I think that Megan McArdle is wrong in at least one particular in her post on the disconnect between what the White House was saying and what Healthcare.gov’s developers apparently thought:
The yawning gap between what the IT people knew and what everyone else seems to have realized is staggering. Now, I’ve worked on some projects in which the business units seemed to have some sort of selective deafness that only materialized when we tried to tell them that they couldn’t have their magic fairy computer system that did everything they could imagine, only better, in the three months they wanted it to take, or for the paltry sum that they were willing to spend. And I learned the hard way not to assume that the business units, or even the chief information officer, had heard and understood what you said. That is how I became gifted in the art of writing CYA memos when I was directed to do the unwise or the impossible. So I do have some sympathy for the IT folks.
But I’ve never seen a gap this complete — one in which the entire IT organization seems to have been panicking about the impossibility of their task, and then the inevitable failures, while the folks issuing the orders were blithely issuing last-minute change orders and telling everyone they could find how swell this was all going to be. Usually, when things are going this wrong, you do more than casually mention it; you sit the folks on the business side down and explain that unless the project is pushed back, it’s going to be an unmitigated disaster.
Someone, somewhere pretty high up in the food chain must have understood that the website could not be ready on time and would not do what the political folks were promising. That person failed to communicate not only the unlikelihood of making the Oct. 1 start date, but also the extent of the problems that would follow if they opened anyway. The policy and political staffs genuinely seem to have been expecting a few weird errors and a little bit of downtime, not a computer system that failed at pretty much every step.
Quite to the contrary, I think it is absolutely possible that nobody in any of the developers’ organizations communicated to anyone in the White House just how bad things were. Nobody wants to be the bearer of bad news. And you don’t get contracts worth in the tens or hundreds of millions of dollars by saying “No”.
I think the developers just figured that they were on a cost-plus contract and if it wasn’t finished on October 1 it would be finished on November 1 or December 1 or some other time and the more time that elapsed the more they were likely to get paid to clean up the mess.
I don’t know if you are correct or not. I do know that a simple cost plus contract would never get executed in our dealings. There would be control mechanisms along the way, and economic incentives and/or holdbacks for performance. Sounds like a crap rookie contract. Always the case when playing with other peoples money.
Separately, I wonder how steve reacts to this – if it mirrors his experience.
http://nypost.com/2013/10/29/docs-resisting-obamacare/
Its not necessarily that this was legally a cost-plus contract, it may be that the bidder figured they could effectively make it out to be one. I think there are a lot of bidders who utilize the technique of getting the low bid, and then try to make every little thing that comes up an extra that wasn’t contemplated in the original bid.
I was disturbed to see reports recently that the winning bidder had the only bid considered. (I’ve also seen contrary reports that three or four bids were submitted, but I assume the discrepancy is that only one of those bids was considered responsive) If that’s true, it sounds like hardly anybody wanted the job. Why not?
Quite to the contrary, I think it is absolutely possible that nobody in any of the developers’ organizations communicated to anyone in the White House just how bad things were.
IMO, logic disagrees with that statement. There were some preliminary tests run, with a few hundred people, and the site crashed. You’re now saying it’s possible that the results of these failed tests were not given over to Sebelius? Wouldn’t she have been privy to knowing these tests would be run, and wanting to know the results — demanding them — if for no other reason than human curiosity?
“Why not?”
I can hear the deliberations: “So if it works, Obama rides in on a chariot to gushes and rose petals. And no one knows our name. If it doesn’t work, Obama can’t even remember there was a project approved, and its all our fault. Hey Ed!? What do you think about the probability of success?” “Negatory, sir.” “OK, do I hear a motion……all in favor, aye? Against? Nea!!!!!………..the neas have it.”
jan
There can be only two states of the world. Either Obama knew and had his damn the torpedos moment, or Sebelius didn’t inform him and committed managerial malpractice and should be immediately fired. She’s still here.
Its the former. I gar-on-tee.
Drew,
Steve seems to have an ear tuned for his own POV, and discredits anything having the slightest push-back to the contrary. Here’s just one organization of doctors, who have been critical of the ramifications of the PPACA from the get go. Their physician collective is one messaging concerns about how this HC law will negatively effect patient care, with a mission statement as follows:
Their prescription to HC reform is a far different one than is prescribed by the followers of the PPACA central government’s approach.
BTW, Drew, I fully agree with the deduction in your last post. The PPACA, being Obama’s claim to legacy fame (other than the OBL thingee), would have been followed more closely by him, than what he is leading people to believe, now that it has become a glitchy mess.
More thoughts on the contract:
Its identified as exempt from competitive public bidding because it was of “Indefinite Delivery and Indefinite Quantity.” I’m not familiar with that type of contract,* but according to thisextensive legal analysis, services can be priced on a variety of basis: “fixed price, cost-reimbursement, time and materials, labor hour, or for negotiated contracts, any type or combination of types of the foregoing.”
I don’t have a problem with bypassing the competitive bidding process, but the lack of clear demarcation of the services to be performed puts the government at risk of paying without definite resolution. For example, the contract could be a fixed price, plus reimbursement of approved hourly rates on the job, with the protection of ceiling on total payout. Once the ceiling is hit, the contractor may disappear, and while the contractor may not want to get a bad rep., the contract would have been performed as it written.
@Drew
… or Sebelius didn’t inform him and committed managerial malpractice and should be immediately fired. She’s still here.
Bullshit. You are being nice.
A competent leader supervises. I seriously doubt that any CEO or other executive you know would issue the orders and walk away. Building a new factory, re-tooling an existing plant, or developing a new widget is a substantial undertaking, and it can affect the bottom-line. There are progress reports and, if necessary, independent assessments.
Authority is delegated, but responsibility is not. Nothing goes perfect, and reports that they are should be a huge red flag. I am sure that you know there is a big difference between supervising and micro-managing. Actually, the two are mutually exclusive, and any leader knows this.
Attn: Michael Reynolds,
You might want to indulge yourself in reading this CNN piece before you sign up for your HC savings.
Jan:
I’ll check it. But not paying much attention to politics right now. Business is heating up in cool and weird ways which I can’t talk about.
Oh, a security flaw? Please. I’ve lost track of how many notices I’ve gotten that my data may have been compromised at this or that credit card company or gaming site (in my son’s case.) Sony’s been hacked so thoroughly I doubt they can order take-out Chinese without hackers asking for extra egg rolls. That’s not even getting into the fact that if I ever ever need a copy of one of my manuscripts I can always find it on the torrents. It’s the age we live in, sadly.
The security issues are with us always, it seems. I’m more concerned with the utter cock-up of the site itself. It’s one thing to steal my data, it’s a whole different matter to make me wait while a page is loading.
Good luck with your business endeavor, Michael. I had to laugh, though, at what concerns you the most — waiting for a page to load??? Oh well, each to his/her own.
Drew- No one here is signing up to be “Obamacare docs” because the term is pretty meaningless. We have not been approached by any insurance company wanting lower rates because they have Obamacare patients. None of the 6 facilities we cover have seen this. If insurers are signing up patients, then assuming they can docs at whatever fee level they want, they will have a problem. As I have noted in the past, it is the same kind of problem you face when selling insurance across state lines. Anyone can sell insurance at low rates, they will just have trouble providing the care. A new insurance company that enters our market wont be able to get the same rates as established carriers unless they have enough volume to make it worthwhile.
Steve
Drew- No one here is signing up to be “Obamacare docs” because the term is pretty meaningless. We have not been approached by any insurance company wanting lower rates because they have Obamacare patients. None of the 6 facilities we cover have seen this. If insurers are signing up patients, then assuming they can sign docs at whatever fee level they want, they will have a problem. As I have noted in the past, it is the same kind of problem you face when selling insurance across state lines. Anyone can sell insurance at low rates, they will just have trouble providing the care. A new insurance company that enters our market wont be able to get the same rates as established carriers unless they have enough volume to make it worthwhile.
Steve
@jan- I have read health care policy and economics nearly daily for many years. I am not really prone to hysteria. I read health care policy by writers on the left and right. For example, you should realize that the ACA does 5 of the 8 things listed by your referenced group. It doesnt do one of them, selling across state lines, very well, but it encourages it. If we had the strong exchanges favored by the left, weakened in an attempt to gain votes from the right, it would work better.
Perhaps most importantly, I would emphasize that the GOP has shown almost zero interest in health care reform when it holds office. Pass unfunded Medicare Part D to buy the votes of old people? Yes. Health care reform? No. There is only one game in town.
Steve
Steve,
My recollections of health care reform attempts has been of ones tacitly explored by both parties, especially in the 90’s. Producing a completed bill, able to be put on the Congressional table, was accomplished by the Obama administration mainly due to political logistics at the time — both the House and Senate had large reliable democratic majorities in which one could reasonably expect the passage of such a bill. Even with such an edge, it was a raucous, bitter fight, greased by pay-offs for votes, a slay-of-hand by Reid, and lies, such as promising abortion would not be included (which it was), in order to get Stupak and his allies to vote for the bill (Congress people needed to get the minimum number for passage).
The Republicans, however, did have their alternative HC reform ideas, which got little to no exposure or press: Patient’s Choice Act of 2009, 130 page proposal; Health Care Freedom Plan, 41 page proposal; Empowering Patient’s First Act, 130 page plan.
IMO, the high-fives you generously give to the dems for the passage of a HC reform bill , Steve, are really not all that warranted, in as far as the process, quality and now workability of the act itself. It was created through luck, crafty orchestration, deceptive promises, and unilateral approval — not really the type of collaboration, bi-partisan brainstorming that has a high chance of producing a worthy product. So far, that has proved to be the case…..
@jan- The GOP will always have a health care plan to put on display when there is zero chance they will have to act on it. They have not pursued reform when they have had the power to do so. Cut taxes? Yes. Health care reform? No.
Steve
Steve,
A bad healthcare reform enacted can be worse than no healthcare reform.
However, the GOP has really not been in as strong of a position, Congressionally, like the Obama administration was in during it’s first two years. So, I don’t think you can honestly compare their weak attempts at such reform, given there was probably no way to get it past the dems, in the first place. For instance, Bush attempted SS reform, but it was immediately given the red light. The same would have happened should he have put even a modest free-market HC proposal on the table.
Not surprisingly, the NY Post story Drew cites is misleading. For instance, the Post writes:
“Another 33 percent [of the doctors surveyed] say they’re still not sure whether to become ObamaCare providers.”
The actual question on the survey is:
1. How many health insurance companies’ Exchange plans you are participating with?
The answers are: 44%, not participating in any exchange plan, and 33.5% not sure.
Notice that the question is not “Do you intend to participate…?”, but “Are you participating…?”.
As the president of the MSSNY [MSSNY President’s Statement on Survey on ACS Survey]says:
Nowhere is the question of intent raised.
There have been projections of future doctor shortages without calculating what effect Obamacare will have on the medical industry. However, when you add in the different kinds of pressure/changes it will exert, creating more bureaucratic paperwork, regulation/time constraints, I think the impact will be enormous. And, no matter how much people like Sam and Steve want to put a smiley face on this type of HC reform, it will be more difficult to maintain the warm/fuzzy/personal/trusting relationships that many have come to enjoy with their physician of choice. As HC consumers are finding out, these relationships are being quickly either altered or severed, altogether. And, along with this depersonalization of medicine trend go some of the subtle incentives holding the more seasoned physicians (especially family practice ones), in place.
IMO, when you add it all up, the upheaval created by the PPACA might create an insurance card for some people, as it shrinks resources and quality of care for everyone else. One resource that will be out of reach for many are the hospitals excluded in the Obama exchanges. Then you have this happening, where the WH is once again trying to keep an informed public at bay, by pressuring insurance companies to keep quiet. It sounds more like The Mob is running things in DC these days! When can we expect legs to be broken?
“And, no matter how much people like Sam and Steve want to put a smiley face on this type of HC reform,”
I wasn’t putting a warm and fuzzy anything on anything. I was correcting a slanted news story. You read about as well the Post writer.
“I wasn’t putting a warm and fuzzy anything on anything. I was correcting a slanted news story. You read about as well the Post writer.”
Sam, you must be dizzy from your spinning!
Trying to parse the absence of “intent” into the story, all so you can claim the Post story was slanted, is ridiculous!
Everything this piece said indicated that NY doctors do not like this HC plan, “Period” — as our honest president has been quoted as saying, when emphasizing keeping one’s HC plan.
Excerpted from the NY Post story:
What is so uncertain about that statement from the President of that medical organization?
Even of the paltry 23% taking on exchange patients, “three out of four doctors who are participating in the program said they “had to participate†because of existing contractual obligations with an insurer or medical provider, not because they wanted to.”
It seems everything about the PPACA has something to do with ‘forcing people’ — from voting on it to now participating in it. Or, in the cases of the insurance companies, themselves — talking about it.
…And, did you even bother to read some of those final physician “anonymously share opinions about the new health care law,” that translated into venting about the law???
Augmenting the doctor shortage implications, here is a USA Today piece written in 2005 warning about dire shortages in the future — in the range of 85,000-200,000 by 2020. This analysis completely refutes an earlier one made by the AMA saying there was going to be a glut of doctors. BTW, the AMA, which supported the President’s PPACA, and puts itself out there as a credible representative of physicians’ POV, represents only 17% of the doctors in the U.S. — a minority figure. In fact a 2010 article claims that the AMA is muzzling doctors, and is actually more a representative, acting on behalf of government interests, than those of the medical profession.