surreal and more surreal

[Winstonm]

I won't be finding myself swearing a blue streak at it sometime in the future.

 

That's too bad because it's now covered by healthcare.

[blackshoe]

Its proper name is "Seppuku". "Hara-kiri" (literally, "cutting the belly") is a vulgarism.

[kenberg]

Its proper name is "Seppuku". "Hara-kiri" (literally, "cutting the belly") is a vulgarism.

 

Nothing wrong with a little vulgarity now and then

[y66]

Rahm Emanuel's brother Ezekiel has some suggestions for fixing healthcare.gov in today's paper.

 

The president should create a new position: an independent chief executive of the federal exchange. On Tuesday, the White House announced that the economic adviser Jeffrey D. Zients will oversee the “tech surge” in the short term. Mr. Zients is a great manager and was a health care industry consultant, but he is also about to take on an important job as director of the National Economic Council. We need someone who can not just begin the repair process, but also run and refine the exchange’s operations for at least the next two years.

Second, the system needs to borrow from other exchanges. While the federal exchange has been a fiasco, many state exchanges have been working well since they launched earlier this month. One of the assignments for the students in my health policy class at the University of Pennsylvania this semester was to window-shop for insurance policies on the California exchange. They found the site easy to use and said there were many choices and the prices were competitive, even before subsidies. These students are the key demographic — young and healthy — that the sites need if they are going to succeed. Mr. Zients and the new C.E.O. should be looking carefully at the California, Kentucky, Massachusetts, Maryland, New York and any other successful state-run exchanges, and seeing which aspects can be adopted into the federal exchange, without reinventing it wholesale.

Next, the administration needs to be candid with the public. Given the disappointing rollout of the Web site, Americans are justifiably suspicious. Starting now, the administration needs to initiate a concerted effort to win back the public’s trust. There should be twice-weekly briefings that feature honest and complete descriptions of both the problems and solutions that the tech team is working on — in all the gory detail. We need to hear from those “best and brightest” experts whom President Obama has enlisted in the tech surge. Transparency is the only way to convince the American people that the situation is under control.

Fourth, delay what can be delayed to focus on the absolute top priority: the customer shopping experience, especially the ability to compare coverage, deductibles, co-pays, subsidized premiums and other information side by side. But there are certain parts of the exchange that can be postponed. For instance, the site doesn’t have to provide the enrollment data of each individual to insurance companies right away. That could be delayed until mid-November.

Finally, once the Web site is working reasonably well, there needs to be an enormous P.R. campaign to engage those young invincibles.

[blackshoe]

"The president should create a new position"

 

Of course. Can't ever have enough bureaucrats, can we? :ph34r:

[y66]

As Fred Brooks pointed out in The Mythical Man Month before most of the guys who built healthcare.gov were born, "adding manpower to a late software project makes it later".

 

Brooks' observations are based on his experiences at IBM while managing the development of OS/360. He had added more programmers to a project falling behind schedule, a decision that he would later conclude had, counter-intuitively, delayed the project even further. He also made the mistake of asserting that one project — writing an ALGOL compiler — would require six months, regardless of the number of workers involved (it required longer). The tendency for managers to repeat such errors in project development led Brooks to quip that his book is called "The Bible of Software Engineering", because "everybody quotes it, some people read it, and a few people go by it."

The reason you need to add a guy like Jeffrey Zients is you need someone on the project who is old enough to have read and understood what Brooks and others learned on that project.

[kenberg]

The key points of the Ezekiel Emmanuel piece are

a. He acknowledges that there is a substantial problem.

b. He examines how this came about.

c. He proposes how to fix it.

 

This is good.

 

 

Of course there will be glitches, of course there will be some issues that are quite thorny. But I, and I expect most people, like to see something along the lines of a., b. and c. above when this occurs.

 

Advances in medical care have been truly astounding in the last couple of decades. When I was young my interests were primarily mathematics and physics. If I were young today, I think I would look at mathematics (some things never change) and biology/medicine. These changes require a changes in the structure. I had pneumonia in 1945 or so. Dr. Setzer, our family doc, came out, prescribed some medicine, told me to stay in bed, and then we all hoped for the best. Yes it worked out but I imagine mothers today appreciate the greater hope provided by medical advances.

 

My health has been good, mostly, so my experience is limited. But I did have some bureaucratic issues with Medicare a while back. But I have had similar issues with insurance companies. The medical world, and the world in general, has simply become more complex.

 

Despite, or maybe because of, all of the complexity it is very important to me that I have a substantial say in my medical treatment. This gets tricky. It's tricky with Medicare, it will be tricky with Obamacare, but it would also be tricky with neither program in place. We need the most talented people we can find at the helm, and we need transparency (often claimed, seldom provided) and scrutiny. The Emmanuel article fits right into my thinking on this.

[y66]

Hmmm. I wonder where all those multiple enrollments on healthcare.gov are coming from?

 

Sebelius and Zients are probably on there way over to kenberg's house now.

[barmar]

It seems to me that if they knew there were problems and knew what they were, it would have been very senssible to just hold it up a bit. That way they would have free access for fixing it. This way they shut it down for a few hours at a time, then bring it back up, then shut it down and so on. Seems dumb to me.

I wonder if they might have done that if the launch hadn't coincided with the government shutdown. They may have put on rose-colored glasses and hoped that it would go well enough to provide a political win. Unfortunately, it didn't -- so the Republicans looked bad for shutting down the government, and the Decocrats got egg on their faces for launching a broken site.

 

When the site first launched, and there were reports of it failing, they were claiming that it just couldn't handle the load. That happens -- apparently they expected X number of people to to try it right away, and there were several times that many.

 

But reports I've heard since then indicate that it's much more than just an overload problem, there's also lots of incomplete or incorrect data. E.g. sometimes a spouse will be reported to the insurance company as a child.

 

http://www.newser.com/story/176102/obamacare-site-has-reported-spouses-as-kids.html

 

The Daily Show mentioned that less than 10% of people who have attempted to enroll have been successful.

[barmar]

I do expect better from the US government than from corporations

You're kidding, right?

 

Corporations have incentive to get things right -- if their services don't work, they lose money and can go out of business. Governments don't have much to lose.

 

I may be a Democrat, but I still know that private industry is usually more efficient and productive than the public sector. There are just some services that are hard for private businesses to provide (there's no profit in fire-fighting or welfare, for instance), and we need governments to do them.

[mycroft]

http://www.newser.com/story/176102/obamacare-site-has-reported-spouses-as-kids.html

 

The Daily Show mentioned that less than 10% of people who have attempted to enroll have been successful.

While the issues are serious, and there was definitely a problem, it seems par for the course for IT rollouts, especially government IT rollouts. The standard contracting methods, that work well for F-101s (well, they don't, there's 6 months to two years of shakeout for them, too, it's just that you tend not to hear about that as much), don't seem to work well for IT, especially when the turnover time is frequently less than the "build a contract" time. Please note, par for the course isn't, in fact, good.

 

having said all of that, the correct statistic is that about 10% of people who have logged in to look have successfully enrolled in a plan. While that's still not great, if you discount all the people who were just looking around, or were organizing plans so they could talk to their families or their workplace, or... it's probably a fair bit higher.

 

I have 30 years of experience with crappy UI. I have fewer years of experience with good UI. I also happen to be one of those for whom icons are actually slower than text, so a lot of "good UI" is crappy for me.

[blackshoe]

You're kidding, right?

 

Corporations have incentive to get things right -- if their services don't work, they lose money and can go out of business. Governments don't have much to lose.

 

I may be a Democrat, but I still know that private industry is usually more efficient and productive than the public sector. There are just some services that are hard for private businesses to provide (there's no profit in fire-fighting or welfare, for instance), and we need governments to do them.

Do we really? That's the welfare-statist argument for welfare, certainly, but that doesn't make it valid. Oh, sure, during the Depression, when nearly everybody needed help, private charity wasn't enough, but that was an anomaly. As for fire-fighting, I bet private industry could find a way to make a legitimate profit on it. It's one of those "but we've always done it this way, so it must be the only way to do it" things.

[hrothgar]

As for fire-fighting, I bet private industry could find a way to make a legitimate profit on it. It's one of those "but we've always done it this way, so it must be the only way to do it" things.

 

This is the wrong way to frame the key decision.

 

This issue isn't whether private industry can "make a legitimate profit", it's whether a market based solution will provide an efficient level of fire prevention.

[kenberg]

Hmmm. I wonder where all those multiple enrollments on healthcare.gov are coming from?

 

Sebelius and Zients are probably on there way over to kenberg's house now.

 

I'll pick up a couple more bottles of wine while I am out. In vino veritas. If we don't reach a solution we will at least enjoy the discussion.

[y66]

It looks like barmar did some housekeeping on the thread. Perhaps you could refer him to your new pals when you see them.

[mycroft]

Heh, I was going to comment on private fire-fighting services. They do work, and they do make a good profit. But they have the small side problem that houses burn down if you can't afford to pay to keep it up, or if the private services decide that "when the clients' house is on fire" is a *great* time to renegotiate the contract, or if the wrong fire service shows up first, or... and that's bad for neighbours whose houses also catch fire.

 

It was having seen how things did work in the free market that governments decided that it should be a public service, because they couldn't manage to do it *worse*...

[blackshoe]

Assume the following:

 

1. There is no "gummint" fire-fighting service.

2. I have what I consider to be a good contract with a private service, in case my house catches fire.

3. My neighbor has no such contract.

4. My neighbor's house catches fire.

 

First thing I'm going to do is call my service and tell them what's going on, in case the fire jumps to my house. If I have a good contract with them, this possibility will be part of it.

I may, if my contract allows it and I expect that my neighbor will pay me back when he can, ask my fire service to put out his fire.

 

In a reasonable system, any private fire service that tries to "renegotiate" the contract when the client's house is on fire will get hauled into court and end up buying the client a new house and new furniture, and paying additional reparations. Given this, it will not be cost effective for such services to pull this stunt.

 

"Wrong service shows up first" can be dealt with by prior contract.

 

As soon as something seems not to work perfectly, many people want somebody else, usually "the government," to "fix it, right now!" Ironic, really, in view of the problems with the Obamacare rollout. <_<

[Winstonm]

You are on vacation. Your house catches fire. Your neighbor notices, but since it is none of his business, and he does not know which fire department you have chosen to use, he ignores it. Your house burns to the ground.

 

Congratulations. You now get to test your insurance company choice.

[sharon j]

We live in a large unincorporated area and have private fire protection. There is only one company providing the service. Contracting with them is optional and many do not. This, of course affects the prices buyers pay for protection. They will respond to and fight all calls. If you do not have a contract, they bill you at an hourly rate, which is quite high. They have recently filed for chapter 13. This has many worried about the future of the company and future fire protection.

 

To me, this is much like the health insurance industry. Those who buy health insurance pay higher premiums for those who do not.

[ArtK78]

Those who buy health insurance pay higher premiums for those who do not.

I can certainly understand this statement. Those who do not buy health insurance don't pay anything.

[hrothgar]

Assume the following:

 

1. There is no "gummint" fire-fighting service.

2. I have what I consider to be a good contract with a private service, in case my house catches fire.

3. My neighbor has no such contract.

4. My neighbor's house catches fire.

 

First thing I'm going to do is call my service and tell them what's going on, in case the fire jumps to my house. If I have a good contract with them, this possibility will be part of it.

I may, if my contract allows it and I expect that my neighbor will pay me back when he can, ask my fire service to put out his fire.

 

 

Putting fires for potential customers with no existing contract is going to be an incredibly lucrative opportunity for the fire department.

 

There's no way that the a profit maximizing company is going to grant you the right to sub contract their services without significantly increasing your own rates.

[Winstonm]

I don't grasp the ideology that profit is the raison d'tre for all human economic activity. IMO that is fanciful thinking that does not transfer well into real-world action.

[sharon j]

I can certainly understand this statement. Those who do not buy health insurance don't pay anything.

lol

[ArtK78]

Those who buy health insurance pay higher premiums for those who do not.

Actually, I misread your statement. I read it to be "Those who buy health insurance pay higher premiums THAN those who do not." Which is a funny statement.

 

Taking your statement as phrased, you are stating that insurance premiums paid by those who purchase health insurance are higher than they otherwise would be if the uninsured were, in fact, insured. I don't know if this is true or not, as there is no direct cost on the insurance companies due to the problems of the uninsured. Your argument may be that health costs in general are higher than they would otherwise be because health care providers have to bear the burden of treating uninsured individuals who do not have the ability to pay, and the health care providers pass along these costs to those who can pay - the insurance companies - and that the insurance companies pass along these costs to their policy holders in the form of higher premiums.

 

This is one of the rationales behind universal health coverage. Another is, of course, that it is to the benefit of the general public that all individuals have health care coverage.

[Aberlour10]

Surrreal and more surreal...this is a good description for what happens in the transatlantic relationships in these days.

The european media, especially in Germany and France are full with articles, reports, comments about the newest,

developments in the NSA affair while even so serious newspapers like NYT WP LAT seem to have much more interest

for reports about Baby George, really strange days...

Even the closest US friends like Merkel and Hollande who would never serious criticize USA are now really angry,

the call ENOUGH IS ENOUGH storms through political Europa. Obama's arrogance and ignorance in the way he

responds to the current situation is unprecedented...this is the one opinion throug all political camps.

Does he really recognize the political damage in the relationship with Europe relased by his management.

European opinion on that: Obama does not need friends, he has the NSA.

But nevermind, Baby George seems to be really more interesting for the americans. C'est la vie.