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

#231

Post by liyanchang » Fri, Feb 28, 2014, 2:57 PM UTC

twistedpair wrote: post #149

Perdition wrote: post #144

Earlier quoted context omitted.

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!

The difference here is that they had a very public deadline.

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

#232

Post by mattfenwick » Fri, Feb 28, 2014, 3:06 PM 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.

> correlation studies actually can have significant value - otherwise peer-reviewed journals wouldn't publish them

This is an appeal to authority. And unfortunately, the evidence is accumulating that there are problems with that authority. The success of peer-review depends on the quality of the peers and of the review. If those reviewing don't understand how to evaluate a correlation study, or do understand but don't take the time to properly evaluate it, then garbage will slip through.

It turns out, lots of garbage is produced and sent to the reviewers, as was noted in a recent Nature feature:

http://www.nature.com/news/scientific-method-statistical-err...

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

#233

Post by ctdonath » Fri, Feb 28, 2014, 3:15 PM 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…

Does the extrapolated result include the number of people who are losing their insurance because of this program?

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

#234

Post by pikewood » Fri, Feb 28, 2014, 4:13 PM UTC

"...government regulations did not allow them, even though they offered, to be volunteers if they worked for any sustained period. So they were put on the payroll of contractor QSSI as hourly workers, making what Dickerson says was "a fraction" of his Google pay"

This information troubles me, because QSSI was just hired to fix Maryland's broken Health Exchange site. It sounds like the company is cashing in on the donation of brandonb and others experts' time?

brandonb, is your team involved with the Maryland efforts, or is that a completely separate team?

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

#235

Post by Mvandenbergh » Fri, Feb 28, 2014, 4:16 PM UTC

chocosoes wrote: post #226

this may sound stupid but i'm just wondering why the article is dated in the future (Mar 10, 2014)? we're on even on March 3 yet, and yet its there http://search.time.com/results.html?N=46&Ns=p_date_range|1 I'm not a regular time magazine reader, am I missing something here?

Magazine articles are usually dated to the print edition they appear in.

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

#236

Post by puppetmaster3 » Fri, Feb 28, 2014, 4:23 PM UTC

Hmm. OK, here:

#1: Understand the customer!

In this case it's http://en.wikipedia.org/wiki/Karen_Ignagni (They lobbied a congressman from Chicago w/ donations to elect, and Republican side is pissed their side did not get more.) In EU, it tends to be written for the people, but in USA, it's the lobbyists as customers.

#2: You can't fix political problems with software!

For example we can make the problem 10 times less by allowing each state to manager Healthcare and compete for residents. Like Massachusetts. It's a fools errand. But you can milk the feds if you bribe the right official.

#3. You won't find good and un-employed engineers!

Not in SV anyway. A - type engineers are ~ $240K and up. Y-combinator is mostly n00b growth hackers, not expereinced coders. Plus the rumor is that you have to be loyal to the party of New Democrats as the main req, not software systems.

#4. I heard it's written in .NET and Oracle Access Manager.

A requirement? That's not what google plus, facebook or iTunes use or such use. I don't want to code w/ those people that use that stack ( but I would have a great time w/ them after 5pm, they tend to be nice people ).

Kalvin and Brandon: The most patriotic thing to do is to not try and catch a falling knife so that each state can have a system they own - and we can move to a state that has a good one. Party greetings to you.

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

#237

Post by melvinram » Fri, Feb 28, 2014, 4:37 PM UTC

jobu wrote: post #18

Wow! They weren't even caching database calls: HealthCare.gov had been constructed so that every time a user had to get information from the website's vast database, the website had to make what's called a query into that database. Well-constructed, high-volume sites, especially e-commerce sites, will instead store or assemble the most frequently accessed information in a layer above the entire database, called a cac…

a. This struck me as dramatically unprofessional. How could they not do caching? Mind blowing when you consider that they knew their audience was a significant part of the country.

b. The explanation of cache seemed a bit too plain and didn't give enough context in the article. I was thinking an analogy might have work better, such as:

Caching is way of reducing the amount of work that needs to be done by a system. Suppose you had a system that was hooked up to a thermometer and reading the temperature from this thermometer takes 1 second.

Without caching, every time you asked the system what the temperature was, it would do a new reading from the thermometer. If 1000 people asked the system what the temperature was, it would do 1000 readings, which would take 1000 seconds collectively.

With caching, the first time the system was asked, it would do a reading and it would save the reading somewhere it could get it much faster than 1 second, let's say 0.01 seconds. For all subsequent readings, it would use the saved reading, until enough time had pasted to do warrant doing a new reading.

----

Obviously, my version is 3 paragraphs long so it's not ideal either :D

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

#238

Post by mattfenwick » Fri, Feb 28, 2014, 4:39 PM UTC

Fomite wrote: post #192

ekianjo wrote: post #190

Earlier quoted context omitted.

Sorry, but no. 100 times no. Correlation is very often linked to a third factor or multiple factors which are not visible, nor measured in observational studies. Besides, let's not disregard the fact that correlation still has some good chance to be pure luck. Even correlation with 95% confidence statistical significance can be a random result in a non-nil number of times. So, no, you never prove anything nor imply a…

Find me where I said proof . There are all kinds of things that we cannot prove, because it is either impossible or wildly unethical to conduct a randomized study. For those things, you can make a determined effort to control for as many "third factors" - the technical term for them is confounders - and that gives you a level of evidence which is well above guessing. Since I can't reply to your comment, my responses…

> make a determined effort to control for as many "third factors"

How can you tell if you missed one?

> [...] gives you a level of evidence which is well above guessing

> It is better than guessing

Why? Without any support, this seems to be an appeal to probability.

> a well conducted observational study

> a really bad study

The fallacy of moving the goalposts; also the no true Scotsman fallacy.

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

#239

Post by twistedpair » Fri, Feb 28, 2014, 4:41 PM 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…

Thx. Spent years working in oncology, so I'm quite familiar that people can survive. My point is that American medicine is insanely expensive because we don't know where to draw the line. Now, more than before, we focus on anything to keep the heart beating and the lawyers from suing, regardless of whether the quality of life and and dignity of the patient is non-existent.

Given this, I would argue the "poor person" in this argument could easily get similar levels of necessary care as the insured individual through Medicare. The insured (preferably rich) person could however travel to all the best clinics, participate in many medical trials and experimental operations, and quite likely simply spend their final months of life as a guinea pig with a similar outcome as the "poor person." The only upside is the insured individual gets to bankrupt themselves and family in the process as insurance doesn't cover most of these non-standard therapies. I've seen it happen to too many people.

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

#240

Post by aamar » Fri, Feb 28, 2014, 5:04 PM UTC

Fomite wrote: post #208

aamar wrote: post #204

Earlier quoted context omitted.

You are right, the 2009 Wilpers paper does bucket out current and former smokers, as well as look at BMI and other factors. The authors should be credited for that. But when those factors are considered, the null hypothesis is only barely rejected at 95% confidence. The Kronick paper uses a much larger dataset and discusses the issue of what is controlled for more extensively.

So wait, now not only are we using hypothesis testing as your sole means of evaluating whether or not an effect exists, but you're moving the threshold around because...you want to?

No, I don't think I'm arguing that. It's not a question of any one methodology always being better than others, or correlation studies always being wrong. The question is what we should reasonably believe in light of several analyses of various strengths.