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A Billion User Load Test on Healthcare.gov

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Re: A Billion User Load Test on Healthcare.gov

#61

Post by tptacek »

LargeCompanies wrote: post #46
coldcode wrote: post #6

I wonder if this healthcare.gov will exist a year from now. It is nice to see how far it has come in 2 years.

Doubtful Trump is getting rid of it. Personally I preferred the previous way of signing up for coverage ... call up a private insurer and sign up? The cost was less too as I wasn't paying for insurance for lazy sally or Joe Schmoe! So for me Obamacare/social medicine forced those who do and work to pay and cover for those who don't. See ya Obamacare(love obama though). Also the $300 plan I paid each month for sucked.…

Calling insurers and buying directly is potentially cheaper, because those insurers aren't selling marketplace plans --- the marketplace plans have guaranteed-issue requirements, and must conform to minimum standards that off-marketplace plans do not.

The downside is that if you have anything interesting on your medical history --- including many things in your past that aren't chronic conditions, but could be predictive of future health care costs in some circumstances --- you will be turned down without recourse. That's the problem with the pre-Obamacare individual health care market: it didn't work.

Re: A Billion User Load Test on Healthcare.gov

#62

Post by Retric »

ProAm wrote: post #21
Certhas wrote: post #18

Earlier quoted context omitted.

I know it's just a throw away joke, but this persistent idea that government is incompetent, no matter what is really damaging. When it comes to health care systems there is no evidence whatsoever that less government means more efficiency, if anything the US is a huge example to the contrary.

Im not really joking, their ability to do anything efficiently or correctly for a reasonable sum of money is embarrassing. I know it's a joke as well, but it's funny because it's true.

Social Security has vastly lower overhead than any equivalent private program.

Now, you can see crazy waste on both sides EX: Drug Advertising. But, it's hard to look at this objectively.

Re: A Billion User Load Test on Healthcare.gov

#63

Post by mbesto »

tptacek wrote: post #58
sixbit wrote: post #24

Healthcare.gov is the absolute worst. They had a button "End coverage for 2017" I clicked it around the end of November because I chose a non-marketplace plan for 2017, and the end result of that click was Cigna my current marketplace insurer for 2016 received a transmission from them, and interpreted it incorrectly, which made my 2016 plan inactive and retroactively terminated me back to 08/31 despite having paid al…

I had a similar problem with BCBS --- twice, actually, the latter of which cost me most of a year's deductible and almost left us without insurance. My impression is that the problem with the insurers, not with HC.gov.

This. I've actually worked with some large payers and they are just literally not set up organizationally, technically, and systematically to work with individuals or even very small businesses for that matter (less than 5 employees). Furthermore not only are they not setup to help individuals, they can't even figure out whether it's financially viable for them or not.

Re: A Billion User Load Test on Healthcare.gov

#64

Post by tptacek »

mbesto wrote: post #63
tptacek wrote: post #58

Earlier quoted context omitted.

I had a similar problem with BCBS --- twice, actually, the latter of which cost me most of a year's deductible and almost left us without insurance. My impression is that the problem with the insurers, not with HC.gov.

This. I've actually worked with some large payers and they are just literally not set up organizationally, technically, and systematically to work with individuals or even very small businesses for that matter (less than 5 employees). Furthermore not only are they not setup to help individuals, they can't even figure out whether it's financially viable for them or not.

A big problem with the individual market is that it isn't financially viable to serve the individual market at reasonable prices, because in the US market, not holding a job with adequate health insurance is a huge adverse selection marker.

Startup founders should be a lot more concerned about this than they seem to be. Health insurance almost screwed me at Matasano in 2005; it would have, had Erin not taken a full time job elsewhere until Matasano had group coverage.

Re: A Billion User Load Test on Healthcare.gov

#65

Post by mozumder »

ProAm wrote: post #21
Certhas wrote: post #18

Earlier quoted context omitted.

I know it's just a throw away joke, but this persistent idea that government is incompetent, no matter what is really damaging. When it comes to health care systems there is no evidence whatsoever that less government means more efficiency, if anything the US is a huge example to the contrary.

Im not really joking, their ability to do anything efficiently or correctly for a reasonable sum of money is embarrassing. I know it's a joke as well, but it's funny because it's true.

My experience is the opposite. Private companies seem completely inefficient compared to government, and I've worked as engineers in both.

Really it is only a right-wing profit-driven talking point to say government is inefficient, mostly to protect against their profits that government takes away.

Government is exceedingly efficient.

Re: A Billion User Load Test on Healthcare.gov

#66

Post by mbesto »

tptacek wrote: post #64
mbesto wrote: post #63

Earlier quoted context omitted.

This. I've actually worked with some large payers and they are just literally not set up organizationally, technically, and systematically to work with individuals or even very small businesses for that matter (less than 5 employees). Furthermore not only are they not setup to help individuals, they can't even figure out whether it's financially viable for them or not.

A big problem with the individual market is that it isn't financially viable to serve the individual market at reasonable prices, because in the US market, not holding a job with adequate health insurance is a huge adverse selection marker. Startup founders should be a lot more concerned about this than they seem to be. Health insurance almost screwed me at Matasano in 2005; it would have, had Erin not taken a full t…

My wife (startup founder) is under my insurance (I'm a full time employee that gets $12k per year towards UHC healthcare). Even if she paid the same from her company (~15 employees), her deductible would be double what it is currently. If she went under her own company health insurance, we would have to pay at least an extra ~$2,000 this year out of pocket for various health related services she incurred.

From a macro lens there is definitely a huge disincentive to start a company in this country.

Re: A Billion User Load Test on Healthcare.gov

#67

Post by foota »

vertex-four wrote: post #27
foota wrote: post #22

Earlier quoted context omitted.

I believe it was one of the first projects of the digital service. ( https://www.usds.gov/ )

Not quite. It was designed by a contractor, developed by several others, and once it was released to the public and shown to be dreadful, another contractor was put in charge of fixing it. It's still primarily developed by contract to this day. The first head of the USDS was involved in coordinating the fixing of Healthcare.gov, though.

That's probably what I was thinking about, thanks.

Re: A Billion User Load Test on Healthcare.gov

#68

Post by ProAm »

mozumder wrote: post #65
ProAm wrote: post #21

Earlier quoted context omitted.

Im not really joking, their ability to do anything efficiently or correctly for a reasonable sum of money is embarrassing. I know it's a joke as well, but it's funny because it's true.

My experience is the opposite. Private companies seem completely inefficient compared to government, and I've worked as engineers in both. Really it is only a right-wing profit-driven talking point to say government is inefficient, mostly to protect against their profits that government takes away. Government is exceedingly efficient.

I've worked in both as well and vehemently disagree.

Re: A Billion User Load Test on Healthcare.gov

#69

Post by tptacek »

mbesto wrote: post #66
tptacek wrote: post #64

Earlier quoted context omitted.

A big problem with the individual market is that it isn't financially viable to serve the individual market at reasonable prices, because in the US market, not holding a job with adequate health insurance is a huge adverse selection marker. Startup founders should be a lot more concerned about this than they seem to be. Health insurance almost screwed me at Matasano in 2005; it would have, had Erin not taken a full t…

My wife (startup founder) is under my insurance (I'm a full time employee that gets $12k per year towards UHC healthcare). Even if she paid the same from her company (~15 employees), her deductible would be double what it is currently. If she went under her own company health insurance, we would have to pay at least an extra ~$2,000 this year out of pocket for various health related services she incurred. From a macr…

I think a lot of 20-somethings think that they'll have the same access to health insurance they get now when they're in their 30s and starting a family.

Re: A Billion User Load Test on Healthcare.gov

#70

Post by sixbit »

GFischer wrote: post #56
jlebar wrote: post #32

Earlier quoted context omitted.

Now we see the real test of whether healthcare.gov has reached the level of consumer tech: Does bug-report-via-top-ranked-HN-comment get anything done?

Both Nava and healthcare.gov people replied, in under an hour. Looks like a win for the OP (or as much of a win it can get in this fucked-up situation).

Fingers crossed!
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