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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

#151

Post by twistedpair »

Crito wrote: post #56
wooter wrote: post #41

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. You should be proud of what you've done, but we should also all be grateful to have this opportunity." Hospitals don't let uninsured people die and insuring people doesn't magically save their lives.

Hospitals do "let" uninsured people die because they are not obligated to provide the full extent of their care capabilities to people who cannot afford it. Come in with a hole in your abdomen, and for sure they'll patch you up even if you don't have insurance. Come in riddled with cancer? Don't expect the same as they would give somebody who could pay themselves or had insurance. This said, it is still a shoddy use…

> Come in riddled with cancer? Don't expect the same as they would give somebody who could pay themselves or had insurance.

Ah, yes, the classic American healthcare problem. The poor person just gets to go to hospice and keel over. The rich person gets to limp along, endure 3 rounds of chemo, and spend the few remaining months of her life hooked up to machines in what is arguably a Pyrrhic victory and even lower quality of life.

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

#152

Post by beat »

protomyth wrote: post #134
beat wrote: post #84

Earlier quoted context omitted.

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 w…

The problem with that is that the people with the highest medical costs (the elderly) are retired and no longer generating income to pay for their care. Gotta pay for that somehow. The whole point of insurance is to distribute costs.

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

#153

Post by rhizome »

djKianoosh wrote: post #101
jquery wrote: post #68

Earlier quoted context omitted.

What if you'd like to help out but aren't an anointed™ one?

what do y'all mean by anointed? I've been a gov contractor for many years. It doesn't take all that much to get into this space. Basically, if you're a citizen and don't lie on applications and resumes and in interviews then there's really not any significant barrier to entry.

He asked for "amazing."

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

#154

Post by dannyr »

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…

"But I don't think a statistic like this should be left unchallenged on HN."

Yeah, thanks for fighting for the cause! #sarcasm

Is HN supposed to be a place where we try to find a flaw on every statement and make sure it doesn't go unnoticed?

What you pointed out doesn't even diminish an ounce of what Brandon and his teammates are doing.

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

#155

Post by dragonwriter »

wooter wrote: post #41
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. You should be proud of what you've done, but we should also all be grateful to have this opportunity." Hospitals don't let uninsured people die and insuring people doesn't magically save their lives.

> Hospitals don't let uninsured people die

They don't do as much to stop them from dying. (Other than public hospitals -- of which there are a limited number with limited capacity -- they are only obligated to stabilize them in the ER and then, if they have further medically-necessary care but are stable, they can discharge them and/or transfer them to a public hospital if one is available, whereas those that have resources, insurance or otherwise, to pay would be admitted.)

> insuring people doesn't magically save their lives.

Strictly true -- it doesn't do so magically. It does so, instead, but the relatively mundane mechanism of providing them the ability to pay for care other than emergency stabilization, which reduces the probability of them having such care denied or delayed.

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

#156

Post by protomyth »

beat wrote: post #152
protomyth wrote: post #134

Earlier quoted context omitted.

"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 w…

The problem with that is that the people with the highest medical costs (the elderly) are retired and no longer generating income to pay for their care. Gotta pay for that somehow. The whole point of insurance is to distribute costs.

An expansion of social security / medicare (particularly if they were paying into a health savings account throughout their low risk period) to cover drugs and such would have been quite a bit cheaper. The youth already are paying for the elderly with taxes, we shouldn't run a con job on them too.

The concept of insurance we use for healthcare is broken.

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

#157

Post by dragonwriter »

kyro wrote: post #64
wooter wrote: post #41

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. You should be proud of what you've done, but we should also all be grateful to have this opportunity." Hospitals don't let uninsured people die and insuring people doesn't magically save their lives.

You're talking about EMTALA, which is an act that prohibits turning away uninsured patients away who are in need of emergent care. Once the patient is stabilized and either discharged or admitted, they are subject to payments. The patient with metastatic cancer who needs chemoradiation on an outpatient basis must pay for his/her care.

> You're talking about EMTALA, which is an act that prohibits turning away uninsured patients away who are in need of emergent care. Once the patient is stabilized and either discharged or admitted, they are subject to payments.

More importantly, as it only requires emergency stabilization and not further care to be provided without regard to ability to pay, once they are stabilized they can be discharged instead of being admitted.

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

#158

Post by dragonwriter »

protomyth wrote: post #156
beat wrote: post #152

Earlier quoted context omitted.

The problem with that is that the people with the highest medical costs (the elderly) are retired and no longer generating income to pay for their care. Gotta pay for that somehow. The whole point of insurance is to distribute costs.

An expansion of social security / medicare (particularly if they were paying into a health savings account throughout their low risk period) to cover drugs and such would have been quite a bit cheaper. The youth already are paying for the elderly with taxes, we shouldn't run a con job on them too. The concept of insurance we use for healthcare is broken.

> An expansion of social security / medicare (particularly if they were paying into a health savings account throughout their low risk period) to cover drugs and such would have been quite a bit cheaper.

You act as if an expansion of Medicare to cover prescription drugs was an alternative to the more recent reforms, rather something that already happened prior to them and did not, as you suggest, address the problem that the more recent reforms were aimed at.

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

#159

Post by grecy »

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…

My god I wish my company would instigate Rule 2 !

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

#160

Post by kalvin »

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…

(I'm working with Brandon)

To clarify, you don't need to be able to commit long term-- if you can take leave from what you're otherwise doing for a few months, that's enough.

If you want to work on something with real impact and help change the culture of government technology, email Brandon above! We're actively looking for a few good people.

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