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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

#71

Post by shpiel »

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…

What type of database did they use? What type of caching would be desirable? Most modern RDBSes, like Postgre, Oracle, or Microsoft SQL server, have internal LRU caching already implemented. InnoDB tries to store everything in memory.

I wonder if they meant that the default caching was turned off, or that all the queries had "no cache" clauses, or that an additional caching layer (Redis, Memcached) was not implemented?

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

#72

Post by brandonb »

jquery wrote: post #68
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…

What if you'd like to help out but aren't an anointed™ one?

You certainly don't have to be anointed™ or have worked at any particular companies.

I'd say the two most urgent roles we're looking for now are: * Site reliability engineers * Software engineers, including backend and frontend

If you do something else, like design, product management, or data science, feel free to send me an email anyway — I'm certainly happy to check around and see what's needed!

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

#73

Post by brandonb »

joehillen wrote: post #63
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…

Why isn't it open source like it was before?

The portion that was open-sourced was actually only the static portion of the site (the 'Learn' side). That was taken down before I got here, so I'm not sure on the complete backstory, but I think it confused a lot of people since they assumed it was the source for the whole site.

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

#74

Post by vwinsyee »

trhway wrote: post #67
vwinsyee wrote: post #57

Earlier quoted context omitted.

> 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 ha…

>mortality rate is significantly higher for uninsured than for insured. correlation doesn't mean causation. >to help make our government work better i somehow doubt that throwing a team of "rockstars" to clean up the mess is making the government to work better. If anything, it enables the typical government behavior we saw in the case of healthcare.gov.

> correlation doesn't mean causation.

As a statistician, I guess I should be happy that more people are aware of this. But I also think too many people are taking "correlation != causation" superficially. I mean, almost all of science is based on significant correlational findings, especially when the traditional way to prove causation (i.e. via randomized trial) is unethical (i.e. we can't randomly assign people to be insured vs. uninsured).

Along these lines, I often find people who say "correlation != causation" don't stop and wonder "so how _can_ we prove causation (in a non-randomized study)?" I guess many of them can be partially excused since the answer is non-trivial. But generally, here's a few rules of thumb for making a stronger case for causality from correlation:

* the effect size is relatively large (e.g. uninsured children die at 60% higher odds than insured children)

* the cause comes before the effect (e.g. people are uninsured before they go to the hospital and/or die)

* reversible association (e.g. risk of dying at a hospital changes when people get insurance)

* consistency / consensus across multiple studies (e.g. many studies showing that a difference in insurance status is associated with a significant difference in hospital mortality )

* dose-response relationship (e.g. I didn't link examples previously -- but there were a few studies showing that different levels of insurance, from none to Medicaid to private, is associated with different rates of hospital mortality)

* plausibility (e.g. even from a qualitative point of view, it's quite believable that people who unable to pay a hospital bill might get worse service)

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

#75

Post by quickpost »

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…

Awesome rules. Posting on my wall right now.

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

#76

Post by smacktoward »

quickpost wrote: post #75
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…

Awesome rules. Posting on my wall right now.

Rule 3 could be dangerous, though. It makes sense when you're in crisis mode, but when you're not focusing exclusively on things that could jump up and bite you tomorrow can lead to strategic tunnel vision -- missing opportunities for big wins because you were too busy chasing small ones.

Not really an issue for them since healthcare.gov sort of became the dictionary definition of "crisis mode," but worth keeping in mind if you're on a project with a more normal trajectory.

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

#77

Post by smacktoward »

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.

These folks are trying: http://www.dobt.co/

It's an incredibly difficult thing to do, though. Procurement practices that are enshrined in law are much harder to disrupt than those that are just bad habits that ossified over time.

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

#79

Post by at-fates-hands »

brandonb wrote: post #46
wooter wrote: post #41

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. 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.

An estimated 26,000 people die each year due to lack of insurance coverage. That's part of the reason the Affordable Care Act was passed. For more information, see this Reuters article from 2012: http://www.reuters.com/article/2012/06/20/us-usa-healthcare-...

Too bad the people who actually need it, are not signing up. Not to mention the people who HAD coverage are now getting cut off of their insurance and forced into the exchanges. A complete failure anyway you look at it.

http://www.forbes.com/sites/theapothecary/2014/01/18/coverag...

"Instead of expanding coverage to those without it, Obamacare is replacing the pre-existing market for private insurance. Surveys from insurers and other industry players indicate that as few as 11 percent of those on Obamacare’s exchanges were previously uninsured"

But wait a minute! Obamacare was supposed to cut my rates my $2,500 A YEAR right? WRONG. Apparently, it still costs too much for the people who really need it:

"Of those that didn’t sign up for Obamacare-based coverage, 52 percent stated that “affordability” was their biggest complaint with the exchanges’ plan offerings. Only 30 percent cited “technical challenges in buying the plans.”

"Joan Budden, chief marketing officer at Priority Health, told Wilde and Mathews that Michigan’s health insurers had expected 400,000 uninsured Michiganders to enroll in exchange based plans during the initial enrollment year. According to the latest data from the Obama administration, as of December 28, only 75,511 had “selected a marketplace plan.” Of those, only an unknown fraction had paid their first month’s premium, and therefore were actually enrolled in new health coverage."

So if this is such a success, why isn't the White House trumpeting the real numbers of people who've signed up then??

http://www.washingtontimes.com/news/2013/oct/4/white-house-s...

"For the fourth day in a row, the Obama administration on Friday declined to release figures on how many Americans have purchased health insurance through the just-opened online markets tied to the new health care law.

White House spokesman Jay Carney told reporters that millions of people have visited the federal HealthCare.gov site, which directs people to coverage options, but he did not have “specific data” at this early stage in the enrollment period."

There are better ways to do this than handing over 1/3 of our economy over to the Federal Government. You want competition? You can start by letting insurance companies deal across state lines. More competition, increased quality of care, lower costs and better care for everyone.

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

#80

Post by argumentum »

brandonb wrote: post #65
nimz wrote: post #2

HealthCare.gov is definitely NOT fixed or "revived" yet. I was trying to register for healthcare for the Feb 15th deadline and there were errors after errors. At the end, after hours of trying and waiting on hold for the tech help-line, I was not able to register at all and missed the deadline. The help-line's answer was, we are still working out the kinks, please print out the PDF and fill it out manually. It's stil…

Yep, in spite of the progress made since October (when the site was entirely down for days at a time), there are absolutely still problems. I also see you're a YC alum! If you're interested in helping out, or just to provide an error report on the problem you encountered, email me at brandon@hcgov.us.

Do you have any involvement with the individual State websites? I've had so many technical problems registering in California.
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