Thursday, October 24, 2013

HealthCare.gov in the Congressional crosshairs


"Testy," "acrimonious" would materially understate the contentiousness of the House hearing, which I am following live online as I write. I would not want to be these CGI Federal and QSSI people right now.

I'm about 2/3 of the way through the Jeff Bezos/Amazon.com bio as of now. Highly recommended read. I bought the hardbound edition at CostCo, and will probably also spring for the Kindle edition ($10.99) as well. Worth it for the easy citation examples I will proffer. There are lessons that could be applied to this jaw-dropping HIX CusterFluck.


Below, one of my high school friends just posted this on Facebook.


Bill is a semi-retired multimillionaire who made his money the old-fashioned way. He built a wildly successful international periodicals distribution business, sold it for a huge cashout, and now dabbles as a "hard money lender." We played together in our Somerville NJ dance band in the early 1960's. Great guy. Smart guy. Still plays the sax (as I do on guitar, episodically).

He hates "ObamaCare" (and the federal government more generally). We joust online every now and then, and I usually fold after things get "elevated" by replying "so, how about those Red Sox?"

IN THE WINGS

The Big Prize in the unfolding "reality show" psychodrama. I'm sure she's rehearsing her lines.

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TODAY'S TESTIMONY  SUMMARY THUS FAR (12:56 EDT)
"It's not our fault. That was not our responsibility. It's CMS's fault. We did everything we could. We'll get back to you on that..."
Stay tuned. Pass the popcorm...

POST-HEARING HEADLINE
Contractors point fingers over ObamaCare botch, blame gov't for poor testing

The finger-pointing was in full swing Thursday at a tense Capitol Hill hearing where the contractors behind the botched ObamaCare website defended their work and claimed the government failed to properly test the system before launch.

The contractors faced tough questioning from lawmakers on both sides of the aisle, who voiced frustration with the weeks-long problems surrounding the federal hub. Lawmakers cast doubt on attempts by contractors, who were paid millions, to claim they were not responsible for many of the site's problems. Top contractor CGI Federal revealed it was paid $290 million in taxpayer funds...
Yes. I've just watched about 4 hours of predictable finger-pointing and blame-deflecting.

UPDATE




OCT 25th UPDATE
The Midterm Grade for HealthCare.gov
By UWE E. REINHARDT for The NY Times


...President Obama taught constitutional law at the University of Chicago Law School. How would he have graded a student’s performance on, say, a term paper or test that the professor viewed as “unacceptable,” especially when there was “no excuse” for the paper’s deficiencies?

One would hope that the grade would have been F, even under modern grade inflation. I certainly would affix that grade to such inexcusably deficient work.

But who exactly should be assigned the F for the troubled rollout of HealthCare.gov?

At the Rose Garden ceremony, President Obama noted, “There’s no sugar coating it, the Web site has been too slow, people are getting stuck during the application process, and I think it’s fair to say that nobody is more frustrated by that than I am.”

That makes it sound as if the president was surprised and then angered by the poor performance of HealthCare.gov. Indeed, in a television interview Tuesday with Dr. Sanjay Gupta on CNN, the secretary of health and human services, Kathleen Sebelius, appears to suggest as much, even though HealthCare.gov is reported to have crashed days before the start on Oct. 1 when only 100 people tried to register simultaneously.

As someone who has lectured on corporate governance and served on corporate boards, I find Secretary Sebelius’s statement astounding. Is this how the project was managed? They knew the Web site was not working and yet decided to go ahead with it anyway, without the president’s personal O.K. for so strategic and risky a decision?

Once elected, a president becomes chief executive of a giant federal enterprise. Anyone familiar with corporate management would have thought that for as ambitious and technically a complex project as the initial rollout of HealthCare.gov – so important to many uninsured Americans and so politically important to the White House – the chief executive would have remained in very close touch with the management team overseeing the project and thus would have been briefed daily or at least weekly on the progress of the project and especially on any problems with it.

Woe to the members of the management team in a corporation if problems with a project are hidden from the chief executive when they become known, exposing the chief executive to embarrassing public relations surprises. Heads would roll. The board, however, would assign the blame for such problems not primarily to the management team and instead to the chief executive himself or herself. He hired and supervised the team.

From that perspective, the blame for the disastrous rollout of HealthCare.gov goes to its entire management team, to be sure, but primarily to the chief executive on top of that project. In my view, not only the proverbial buck stops on the chief executive’s desk, but, for the management of this particular project, the grade of F goes there as well...
Ugh. I wonder whether HHS Secretary Sebelius survives this mess, all her dismissive talk notwithstanding. I'd bet money that she doesn't. Maybe not straight away, but this is astonishingly inept. The President is not going to fire himself.
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FRED TROTTER SCORES AN INTERVIEW WITH WaPo's EZRA KLEIN

One of my Health 2.0 Refactored Conference shots
Wonkbook: How HealthCare.gov looks to a health IT pioneer
By Ezra Klein and Evan Soltas, Updated: October 25, 2013

If you watched Thursday's monkey court -- sorry, heath care hearing, you didn't learn much save this: Democrats have a policy interest in fixing HealthCare.gov's problems but a political interest in downplaying their severity. Republicans have no interest in fixing the problems but a strong interest in publicizing them. The result is that the party that wants to talk about what's wrong with HealthCare.gov doesn't want to actually figure out how to fix it while the party that wants to fix it doesn't want to talk about it.

The assembled contractors weren't any more informative. They retreated behind a haze of acronyms and finger pointing and uncomfortable silences.

So for Wonkbook this morning, I spoke to someone who actually is more informative. Fred Trotter, the author of "Hacking Healthcare," is a pioneer in the health IT world. He's someone who actually does the kind of cutting-edge software development using the kind of cutting-edge techniques that people feel HealthCare.gov needed. A lightly edited transcript of our conversation follows.


Ezra Klein: Are you surprised by the rollout of HealthCare.gov?
Fred Trotter: I’ve been in health IT for years. I have this data set where I look at the health-care system as a whole and model it out. I have experience as a government contractor working on VISTA for the VA. So it doesn’t surprise me at all. What you need to run a massive consumer web site is the latest in horizontal scaling and that’s hardly approved software for the federal government. The federal government has very conservative mechanisms for purchasing off-the-shelf software and creating new software. That puts a lot of constraints on them.

EK: Explain what horizontal scaling is.

FT: When you get a certain amount of traffic going to any site on the internet a single computer can’t handle it. In order to handle tremendous amounts of traffic you have to have more than one computer sharing a task. At modern sites like Amazon and Ebay and Google, the main innovation they’ve pioneered is using lots of computers at the same time to answer one query to the web site.

But it’s a different problem for different tasks. If the federal government wanted to sell billions of books online that’s fairly understood. They could just look at Amazon. But they’re trying to do something entirely new. And that means that what they’re talking about is the invention of something new. The way Congress looks at software is that there are these sites that do these amazing things and we should do that, too. They don’t realize that a tremendous amount of invention has gone on at these scaled web sites to handle these processes.


EK: I’ve been reading the new biography of Jeff Bezos, as he is now my master and overlord, and an ongoing theme is that Amazon’s tech had to keep being reinvented as the site grew. And that process, it’s clear, was really hard, and getting it right was really important to why Amazon and not some other e-commerce site won. How much more difficult of a problem did the federal government give itself when they tried to unveil a single piece of tech that could handle huge traffic on day one?
FT: They screwed themselves twice. The first thing they did that was very foolish was to go at scale. Usually when the government understands the problem of that they do things in phases. They didn’t draft everyone for Vietnam all at once. That’s the model they should’ve used. They should’ve said people born in January can now get health insurance. Then it should’ve expanded to everyone born in the first quarter. And so on. But they presumed scale was easy. That was the first mistake. The second was assuming invention was easy. And scaling something that hasn’t been invented yet -- that’s technological suicide...
Interesting. I'm 100 pages shy of finishing the Bezos book. Will have some observations.
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Just in...
Healthcare.gov will work smoothly by end of November, government pledges
Maggie Fox NBC News

The troubled federal health insurance website will be fixed by the end of November, giving uninsured Americans two weeks to get signed up in time to have health insurance by the earliest possible date, officials pledged Friday.

One of the main government contractors, QSSI, has been assigned to oversee the fix, says Jeff Zients, the newly appointed chief White House economic adviser who’s been tasked to fix the logjammed website.

“We are confident that by the end of the November, healthcare.gov will be smooth for the vast majority of users,” Zients told reporters on a conference call.

“Over the last week we worked with a team of experts to conduct an assessment of the overall state of the healthcare.gov site," Zients said. They lent "fresh eyes" to the problems plaguing the site. “The system is getting better,” he added. “There is a lot of work to do but healthcare.gov is fixable.”...
We shall see.

SATURDAY MORNING UPDATE

On the cusp of Halloween...

Why We Need a Healthcare.gov Witch Hunt
It is the only way we have a shot of settling a big debate: Can government do big things?
By John Dickerson, Slate

Washington think tanks your moment has arrived! Healthcare.gov is a mess and someone must chronicle exactly what went wrong. The press is trying, of course, but we also must cover the aftermath—the parade of predictable behavior that obscures more than it illuminates. Did you see the hearing in the House Energy and Commerce Committee yesterday? Despite the best efforts of Chairman Fred Upton, between the grandstanding, confused questions, and the witness fog machine, it's a wonder anyone got out alive. Meanwhile, Republicans are pointing fingers, placing blame, and otherwise showing disgust that a program that they have tried to kill is being run so badly. (Perhaps they're jealous that the administration is better at undermining Obamacare than they are.) Administration officials, on the other hand, are caught between covering their backsides, spouting plumes of happy talk, and hiring more people to collect the springs and sprockets from the launch pad where the whole thing went kaput. On Friday, officials in charge of the #techsurge said that healthcare.gov would be running smoothly by late November, two months after the launch.

Here's why a controlled witch hunt is needed: This episode is about much more than a website. That’s true with respect to health care, as Ezra Klein points out, and it’s also true because there are big national issues at stake that have nothing to do with the specific issues of sickness and health. Can government do big things? Sen. Lamar Alexander famously said during the health care debates, "We don't do comprehensive well"—meaning that any law that is big and complicated will fail. Is that right?

Alternatively, has partisanship and gridlock created a situation where small flaws in a law can't be fixed through tweaking legislation because such legislation can never pass? Is there something about complex technology that confuses the bureaucracy? Is the procurement system nuts? Does the political nature of all administration activity mean that no one is capable of reporting that the launch of a key element of the president's signature legislation is going to throw a rod? Some of the states seem to be doing just fine. Is that because they are smaller enterprises or because the people working on state health exchanges have more flexibility?...
...This [witch hunt] project should be one everyone loves. Only the most devout libertarian doesn't want the government to do anything. Those who want a smaller government should still want it to operate efficiently. Liberals, and people like the president, who believe in smart government, should be pushing hard for answers. If they're not interested in a thorough deconstruction of what went wrong for policy reasons, they should care for political ones. Healthcare.gov is now a very good excuse for anyone who wants to oppose an activist federal government. All a lawmaker has to say is that they don't want the same government that ran healthcare.gov in charge of X, where X is anything you want to see stopped in its tracks.

Right now, no one in this drama is trying to learn from the mistake. That's understandable, but it also guarantees that the mistake will be repeated.
Not sure I agree with the inflammatory, made-for-Ted-Cruz "witch hunt" characterization. But, it's like putting "sex" in the title as an attention grabber, I guess.
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SUNDAY MORNING UPDATE

This is pretty funny.

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More to come...

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