Did we take a giant step forward, and then two . . . (you know the rest)

The whole story of the ACA roll out is yet to be reported in depth, but this morning in his Wonkbook email, Ezra Klein provides a credible – and disturbing – overview of what led up to the massive failure of the web portal. There’s a lot more at his Wonkblog at the Washington Post.

The best news for Obamacare is that almost everyone — including the Obama administration — realizes the crucial online portal is currently a disaster. . . Actually, that’s been the problem: President Obama didn’t know that. Nor did White House chief of staff Denis McDonough. Nor did Health and Human Services Secretary Kathleen Sebelius, who will be testifying to that fact next week.

It would be one thing if Obamacare’s problems had been unknowable. But they weren’t. Staff at HHS and CMS saw this coming for months. Insurance companies began predicting a mess long ago. But the bad news was shaded and spun as it made its way up the chain of command. The alarming failures seen in the (inadequate) load tests were written off as bugs that would soon be fixed.

As Lena Sun and Scott Wilson reported, “Days before the launch of President Obama’s online health insurance marketplace, government officials and contractors tested a key part of the Web site to see whether it could handle tens of thousands of consumers at the same time. It crashed after a simulation in which just a few hundred people tried to log on simultaneously.”But staff was terrified to speak on the record, or even on background. Some of the concerns slipped out, like in this Wall Street Journal story. . . . As Jonathan Cohn writes, “the management failures here were real and took place on multiple levels.”

Obamacare has a chance because those management failures are over. The White House now has a brutal clarity about the depth and extent of the system’s problems.

. . . Managers up and down the chain realize their careers are in jeopardy if they deliver sunny reports that prove false.. .For all that, no one actually knows whether the system will be fixed in the next few weeks — the crucial window, experts think, before the problems begin to degrade the risk pool and raise premiums.

So far, there’s been huge improvements in the number of Americans able to get into the site and create accounts, but insurers aren’t reporting much improvement . . .

The White House is optimistic that the problems will be solved in time. . .  If there’s a reason to believe them, it’s that they’ve learned how dangerous unfounded optimism is.

Did Obama really hand this off and assume it would be okay? Or did he ride HHS for progress updates but never insist on hearing the downside reports? Did Sebelius do the same thing?

Will the very same Administration that succeeded in taking took us a step closer to the century long  battle for universal health care also be the Administration responsible for its failure?

I think it’s a fair question.

30 responses to “Did we take a giant step forward, and then two . . . (you know the rest)

  1. Oh for crying out loud, Moe. Of course it was handed off. The president can’t do everything. People at the top delegate. People in the middle delegate. I DELEGATE.

    The question is not why didn’t the president write computer code, but it IS why did the chain of command fail — why did underlings not bring it to their supervisors so that it could — as it should — make it up the ladder.

    The buck stops with the President. It is his responsibility to clear it up and to make sure similar problems in the chain of command do not happen.

    That said, I personally spent about 6 hours on my insurance company’s (CareFirst) website and experienced time outs, lengthy waits, incomplete information and incredible frustration. That is what it is like dealing with insurance in my vast experience. So perhaps the Obamacare website is really just like all the rest.

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    • Elyse – no disagreement with how that stuff works. I didn’t expect him to write code, or be deep in the development loop. But this wasn’t just any new program. . . this was to be his – and the left’s – signature accomplishment. And it had political and corporate enemies around every corner.

      So I think he should have been much more engaged than it sounds like he was – if a President is contemplating a strategic move overseas, you bet he’s listening to the naysayers as well as the architects who proposed the plan. Shouldn’t he have done that here?

      I”m sure he (and Sebelius???) insisted on regular reports and asked if it was on time and would work. But if he simply took the word of their staffs, that’s a failure.

      A lot of front loaded computer glitches would be normal with a launch like this. I wish that were the extent of the problem. I think the very worst of it is that they never ran a full bore beta test.

      It was designed with the assumption that the States would all create their own ‘marketplaces’ and that so many opted out (creeps) meant a big traffic problem. But they knew this almost a year ago.

      Ahhh, I’m just frustrated because I so dearly want this to work

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    • Also . . . meant to add that I totally agree with you that it’s screaming nonsense when people claim what we have now is working. We’ve all dealt with health insurance companies over the years and I found it infuriating and increasingly less valuable. Have I mentioned lately (yes, of course I have) how easy Medicare is? Have absolutely utterly reliable it is? How simple to navigate their website is?

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  2. What? You mean to tell me that the web site glitches have nothing to do with the law itself?

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  3. Pingback: Why Should They Get it Better? | FiftyFourandAHalf

  4. George Will commented on something all of you are missing. The website is not the real problem. The whole ACA is built on one main idea. You have to get millions of young healthy adults to sign up and pay a lot more than market prices for their coverage to balance out the old and the sick. They ain’t the ones who will flock to the exchanges. One guess as to who will swell the numbers once the website is fixed.

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    • The young and healthy wouldn’t be eager to pay for insurance – so hence the tax penalty to get them to sign up.

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    • True, Alan, young people are relatively disinclined to prepare for the future, but I think you and George Will are underestimating the situation. Society is chock full of examples for them. Heck, most everybody has older relatives with health problems and despite all the moaning, this country is much wealthier than it used to be. It’s a matter of personal budget priorities, just like the price of gas as an example. When gas went above $3 a gallon you would have thought the world was ending, but now people have adjusted by driving less and buying more fuel-efficient rides. I think the same will be true of the ACA – it will be a necessity that brings peace of mind. If they can get the *&$#@ software fixed, that is. I saw a painful political cartoon in USA Today: it showed that the government has called in Dilbert and his co-workers to fix the problem. Ouch!

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      • Jim,

        I beg to disagree. I compare my generation to those in their 20s now.. Why are all of these kids still on their parents insurance? Why was I able to easily get employment and full insurance at 19 and buy a house at 21 with no co-signer? Was I smarter ? No. Did I work harder ? No. Was big business and the corporate world less evil in the 1970s than now? Freakin No!

        The slow growth economy we have been in for 5 years is a disgrace. We are not generating the wealth necessary to pay for everything including healthcare. As an old fogey, in my day you made enough money with benefits to support yourself and a wife and a couple of kids with all of their medical. Now kids have to stay on their parents insurance until 26 because the jobs to support a family with medical benefits are not there. And they are the ones with college degrees.

        You think these kids who already do not make enough money to start families should now be gouged on health insurance premiums to pay for geezers like you and me. They are not going to do it and I do not blame them one bit.

        My earlier point again. The website is the least of the trouble. Fix it, then beware. These healthy young adults will not be patsies much longer.

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        • Fine, Alan. When you start fixing it I reccomend you start with repealing EMTALA. Yee Haw!

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          • I had to go google EMTALA – ahhh, the Reagan administration and their damn socialism!! The Wiki says:

            The Emergency Medical Treatment and Active Labor Act (EMTALA)[1] is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment.[1]

            Wow – “no reimbursement provisions” means, I guess, that the hospitals are on their own.

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            • That’s right, Moe, EMTALA leaves the hospitals on their own to collect on ER bills. My understanding is that they do try to do so, including in some cases selling the debt to collection agencies at a discount. But, as the old saying goes, you can’t get blood out of a turnip. The healthcare marketplace would look vastly different without EMTALA. At the time it was enacted in the 1980’s, hospitals had begun the practice of “dumping” customers who couldn’t prove they could pay, loading them into ambulances and delivering to others who would take them, a rapidly-dwindling number.

              This is the elephant in the room when the GOP talks up personal responsibility, fairness and capitalism, all the while never mentioning a single word against EMTALA, the single largest unfunded government mandate ever enacted in this country. I kid you not.

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              • Why Jim, are people so determinedly blind to the fact that taxpayers end up paying for the uninsured?

                A few months back, Time Mag dedicated an entire issue to a single story. “A Bitter Pill” by . . . Brill? . . . it went deep into how hospitals charge and how Pharma works. Devastating story. At the time, I fully expected it to change the national conversation. But aside from a brief flurry of talk show appearances, it went away. I was stunned.

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                • I too am surprised that Brill’s essay seems to have had so little impact, Moe. I guess it’s just that economics is so dang complicated that people just give up trying to cope with it. You are right of course, there’s no free lunch. As I’ve said elsewhere, it is a myth that healthcare is unaffordable. The problem is that it is unreasonably priced.

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        • Alan, no doubt many young people – feeling bulletproof as the young always do – will pass on ACA. But I hear people defining ‘young people’ as though they were all carefree single 20-25 year olds. But they’re not. They’re in their late 20’s, early 30’s, maybe older. They’re married, they have kids. Or maybe they have had insurance before in another job and like being covered.

          Also, while the penalty is paltry the first year or two, it goes up and up and up for every year a person remains uninsured and in five years or less it starts making financial sense to get the insurance.

          ACA has serious flaws that need attention, and if the GOP would get down to doing the job of governing, the fixes and changes could get underway. Like anything this big,, that process will be ongoing for a long time and the as circumstances change so must the plan.

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          • Ms. Holland,

            I believe you have allowed yourself to fall victim to a myth. The myth that there are large numbers of healthy young adults who fail to provide health insurance for themselves because, one they believe they are invincible, and two they are just cheap. These freeloaders must be brought to heel and forced to pay higher than market premiums so that the sick and the old can have lower premiums. What happened to the mythical rich guy who would pick up the tab ?

            You believe that once the website is fixed everything will take care of itself. One of us is in for a serious reality check. When Senator Max Baucus warned of the coming train wreck, 6 months ago, he was not talking of the website.

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            • Alan, I’ve never beleived that ACA would be perfect, now or in the future. It’s very imperfect, but it’s a step in the right direction. One thing it does is build in incentives for good outcomes as well as for cost efficiencies so we can slowly back away from ‘fee for service’ which is killing us.

              Anyway, as you no doubt know, my choice was always “Medicare for All”. This is a thin substitute, but better than what we’ve got.

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      • Ouch indeed Jim.. I don’t expect to see this website stuff resolved for a while. Increasingly sounds like a bigger and bigger fix needed.

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  5. Just Fix it!…..

    That’s what they should worrying about on the healthcare.gov website…

    I know we tend to jump ahead in the political world but first things first….

    The site DOES have problems….

    The White House says that HHS is on the case….

    Then they need to be left alone to do their job…

    What is NOT needed is the people doing the fix to be standing in front a House Republican political witch hunt….

    http://www.politicaldog101.com/2013/10/23/open-thread-for-october-23-2013-just-fix-it/

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    • Agreed james – I heard some of those hearings yestterday and they were only about blame ad didn’t acheive a single thing.. There’s plenty of blame to go around but yup, what’s important now is concentrating on fixing the damn thing. And that ain’t going ot be easy.

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  6. I find it hard to believe that Obama knew well in advance that the website would be a glitchfest. It’s probably the case of issue reports going up the management chain and getting rosier the higher they go up.

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    • Hey X, welcome to WW. I’m sure too that in true CYA fashion the reports looked pretty good by the time they got to him. But I don’t let Sebelius off the hook on this one – it was her job and managerial oversight on something this enormous should never stop with reports. They needed to do something like ‘war games’ to test how the system would deal with unanticipated problems. You need a ‘team B’. I wonder if they had that?

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      • I don’t know if it was Sebelius or not, but someone had to be in charge of creating the website. The fact that they did not do any testing of the full site until a few days before was a huge red flag, because releases of that size should get at least few weeks, if not months, of beta testing.

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        • X – I’m late getting back here so don’t know if this is mentioned above . . . but why not a staggered roll out? First, just people with names starting with A, B or C for a few days, then D, E and F and so on. Then everyone. It might have at least helpped.

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          • This may sound like a good idea in theory, but it becomes really hard to coordinate all these installs, unless they are far apart – a month or more. Also, first you have to make sure the code works for one group but not the other, then change it back so that all groups work. As you might guess, this creates potential for yet more glitches. I still think it would be easier to identify and fix bugs if, say, the site opened for a pilot testing for just a couple of states first for a few months, then went live for all states it covers, but even that would require that the insurers are on board with this.

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            • Ahhh, I see.

              In any case, as time goes on, it looks more like the problems are big enough that even were it possible to stagger enrollment, it might still have happened just as it did.

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  7. They choose the wrong techies, who used the wrong technology. Did they try to do it on the cheap? It’s a mess and will be VERY hard to fix. There was a perfectly good system in place, it’s called Medicare…but “no”, the Republicans just couldn’t see how great that would be for the country. Or maybe they could and couldn’t go along with it.

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    • Exactly . . . Medicare for All with everyone young and old paying in would instantly solve the country’s future cost problem with Medicare; it would self finance, insure everyone and bring down all the costs. But that would be too easy I guess. And it’s practically Communism!

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