Obama's Trauma Team: Inside the Nightmare Launch of HealthCare.Gov • Hacker News Board

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

#161

Post by protomyth » Fri, Feb 28, 2014, 1:05 AM UTC

dragonwriter wrote: post #158

protomyth wrote: post #156

Earlier quoted context omitted.

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…

The changes made are woefully inadequate for, among other things, cancer drugs. They didn't fix or even make a good attempt at the problem.

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

#162

Post by supercanuck » Fri, Feb 28, 2014, 1:13 AM UTC

watwut wrote: post #127

sp332 wrote: post #59

Earlier quoted context omitted.

Rule 3 is what managers are for. The engineers will want to work on cool features or challenging problems, not the most urgent ones.

Only if you employ bad or only junior engineers. If you can not deal with priorities, then you have no right to call yourself senior. Especially when it comes to urgent. Good engineers are able to finish work even if you do not babysit them.

Whoever said there was no true scotsman is a liar!

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

#163

Post by jdminhbg » Fri, Feb 28, 2014, 1:16 AM UTC

beat wrote: post #110

liber8 wrote: post #100

Earlier quoted context omitted.

Honest, non-snarky question for you: How is it that you could not afford a half-dozen trips to your doctor, but you could afford your medical insurance premiums? Are your premiums subsidized or free? Is the doctor terribly expensive? (I'm assuming that your doctor charges $250 or less per visit. Six visits would cost $1,500. I'm assuming those visits were spread over at least a number of months, so you could see whet…

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…

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

> Honest, non-snarky answer... to be pedantic, for me it's not a question of affordability.

This is a pretty good representation of the quality of health care discussion on HN.

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

#164

Post by spoiledtechie » Fri, Feb 28, 2014, 1:16 AM UTC

qdog wrote: post #22

mikeash wrote: post #13

Earlier quoted context omitted.

Would explain a lot if so. Any developer you can get for that rate who has been working for 10 years likely does not have 10 years of experience, but 1 year of experience repeated 10 times.

40x99x50=~$200k/year. That doesn't seem unreasonable compensation, what am I missing?

$99 an hour turns into about 50$ after it goes through companies pockets.

Speaking from experience as capture manager.

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

#165

Post by aamar » Fri, Feb 28, 2014, 1:17 AM UTC

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 agree that correlation studies can be valuable, but I see many correlation studies as (intentionally or not) exploiting a propensity (arguably a bug) in human reasoning that conflates it with causation. In this situation, we have thorough documentation of multiple people clearly making the error.

I'm actually not sure the study authors should be blamed.

But: given how politicized this question is, they could have reasonably anticipated the misuse of their results, and thus could have written their results in such a way as to avoid this. Or they could have publicly corrected non-experts who cited them for causation. Or: they could have controlled for factors that would make mortality and insurance-status independent. This last option is difficult & requires complex judgement calls (see [1] for a reasonable attempt), but even if you feel the other two aren't required of academics, this last one very much may be.

(Separately, I agree that Politifact should not be trusted automatically, but these seem like reasonable analyses, and I did not quickly find anything better.)

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739025/

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

#166

Post by mlangdon » Fri, Feb 28, 2014, 1:22 AM UTC

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…

You're not allowed to "other than that" preexisting conditions. I'm one and the ACA means I got to quit my shitty telesales job and take a no-insurance-provided-at-a-small-company first software development job.

There are millions like me who can take risks for the first time, whether that's working for a small company or starting one. And I don't have to worry about the next 40K hospital bill burying me.

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

#167

Post by rmrfrmrf » Fri, Feb 28, 2014, 1:23 AM UTC

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…

"And, as the motley team of software engineers looked on in admiration, a single tear drop departed from Mikey's eye. As the drop hit the marble floor, it suddenly exploded into a majestic bald eagle, who screetched dutifully and flew out of the White House."

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

#168

Post by aamar » Fri, Feb 28, 2014, 1:50 AM UTC

dannyr wrote: post #154

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…

"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.

> 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?

A recurring and important (to me, anyway) question here is how technical skill may be leveraged to provide real value to the world. This is a hard and unanswered problem. This [brandonb's] statement is so strong that, if it were true, it would eliminate a vast territory of alternate [possibly correct] paths to answers ("oh, you did X? My code saved 50 lives this year."). So it [brandonb's statement] is worth challenging (or correcting) more so than any random statement here. And yes, I do view promoting accuracy (even disillusion) as fighting for the cause.

I hope Brandon will accept my sincere thanks for working on something that is important. Irrespective of health impact, the financial risk borne by the uninsured is an important issue and not controversial.

edit: clarifications in []

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

#169

Post by hga » Fri, Feb 28, 2014, 1:57 AM UTC

mikeyouse wrote: post #150

hga wrote: post #126

Earlier quoted context omitted.

" 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/...

That may be so, but your link doesn't support your counter-claim.

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

#170

Post by Crito » Fri, Feb 28, 2014, 2:07 AM UTC

twistedpair wrote: post #151

Crito wrote: post #56

Earlier quoted context omitted.

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 qual…

You know that many people actually survive cancer and go on to live otherwise regular lives, right?