Sunday, October 13, 2013
Famously Horrific IT Decisions
As late as the last week of September, officials were still changing features of the Web site, HealthCare.gov, and debating whether consumers should be required to register and create password-protected accounts before they could shop for health plans.And so, of course they decided that you should be able to get no info before giving the government all your info.
This one decision is the source of many of their problems, because at 60-70 million people need info on these plans. About one-third of the states set up their own exchanges, but they were supposed to follow the government specs.
On the face of it, my guess is that this was a political decision, because they didn't want people to see the true cost of the coverage. Also it would have allowed journalists and other people to analyze the cost of the subsidies (horrific). If you want to generate massive traffic on a website that is not designed for it, turning a 15 minute inquiry with one database inquiry into a 14-hour struggle with over a hundred db transactions is going to be successful. Many would not define that as success, but hey, spinsters have different standards.
The specs were issued late - very late. Some of the functions even on the state exchanges require calls to government info.
The capacity does not apparently exist to get this done on time, and it is the government which created this mess. You can file the paper applications, but then the people who process the paper applications have to enter them in the site that is pitifully inadequate. So if you are going to have to do that, you should do it early and send it directly to the government by mail that's going to give you a delivery confirmation receipt, which you will need to keep.
I have spent the last few weeks digging in the ACA dirt burrowing past the government-imposed data blackout, and I will be posting a series of articles for people who are forced into this mess.
The only thing that is going to save this process at all is that the insurance companies have set up their own websites with calculators, and here's a multi-state site. You can use ValuePenguin to find the list of plans in your area for many states as well as the base premiums, and it does contain a basic calculator so that you can figure about what your premium cost will be.
In the annals of government FAILURES, this one will be legendary.
From what I can tell, the plans available to me are more expensive than the privately available plans, when you start looking at what they do and don't cover. They were clearly not designed with children in mind.
It looks to me like you've got to be nearly eligible for Medicaid before the subsidies are large enough to make a good value proposition. But if your income is that low, the deductibles are going to kill you.
Essentially, this insurance is near-useless for families with children.
#2, #3, #4 and #6.
And I'd put snark-quotes around #3.
During its first month of release many stability, registration, and billing issues hurt public perception of the game. Some gaming reporters[which?] said it was the worst launch of an MMO in the history of the genre. Funcom spent about 6 months fixing the game, particularly the beginning experience. The company then took the "fixed game" on a press tour to convince reporters to give it another try, even though reviews and scores had been printed months before. At the same time, the company needed to build subscribers, which was very difficult given the reputation of the game. Funcom introduced the first "free trial" of the game and gave out returned boxed copies for free at the 2002 Game Developer's Conference.
The dependency -- it burns!!!
However for the very low income population, the cost-sharing is greatly reduced, so the deductibles and copays you see do not apply.
The middle class may be very limited in their health care options.
When the program was actual food stamps, at least people had those stamps. Now, if the power or telecom lines go out they're screwed - no way to access their benefits.
And this was a system failure, so rapidly restored. But when you have a long power crisis in an area (think various storms that knock power and communications out for a week or more across a substantial area), these people are in trouble.
At what income level does the cost-sharing change? I can't seem to find any solid information on that without selling my soul to Obamacare.
Cost sharing percentages are 6% at 100-150% of FPL, 13% at 150-200% of FPL, and 27% at 200-250% of FPL. 30% is the full cost-sharing at the silver level, so you can see the last tier doesn't help much.
FPL per family size in 2013 is about:
11,500 for 1 person,
15,500 for 2 persons,
19,500 for 3 persons,
23,500 for 4 persons.
There's a little fudge factor in the ACA numbers.
Note that the subsidy and cost-sharing reductions are figured on MAGI, not AGI.
2013 FPL guidelines are being used for 2014 ACA. The precise figures (there are differences for Alaska and Hawaii) can be found here.
The bottom line for most families with children who do not qualify for a subsidy is that you have to cut your income or go to catastrophic insurance.
But also think FAA Advanced Automation System, and consider the parallels:
What went wrong? Just about everything. Here's how the General Accounting Office put it: "FAA did not recognize the technical complexity of the effort, realistically estimate the resources required, adequately oversee its contractors' activities, or effectively control system requirements."
The project was probably doomed on the drawing board by an unrealistically ambitious plan. "It was basically a Big Bang approach, gigantic programs that would revolutionize overnight how FAA did its work," says Pete Marish, a senior analyst at GAO.
"We royally screwed up AAS, no doubt about it, in any way that a project could be screwed up," says FAA Associate Administrator for Acquisitions Steve Zaidman. "The benefits of AAS came at the very end," he says, and since the project never reached the intended finish line, most of them never materialized..
Sometimes the relevant history is fresher than 600 years ago. The point is that it is relevant.
We could afford to crash Mars landers, but when you start playing with tens of millions of lives, the stakes run pretty high.
I have extremely crappy insurance through Lifewise, from my job. It's basically what I would get from the Bronze plan and about the same price.
Of course, there are plenty of software-project failures in the private sector, too...for an example, just google with the keywords HALLOWEEN and ERP. But these tend to be self-limiting in ways that the government failures are not.
Teri - the worst problem with the exchanges is that the specs were written so late that the best firm in the world could not have gotten the job done to the specs. They were arguing about stuff right through the summer and the fall.
It is remarkably hard to accomplish any programming job if the job is not defined.
The second major IT problem occurred when usage demand was underestimated by more than 500%. I cannot fathom why, and it is entirely the administration's fault. The hard numbers alone of the uninsured/underinsured/Medicaid eligible should have dictated far more capacity.
It doesn't appear that they will even be able to process the paper apps, which must be hand input into the system.
I work for a software company now and it still happens. Some installations go smoothly and others are complete disasters. If you're wondering how the same software can work great at one company and be a disaster at another, I already gave you the answer.