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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

#171

Post by rdl »

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…

Thanks for doing this. I still think completely replacing it from October to ~December, and extending the deadlines, might have been a reasonable choice, and re-architecting to move all PII related stuff away from the "shopping" stage and only into the final request stage, but I guess it's better now. The "replace everything, end all the contracts, etc." option might not have been politically viable, and showing people the pre-subsidy prices with subsidy adjustments later in the process probably would have been a bad political move, too.

(I'm not in a federal marketplace state, though, and I ended up having my insurance canceled under ObamaCare and got a 364 day short term $750k policy instead. Still no idea what I'm doing in 2015.)

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

#172

Post by jrockway »

jdminhbg wrote: post #163
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…

> 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.

He misspelled one word. s/couldn't/mightn't/.

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

#173

Post by rdl »

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.

The elderly (>65, or >62 in some cases, etc.) are already covered by medicare and social security. The disabled were covered by medicaid and ssi.

Underemployed (part time, whatever) or sort-of-poor and not disabled people in their 50s are a major segment who can't pay the real cost of their medical care, though. Or, people with lifelong expensive illnesses in the 0-64 age range (who are often making a lot less money than median, too, due to their medical conditions.)

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

#174

Post by dannyr »

aamar wrote: post #168
dannyr wrote: post #154

Earlier quoted context omitted.

"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]…

I'm curious what do you think would have happened if you just let it go.

"This is a hard and unanswered problem. This statement is so strong that, if it were true, it would eliminate a vast territory of alternate paths to answers ("oh, you did X? My code saved 50 lives this year.")."

It seems like you are more of the problem rather than Brandon's statement. No matter what Brandon says, accurate or not, people will still find a flaw in it. People will see what they want to see.

If you want to eliminate alternate paths to answers, the sure way to do that is not say anything at all.

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

#175

Post by thisisdave »

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…

>It did not control for many factors that may be relevant (e.g. smoking).

Unless I'm misreading the polifact article you linked to in [2], it says that the 2009 study did control for smoking, and that they did a better job of controlling for such factors than previous studies.

> Still, their work stands out from previous efforts because it used more recent survey data and presented a more apples-to-apples analysis between the uninsured and insured populations. For example, it compared deaths rates for uninsured smokers with insured smokers, as well as other factors such as drinking, obesity, income and education.

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

#176

Post by joshAg »

kalvin wrote: post #160
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.

man, i wish i had come across this offer a few months ago.

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

#177

Post by Tloewald »

pdeuchler wrote: post #21

>> "It is also a story of an Obama Administration obsessed with health care reform policy but above the nitty-gritty of implementing it. No one in the White House meetings leading up to the launch had any idea whether the technology worked." I used to be this guy. The guy with the lofty ideas, but who thought the implementation was "beneath me". The guy who would sit around, waxing poetic about various features, user…

If Obama's only legacies are preventing (or at least not causing) a second Great Depression and Obamacare (assuming Obamacare works worth a damn) that's not too shabby.

And by my calculations, since we're several months out from the mid-terms, Obama has well over two years left. Not that I'm expecting much from them.

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

#178

Post by akiselev »

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…

Yes because chemo is the first thing we give to people with malignant cancers.

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

#179

Post by RickHull »

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.

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

Right. It sounds like you're implying that was his intent, and he failed. I really think it was an noble effort to get to the heart of what might be a misleading soundbite. Very much in the spirit of HN.

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

#180

Post by aamar »

dannyr wrote: post #174
aamar wrote: post #168

Earlier quoted context omitted.

> 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]…

I'm curious what do you think would have happened if you just let it go. "This is a hard and unanswered problem. This statement is so strong that, if it were true, it would eliminate a vast territory of alternate paths to answers ("oh, you did X? My code saved 50 lives this year.")." It seems like you are more of the problem rather than Brandon's statement. No matter what Brandon says, accurate or not, people will st…

I hope my clarifications help explain what I meant in my parent comment.

I believe the following are potentially bad consequences of Grayson's/Mikey's claim spreading:

- People work on insuring others, at the expense of other activities that they would otherwise believe to be more valuable.

- Insuring people (or the ACA) is deemed a failure because mortality rates do not come down as "expected", plausibly leading to the ACA's repeal.

- A developer expends time working on the project expecting mortality rates to improve; when it doesn't, the uncritical idealist becomes an uncritical cynic, rejecting any future promise of saving lives/improving things.

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