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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

#141

Post by 3am »

at-fates-hands wrote: post #79
brandonb wrote: post #46

Earlier quoted context omitted.

An estimated 26,000 people die each year due to lack of insurance coverage. That's part of the reason the Affordable Care Act was passed. For more information, see this Reuters article from 2012: http://www.reuters.com/article/2012/06/20/us-usa-healthcare-...

Too bad the people who actually need it, are not signing up. Not to mention the people who HAD coverage are now getting cut off of their insurance and forced into the exchanges. A complete failure anyway you look at it. http://www.forbes.com/sites/theapothecary/2014/01/18/coverag... "Instead of expanding coverage to those without it, Obamacare is replacing the pre-existing market for private insurance. Surveys from i…

Did you read the links in your post? The first doesn't strongly support your points, and the second was out of date almost 4 months ago.

And that's really saying something, because the first link is an OpEd by Mitt Romney's former health care advisor who is a senior fellow at a conservative think-tank.

Some of the downsides of allowing health insurance to be sold across state lines are addressed at http://www.kaiserhealthnews.org/stories/2010/september/30/se... - and they include an AEI fellow's views for balance. The auto insurance market is a hybrid, though, and doesn't show a large cost savings for states that effectively allow cross-state lines operations via identical regulations.

I think it's also fair to ask also why health insurers that operate in all/most states (UnitedHealth, Aetna, Cigna, Athena, etc) are not substantially cheaper that BC/BS peers that don't.

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

#142

Post by DanielRibeiro »

vwinsyee wrote: post #74
trhway wrote: post #67

Earlier quoted context omitted.

>mortality rate is significantly higher for uninsured than for insured. correlation doesn't mean causation. >to help make our government work better i somehow doubt that throwing a team of "rockstars" to clean up the mess is making the government to work better. If anything, it enables the typical government behavior we saw in the case of healthcare.gov.

> correlation doesn't mean causation. As a statistician, I guess I should be happy that more people are aware of this. But I also think too many people are taking "correlation != causation" superficially. I mean, almost all of science is based on significant correlational findings, especially when the traditional way to prove causation (i.e. via randomized trial) is unethical (i.e. we can't randomly assign people to…

Please turn this into a blog post and submit it to HN. I'd love to see this comment about correlations see more attention ;)

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

#143

Post by aaronbrethorst »

slurry wrote: post #138
aamar wrote: post #96

Earlier quoted context omitted.

> "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.

I'm also skeptical of Politifact's competence.

FTFY

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

#144

Post by Perdition »

mbesto wrote: post #136
brandonb wrote: post #120

Earlier quoted context omitted.

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.

It's amusing because that isn't the way aircraft carriers are made. Something like a tank might just get handed over after only manufacturer testing, but big ticket items like aircraft carriers go through a year plus of acceptance trials and testing.

They don't finish the last coat of paint, load an air wing, and send it out on deployment.

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

#145

Post by keithwarren »

brandonb wrote: post #125
keithwarren wrote: post #121

Earlier quoted context omitted.

What is the biggest issue right now architecturally?

Complexity. We have 10x more code, 10x more components, and 10x more layers than we need. If the initial architecture had been dirt-simple, I don't think the site would have had so much trouble scaling or staying up. But, of course, removing complexity without breaking things takes longer than adding it in the first place. The other big problem is operations — many steps are done manually which should be done with to…

Was there consideration given to doing a wholesale rewrite and later swapping out for that? Seems that if things are overly complex now, it may be easier to hold it together with band-aids while a true long term build is put together...what is going on behind the scenes with respect to this kind of planning?

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

#146

Post by efa »

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…

> people who wanted health insurance could finally get it

Maybe I don't understand Obamacare well enough but I don't understand this statement (which I hear all the time on the commercials). Who couldn't get insurance before this website? I know the health care law did add guarantees around pre-existing conditions. So other than that, who couldn't call an insurance company directly (or use esurance or other portal) and sign up for insurance? This website is just a marketplace hooking you up with normal private insurance companies correct?

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

#147

Post by nobodysfool »

aristus wrote: post #29
dannyr wrote: post #23

I heard that several people from YC startups and Google are helping out. This is one of the reasons why we're seeing a lot of improvements to the Federal Exchange site.

A friend of mine, from Facebook's networking team, also spent a month there. He came back with a thousand-yard stare.

Yea I don't get why we romanticize working long hours and crunch time / overtime. If they would have worked standard 8 hour days things probably would have gotten better faster. In my opinion, working more than 8 hours a day tells me that you're wasting time.

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

#148

Post by mikeyouse »

efa wrote: post #146
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…

> people who wanted health insurance could finally get it Maybe I don't understand Obamacare well enough but I don't understand this statement (which I hear all the time on the commercials). Who couldn't get insurance before this website? I know the health care law did add guarantees around pre-existing conditions. So other than that, who couldn't call an insurance company directly (or use esurance or other portal) a…

    Who couldn't get insurance before this website?
Poor people.

You can only get the Federal subsidies through the insurance exchanges which was supposed to primarily be online, but had small phone support staff too. The phone support staff was completely overwhelmed due to the website problems, which left thousands with no method to get insurance.

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

#149

Post by twistedpair »

Perdition wrote: post #144
mbesto wrote: post #136

Earlier quoted context omitted.

> 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.

It's amusing because that isn't the way aircraft carriers are made. Something like a tank might just get handed over after only manufacturer testing, but big ticket items like aircraft carriers go through a year plus of acceptance trials and testing. They don't finish the last coat of paint, load an air wing, and send it out on deployment.

Amen. Just watch any documentary about building an aircraft carrier. The systems integration phase is the longest part!

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

#150

Post by mikeyouse »

hga wrote: post #126
beat wrote: post #110

Earlier quoted context omitted.

Honest, non-snarky answer... to be pedantic, for me it's not a question of affordability. I'm a software professional with a very good income, and I could do it on my own. I have a friend a few months younger than me. She makes less than $15k/year, and has two children living at home. Under those financial circumstances, she has totally paid off her home, which should tell you how frugal and responsible she is. She h…

" Medical costs are the leading cause of bankruptcy in the US. " In a study by Elizabeth Warren that scored any bankruptcy which included medical bills in the discharged debts as their "being the cause" of it, no matter what the fraction they were.

That's dramatically misrepresenting the quality of the study;

http://www.businessweek.com/bwdaily/dnflash/content/jun2009/...

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