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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

#51

Post by jbooth »

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…

You're not wrong, but anyone who actually has an office in the physical whitehouse, or anyone within, say, 5 layers of the President, actually shouldn't be concerned with the implementation of the technology. They should be focused on getting money and resources to the people who do the tech and running interference for them to help prevent them from being sabotaged by political opponents. In between their other million non-technical job responsibilities, many of which involve a lot of legal, policy and political details.

That said, obviously they should have brought in the campaign website team to oversee this instead of doing the standard federal government contracting route, which leads to a late, over-budget project literally every single time.

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

#52

Post by taybin »

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?

That doesn't include benefits. Any benefits (such as health insurance) would come out of that. I believe the rule of thumb is to add on 20% of a salary for cost of benefits. So this would be closer to a salary of $165k, plus benefits.

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

#53

Post by qdog »

diminoten wrote: post #27
qdog wrote: post #22

Earlier quoted context omitted.

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

That $99 goes to the contractor, not the employee. There's a ton of overhead and profiting that comes out of that $99. I won't even hazard a guess at how much of that $99 actually makes it to the guy or gal's pocket. That said, it's not a bad living wage. I suspect below industry standard though, is what these folks are saying.

Ah, I thought it was a direct contract with the government, not a contracted person from an agency, my mistake.

Of course, I guess I should have assumed that, there aren't many direct government jobs for this type of thing anymore, it seems.

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

#54

Post by untog »

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.

People have to be inside hospitals for hospitals to help them. If you don't have insurance you're less likely to go in the first place.

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

#55

Post by untog »

mgkimsal wrote: post #43

I have a hard time believing that no one anywhere on the original teams understood that caching database calls was good/standard practice. I think even basic examples like that point out the lack of management problem. I can easily envision someone on the team bringing up basic data caching and getting overruled by other people on the team for trivial/stupid/political reasons. With no proper or clear management in pl…

Or just a lack of testing. There's no way to know how many database calls are too many without actually testing the damn thing.

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

#56

Post by Crito »

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 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 of statistics. "1 in 1000 uninsured people die each year" by itself tells us pretty much nothing. What is the rate of death for insured people?

Wikipedia tells me that 8.39 in 1000 people die in America every year, so if uninsured people are only dying at a rate of 1 in 1000 every year, it seems to me that either it is beneficial to be uninsured, or uninsured people are not representative of the population (perhaps because many of them are young and healthy?).

I suspect that what is going on is this person actually meant to say something along the lines of "1 in 1000 people die every year in ways that could have been prevented if they had insurance" A subtle but important difference. The actual mortality rate of uninsured people is most likely much higher than 1 in 1000, but the deaths of uninsured people in motorcycle accidents would not be counted in that "1 in 1000" figure.

Either way, it is shoddy.

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

#57

Post by vwinsyee »

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 and insuring people doesn't magically save their lives.

Not sure where you're getting this. A quick Google Scholar or PubMed search shows a consensus that mortality rate is significantly higher for uninsured than for insured. [1, 2, 3]

[1] e.g. http://jpubhealth.oxfordjournals.org/content/32/2/236.short -- On multivariate analysis, uninsured compared with insured patients had an increased mortality risk (odds ratio: 1.60, 95% CI: 1.45–1.76). The excess mortality in uninsured children in the US was 37.8%, or 16 787, of the 38 649 deaths over the 18 period of the study. Children who were hospitalized without insurance have significantly increased all-cause in-hospital mortality as compared with children who present with insurance.

[2] e.g. http://journals.lww.com/jtrauma/Abstract/2012/11000/Undiagno... -- Undiagnosed preexisting comorbidities play a crucial role in determining outcomes following trauma. Diagnosis of medical comorbidities may be a marker of access to health care and may be associated with treatment, which may explain the gap in mortality rates between insured and uninsured trauma patients.

[3] e.g. https://www.sciencedirect.com/science/article/pii/S000296101... -- A total of 1,203,243 patients were analyzed, with a mortality rate of 3.7%. The death rate was significantly higher in penetrating trauma patients versus blunt trauma patients (7.9% vs 3.0%; P

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

#58

Post by mikeash »

qdog wrote: post #53
diminoten wrote: post #27

Earlier quoted context omitted.

That $99 goes to the contractor, not the employee. There's a ton of overhead and profiting that comes out of that $99. I won't even hazard a guess at how much of that $99 actually makes it to the guy or gal's pocket. That said, it's not a bad living wage. I suspect below industry standard though, is what these folks are saying.

Ah, I thought it was a direct contract with the government, not a contracted person from an agency, my mistake. Of course, I guess I should have assumed that, there aren't many direct government jobs for this type of thing anymore, it seems.

Yep, the government contracts out to a gigantic company who then "hires" you and has you work on the thing, and takes half the money in exchange for doing not a whole lot. It's a sad system.

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

#59

Post by sp332 »

pella wrote: post #10

Dickerson rules: "Rule 1: "The war room and the meetings are for solving problems. There are plenty of other venues where people devote their creative energies to shifting blame." Rule 2: "The ones who should be doing the talking are the people who know the most about an issue, not the ones with the highest rank. If anyone finds themselves sitting passively while managers and executives talk over them with less accur…

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

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

#60

Post by sp332 »

jfc wrote: post #36

> the people running HealthCare.gov had no "dashboard," no quick way for engineers to measure what was going on at the website Someone needs to disrupt the government contracts business pronto.

CGI Federal is a Canadian company that won a no-bid contract to build the site. Good luck disrupting anything; the system doesn't even pretend to be competitive and it's designed to keep incumbents in power.
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