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Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

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Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#131

Post by watwut »

tunesmith wrote: post #85

It's a great article, but this last line drives me crazy: "But in the end [the President] was as aloof from the people and facts he needed to avoid this catastrophe as he was from the people who ended up fixing it." It sounded to me more like he was trusting people whose job it was to deliver. So his failure to micromanage is somehow being "aloof". Never pass up an opportunity to reinforce a media meme, I guess.

My understanding is that bad news did not bubbled up. They stayed hidden and that one is cultural problem.Instead of president being informed that project will be late, programmers were informed that failure is not an option. Turned out it was an option.

Cultural problems like this are often caused by leadership. Whether you will be told bad news depends a lot on your management style and on people you decide to work with. You do not have to micromanage, but if they are scared to tell you the truth, then it is often your own fault.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#132

Post by Shivetya »

untog wrote: post #108
ryanhuff wrote: post #92

Earlier quoted context omitted.

I question the validity of your statement. In the US, for many uninsured, the hospital ER is their primary care outlet.

But by the time they go to the ER it's too late. People with insurance go for regular checkups that will catch things early. Those without will only go to the ER when their situation is desperate.

you would be surprised how many with insurance don't go or don't listen to their doctor. it has nothing to do with insurance and more to do with fear or just laziness

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#133

Post by watwut »

shpiel wrote: post #71
mgkimsal wrote: post #43

I have a hard time believing that no one anywhere on the original teams understood that caching database calls was good/standard practice. I think even basic examples like that point out the lack of management problem. I can easily envision someone on the team bringing up basic data caching and getting overruled by other people on the team for trivial/stupid/political reasons. With no proper or clear management in pl…

What type of database did they use? What type of caching would be desirable? Most modern RDBSes, like Postgre, Oracle, or Microsoft SQL server, have internal LRU caching already implemented. InnoDB tries to store everything in memory. I wonder if they meant that the default caching was turned off, or that all the queries had "no cache" clauses, or that an additional caching layer (Redis, Memcached) was not implemente…

They used markLogic NoSQL store http://blogs.wsj.com/cio/2013/12/03/healthcare-govs-heart-be...

Just for the record, contractor did not wanted to use it and argued the team have no experience with it. Someone in government decided it must be done that way (in spring or summer).

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#134

Post by protomyth »

beat wrote: post #84
jbooth wrote: post #49

Earlier quoted context omitted.

Hospitals don't turn away uninsured at the ER. However, due to lack of regular care, by the time you show up at the ER it might be too late.

I have high blood pressure. Thanks to insurance, I was able to spend a few months with my doctor, experimenting with medications until we found the combination that brought it down to manageable levels. Meds cost me $15 a month or so. Blood pressure medication will almost certainly add many years to my life - decades, maybe. Without insurance, I couldn't have afforded the half-dozen trips to the doctor or the meds. A…

"Without insurance, I couldn't have afforded the half-dozen trips to the doctor or the meds."

This is actually the problem for a large group of insured. It would be cheaper to pay out of a health saving account and have catastrophic insurance than pay the continuing insurance premium. This is especially true for young workers who we are now forcing into an additional cost to support older workers. For the price you were paying for insurance, the health saving account and paying out of pocket for those exams would have been cheaper. People unable to pay that should have been the ones helped by a health care law, not the typical consumer.

If we would get rid of this "one size" crap and deal with the groups we actually have (e.g. "ongoing expensive care", "typical person", "catastrophic"), we would have had a much better system. Grand visions suck for normal people.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#135

Post by jbooth »

hga wrote: post #128
jbooth wrote: post #123

Earlier quoted context omitted.

Shutting down the government for a few weeks probably complicated some things. Can always call non-stop hearings and bring people in to talk instead of work, as well. What, you think nobody plays hardball in DC?

For the former, we've heard that nobody important stopped working during the "shutdown". The latter was entirely a hypothetical ... before the disaster. After, I don't recall anyone truly important being detained in hearings for long (more than a day? with presumably 1-2 days of prep time at most before?), and the Administration has had no compunctions about not sending people to Congressional hearings if they don't…

Shutting down the government because you don't get your way isn't hardball? I suspect if we flipped some D and R labels around, like say this was President Romney's healthcare plan, you'd have a completely different opinion about every detail, up to and including the severity of shutting down the government to try and defund something.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#136

Post by mbesto »

brandonb wrote: post #120
keithwarren wrote: post #102

Earlier quoted context omitted.

Aside from the rhetoric, the political opinions and people firing at you now over the 5-10K thing, I do have an actual question of substance. My assumption when things melted down so drastically, was that the key problem was integration with the various vendors. Yes we all could look at the Html itself and make assumptions about poor practices but given that you are on the inside - what was the biggest issue?

The biggest general problem is that people thought of shipping the site the same way they thought of shipping an aircraft carrier -- you write the code, hand it over, and you're done. It wasn't treated as a running service. So, for example, when the site went down, there wasn't a group of people responsible for bringing it back up. That's what Mikey and the other Site Reliability Engineers fixed. They set up a war ro…

> The biggest general problem is that people thought of shipping the site the same way they thought of shipping an aircraft carrier -- you write the code, hand it over, and you're done.

So, the same problem every vendor encounters when doing a software project. I cannot tell you how many "lay people" can't simply grok this.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#137

Post by hga »

jbooth wrote: post #135
hga wrote: post #128

Earlier quoted context omitted.

For the former, we've heard that nobody important stopped working during the "shutdown". The latter was entirely a hypothetical ... before the disaster. After, I don't recall anyone truly important being detained in hearings for long (more than a day? with presumably 1-2 days of prep time at most before?), and the Administration has had no compunctions about not sending people to Congressional hearings if they don't…

Shutting down the government because you don't get your way isn't hardball? I suspect if we flipped some D and R labels around, like say this was President Romney's healthcare plan, you'd have a completely different opinion about every detail, up to and including the severity of shutting down the government to try and defund something.

Not these faux "shutdowns".

Especially the latest one, where the Park Service went to great efforts, employing a lot more armed Rangers to keep people out of anything they could claim as their turf, including things open 24x7 without corresponding 24x7 coverage, like the WWII Memorial. But not, curiously, a rally for immigration "reform".

Look, I spent a dozen years "inside the Beltway", I know political theater when I see it. It's just that, not "hardball". Heck, they even made the furloughed employees whole, as they have in times past.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#138

Post by slurry »

aamar wrote: post #96
brandonb wrote: post #38

I've been working on healthcare.gov for the last few months alongside a bunch of other Google, Facebook, and Y Combinator alums. I'll always remember what Mikey told us in December, after the site was back up, could handle a non-trivial amount of traffic, and people who wanted health insurance could finally get it: "1 in 1000 uninsured people die each year. It's not an exaggeration to say that due to the work we're d…

> "1 in 1000 uninsured people die each year. It's not an exaggeration to say that due to the work we're doing here, 5,000-10,000 people will live to see the end of 2014." This probably a significant exaggeration. It is based on a 2009 study[1] which examined correlation, not causation. It did not control for many factors that may be relevant (e.g. smoking). The study expressed this in much more careful words: "Lack o…

Why would you blame the study authors for doing a correlation study? I know "CORRELATION IS NOT CAUSATION!!!" is the go-to takedown on the internet, but correlation studies actually can have significant value - otherwise peer-reviewed journals wouldn't publish them.

I'm also skeptical of Politifact's competence to adjudicate public health scholarship.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#139

Post by hga »

watwut wrote: post #133
shpiel wrote: post #71

Earlier quoted context omitted.

What type of database did they use? What type of caching would be desirable? Most modern RDBSes, like Postgre, Oracle, or Microsoft SQL server, have internal LRU caching already implemented. InnoDB tries to store everything in memory. I wonder if they meant that the default caching was turned off, or that all the queries had "no cache" clauses, or that an additional caching layer (Redis, Memcached) was not implemente…

They used markLogic NoSQL store http://blogs.wsj.com/cio/2013/12/03/healthcare-govs-heart-be... Just for the record, contractor did not wanted to use it and argued the team have no experience with it. Someone in government decided it must be done that way (in spring or summer).

Yeah, a database with an unfamiliar paradigm in a project with late and constantly changing requirements, a major one of "no window shopping" in August, and others through the week before launch, is an obvious recipe for an extra big disaster.

Some people have theorized that Accenture's new role is to quietly replace much of the current code base with their not quite so horrible California exchange code.

Re: Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov

#140

Post by MartinCron »

brandonb wrote: post #65
nimz wrote: post #2

HealthCare.gov is definitely NOT fixed or "revived" yet. I was trying to register for healthcare for the Feb 15th deadline and there were errors after errors. At the end, after hours of trying and waiting on hold for the tech help-line, I was not able to register at all and missed the deadline. The help-line's answer was, we are still working out the kinks, please print out the PDF and fill it out manually. It's stil…

Yep, in spite of the progress made since October (when the site was entirely down for days at a time), there are absolutely still problems. I also see you're a YC alum! If you're interested in helping out, or just to provide an error report on the problem you encountered, email me at brandon@hcgov.us.

Just want to chime in and say thanks for your comments in this thread, getting a behind-the-scenes on what might be the highest-profile software project fiasco ever is really cool.
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