IT mediated.

There's been some reported troubles with getting the policy details right, although I think what I heard was about one or more state exchanges---with guaranteed issue and community rating it's rather more simple than normal, but then again a customer's FICO score can and I gather generally/always is used in the pricing. At the other end the insurers aren't reporting trouble in getting and parsing the data, just in it being self-evidently incorrect, e.g. some customers being reported as enrolling and canceling several times. Which they're addressing, while the volume is so low, by calling them up (everyone wants to complete the circle anyway).

On the other hand, you know it took a while for everyone to hammer out those formats, especially the input one. The output should be pretty simple, just needs to have all the particulars correct. E.g it would be a bad sign if an insurer was getting people enrolled in a policy they didn't offer.

> First. Academia is chock full of socialist extremists. Not sure how well you are/where able to see through this if present and filter it out.

You are correct that the academic frame of reference played a large role in developing my worldview, but bias swings both ways. I think it's telling that I am able to back my arguments with specific measurements and comparisons while you resort to philosophical generalities.

Economic incentives in the software industry tend to match competence, effort, and risk-taking with just reward, at least to some degree. Developers tend towards libertarianism because they and their associates are able to make the market work for them. Favorable economic conditions shelter them from market failures (health care costs 2x as much? Eh, it was a benefit anyway, and a small fraction of a typical yearly salary in any case).

Unfortunately for academics, the good they produce is neither excludable nor easily measurable, leading to systemic undervaluation by the market (I'm not talking about CS research here so much as the hard sciences). They are more directly exposed to the market's hairy underbelly and tend to be more skeptical of the whole endeavor because in their day to day lives they and their associates have a much more difficult time coupling value creation to market-provided reward.

> Don't think for a minute that a class such as that actually reflects reality without getting out to the real world. In other words, trust but verify.

Don't think for a minute that the tech/startup scene (to include your employment experience and entrepreneurial activities) actually reflects the bulk of America or the world. Your real world experience is far too narrow to be relevant to the issue at hand. You cannot decide how to manage a forest by staring at a blade of grass. As an in-demand professional (married to another in-demand professional) your experiences are not only nonrepresentative but provably atypical. You need numbers, not self-gratifying philosophical principles to see past this bias.

> You are wrong about such things as medicare being wonderful.

I never said that. I think our hybrid system is a monstrosity.

What I did say was that medicare had low administrative overhead compared to private insurance plans, defined as E(1-cost/payout). In other words, private plans are provably failing to deliver on their promise of greater efficiency by a factor of 4 (and these are the efficient employer-aggregated plans). I also said medicare drove a hard bargain as compared to private plans, a claim which I can substantiate [1], in order to head off a potential attempt to shuffle the blame for the US's inflated costs onto medicare.

The hybrid system is a monstrosity, but I conclude that the private half is dragging down the public half, not vice-versa. My reasons:

* International comparisons (universal systems are beating us by a factor of 2 at cost metrics and matching our quality metrics even if you ignore the ~50M people our system dumps entirely)

* Explicit reasoning about why the health care market is a rat's nest of edge cases for the free market [3]

* Internal comparisons between medicare and private insurance (the 2 reasons I listed which you straw-manned into "medicare is wonderful")

> you seem to be ignoring the effects our litigious society has on the cost of, well, everything

Because malpractice insurance accounts for Doctors disproportionately care about litigious waste just like HNers disproportionately care about ACA exchange contracting waste. Both concerns hide the bigger picture. As bad as these two problems are, they are tiny compared to the macroeconomic problems. Billions vs trillions.

[1] http://www.californiahealthline.org/articles/2013/10/15/stud...

[2] http://www.justice.org/cps/rde/justice/hs.xsl/8686.htm

[3] https://news.ycombinator.com/item?id=6582297