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  #51  
Old 10-29-2013, 12:27 PM
Blakeyrat Blakeyrat is offline
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Originally Posted by Magiver View Post
I don't recall Amazon and Google crashing out of the gate. In fact, their success was because they worked and worked well.

This is pure incompetence thrust upon the public who are now expected to beta test it.
First of all, if you don't remember the major Amazon crashes then that's just an artifact of your memory. (Admittedly Google has always been pretty steady.)

Secondly, my point was that Google and Amazon built up their levels of traffic *over a long time*. They didn't have 50,000 simultaneous users on their first day, they had years to get their servers and applications into shape to handle the traffic. That's the critical difference.
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  #52  
Old 10-29-2013, 08:19 PM
Magiver Magiver is offline
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Originally Posted by Blakeyrat View Post
First of all, if you don't remember the major Amazon crashes then that's just an artifact of your memory. (Admittedly Google has always been pretty steady.)

Secondly, my point was that Google and Amazon built up their levels of traffic *over a long time*. They didn't have 50,000 simultaneous users on their first day, they had years to get their servers and applications into shape to handle the traffic. That's the critical difference.
ACA was created in 2010. They had years to get their servers and applications into shape to handle the traffic.
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  #53  
Old 10-29-2013, 09:32 PM
K364 K364 is offline
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Originally Posted by Claverhouse View Post
The CGI Group, some Canadian Information Tech company...
They adapted the Canadian version, which was pretty simple:

Are you Canadian?
Yes - Good, you're covered.
No - Sorry, can't help you.
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  #54  
Old 10-30-2013, 11:11 AM
Blakeyrat Blakeyrat is offline
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Originally Posted by Magiver View Post
ACA was created in 2010. They had years to get their servers and applications into shape to handle the traffic.
If you demonstrate that the site was completely specced-out in 2010, I'll concede that point.

I'm 99.9% sure it was not until much, much, later. And even after the original specifications were published, they were edited late in the development process.

Last edited by Blakeyrat; 10-30-2013 at 11:11 AM..
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  #55  
Old 10-30-2013, 11:36 AM
Magiver Magiver is offline
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Originally Posted by Blakeyrat View Post
If you demonstrate that the site was completely specced-out in 2010, I'll concede that point.

I'm 99.9% sure it was not until much, much, later. And even after the original specifications were published, they were edited late in the development process.
Amazon did not choose the roll out date. That was done by politicians. As has been discussed, the designers were continually barraged with changes. It was never tested. Which means it never had a director who knew what he or she was doing in the first place. Beta testing was left to the enrollee. It was a political version of the Homer Simpson car.
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  #56  
Old 10-30-2013, 11:40 AM
Blakeyrat Blakeyrat is offline
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Amazon did not choose the roll out date. That was done by politicians. As has been discussed, the designers were continually barraged with changes. It was never tested. Which means it never had a director who knew what he or she was doing in the first place. Beta testing was left to the enrollee. It was a political version of the Homer Simpson car.
Right.

And to be fair, I'm not saying the software company that created it is super-competent, best-in-the-universe-blow-you-away. I'm saying that *nobody* could have done a better job given the same constraints.

Maybe it's *slightly* more of a mess than it would have been if, say, Amazon had designed the site. But I doubt it. And Amazon doesn't do that kind of work anyway, so it's moot.
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  #57  
Old 10-30-2013, 11:41 AM
Really Not All That Bright Really Not All That Bright is offline
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I think Sebelius is probably going to have to fall on her sword over this.
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  #58  
Old 10-30-2013, 01:12 PM
Magiver Magiver is offline
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Originally Posted by Blakeyrat View Post
Right.

And to be fair, I'm not saying the software company that created it is super-competent, best-in-the-universe-blow-you-away. I'm saying that *nobody* could have done a better job given the same constraints.

Maybe it's *slightly* more of a mess than it would have been if, say, Amazon had designed the site. But I doubt it. And Amazon doesn't do that kind of work anyway, so it's moot.
I don't see where you can blame the software company when the government who ordered it continually made changes. This was managed by the government and that goes all the way to the top. It's the job of the President to oversee these projects just like any other CEO. He has to ask for updates and be shown that it works and is on schedule. None of this appears to have been done. This isn't "sorta" problematic. It's a complete hose up.

What makes this worse is that the President ran on a platform of transparency and he has gone out of his way to prevent public disclosure of how bad it is. He's got the time to parade the few who were able to complete the process but has forbidden disclosure of actual numbers. He also stated people would not have to give up their insurance and that it would lower rates. Both of these statements are not only false but he would have to know they were not and are not true. It is impossible for rates of established policies to go down when additional levels of insurance are raised.
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  #59  
Old 10-30-2013, 02:12 PM
Fear Itself Fear Itself is offline
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It is impossible for rates of established policies to go down when additional levels of insurance are raised.
Not it isn't. In fact, if young, healthy people are required to buy insurance, is is impossible for rates to not go down.
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  #60  
Old 10-30-2013, 02:21 PM
Sam Stone Sam Stone is offline
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This is a management problem that flows from the President on down. This is the result of having a chief executive with no executive experience.

Here's the way this would have been done if there was a competent chain of management in place:
  • The whole web portal part of the law would have been subject to a feasibility analysis to make sure it could even be done within the timeframe specified. That includes accounting for the time it takes for the law to be turned into a set of detailed regulations, and for those in turn to be turned into detailed requirements for engineering.

    Requirements analysis and planning for a project of this scope could have easily taken six months to a year after the regulations were set in stone, and I believe those were still being drafted as of last year.
  • A risk mitigation plan should have been put in place, recognizing that the portal was a critical portion of the overall law. That mitigation could have included cutting features, standing up a manual temporary process, or other ways to make sure the whole thing wouldn't come collapsing down if the deadline was missed.
  • The project plan should have been developed, and signed off by all stakeholders from the President on down to the leads of the development teams. That plan should have identified the critical paths, called out for tollgate reviews at critical points in the process, and clearly defined the conditions upon which potential problems escalated up the chain of management. That plan would also include the trigger points for risk mitigation ("If we can't hit milestone 3 by date X, we will revert to the alternate, simpler plan").
  • The President should then have appointed someone to be at the top of this project with responsibility for reporting problems to him if the escalation plan reached that point. For example, if the schedule slipped by more than a month, or a risk was uncovered that threatened a delay of more than X, or if the budget was running behind by X amount. By making it specific, you avoid the problem of an underling deciding not to report a problem because can 'handle it'.
  • The President should be having regular meetings with various staff members, including the person in charge of that project. That person should be giving regular status reports as called out in the project plan so that the President understands whether they are on track. He doesn't have to micro-manage anything or know a thing about software development - he just has to satisfy himself that things are going according to the plan and that the people he trusts to oversee it are satisfied.
  • If the president was unsure of his knowledge or capability to determine that the project plan was realistic and contained the required elements, he should have brought in an outside review board or experts to go over it and advise him as to whether the plan was realistic and controllable, and whether or not it missed key elements like security analysis, penetration testing, integration tests, and whether enough time was allocated for those activities.

Those of you who think CEOs don't matter and don't earn their pay could learn something from this. In my experience, bad management flows down from the top. I've been in one organization long enough to see what happens when you have a bad CEO and a good one. Bad CEOs are the ones who berate their subordinates for bringing them bad news, or respond to requests for help with answers like "Just get it done", or who constantly assign blame or deflect responsibility to the layer below them.

The CEO is the ultimate 'go-to' guy: The one who, when all else fails, can break through the organization logjams and right the ship that's heading for the rocks. When you have a good one, everything starts to line up, everyone knows what they should be doing, clear lines of communication are established, and infighting between groups is at a minimum. When you have a bad one, everyone starts looking for cover or protecting their turf, people become cynical and respond to requests indifferently, information stops flowing as people become afraid to communicate or feel like they'd be wasting their time to do so, etc.

This mess has all the earmarks of management troubles from the top down. No one knew who was really in charge, when critical problems surfaced they were buried somewhere in the bureaucracy, etc.

When Obama said "No one is madder than me!", that's a big clue that his organization is completely dysfunctional and that he doesn't understand the job of the Chief Executive. He wasn't the victim here - he was the perpetrator. What he should have said was, "This was my fault. I should have been on top of this. I will get it fixed."
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  #61  
Old 10-30-2013, 02:23 PM
Fear Itself Fear Itself is offline
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Originally Posted by Sam Stone View Post
This is a management problem that flows from the President on down. This is the result of having a chief executive with no executive experience.
There is one word to describe what happened the last time we had a president with executive experience:

Katrina.

Last edited by Fear Itself; 10-30-2013 at 02:24 PM..
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  #62  
Old 10-30-2013, 02:40 PM
Sam Stone Sam Stone is offline
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Not it isn't. In fact, if young, healthy people are required to buy insurance, is is impossible for rates to not go down.
That's only true for some people, and it's only true if the costs of the additional coverage are lower than the revenue brought in by expanding the risk pool. It's also not true if bringing millions of more people into the healthcare market drives up prices of services out of proportion to the percentage of people added. For example, if this causes a doctor shortage, you could see price increases much greater than the cost savings from broadening the risk pool. Prices will rise to the market-clearing level, and where that is depends on numerous factors.

Of course, you can respond to that by capping prices, but that only ensures that you will get shortages and have to start imposing long waiting times. Which is what happens in most other health care systems.

And let's be honest here - a lot of what is driving up the rates for some people is little more than a clever way to raise taxes on the middle class. When a 60 year old man is required by law to have maternity coverage, the effect is the same as raising his taxes by the cost of that coverage and giving a direct subsidy to women of child-bearing age. They're just using the insurance model to redistribute wealth and to make sure that the redistribution is tasked to health care.

The problem with that is using insurance is a very blunt instrument - you're likely to raise rates on a young middle class person just starting out in life and trying to save for a home and building a family, and give a subsidy to a wealthy older person who happens to have a pre-existing condition and who never bothered to pay for his own insurance until now but who could still afford the (much higher) rates for his condition.

If I'm happy with a catastrophic care plan with a very high deductible because I have a million dollars in assets and can afford a $20,000 deductible and would rather maintain lower rates, that's my business. But when the government says that such a plan is not acceptable and forces me into a much more expensive plan that has a $5,000 deductible, it has made my health care more expensive, AND it's lowered the incentive for me to be a wise steward of my healthcare choices including my health.

That's one of the biggest things going wrong here - the very people being forced out of their plans are the ones who have been doing the most to contain healthcare costs by paying for their own minor treatments out of their own pockets and by controlling their behavior.

For example, non-smokers get a big break in insurance costs when they are in the individual market, but not so much if they're in a large group plan. My understanding is that Obamacare no longer allows price discrimination between smokers and non-smokers, so they've removed an incentive for healthier behavior. That also drives up absolute costs of health care.
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  #63  
Old 10-30-2013, 02:45 PM
Sam Stone Sam Stone is offline
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Originally Posted by Fear Itself View Post
There is one word to describe what happened the last time we had a president with executive experience:

Katrina.
I agree that was a management failure, but of a very different kind. That was a case where a massive emergency happened (one of the largest you'd ever faced), and the government structures just weren't prepared to handle it and had no time to be corrected. It's actually a much more excusable error in that sense because it's a harder management and resource allocation problem.

The equivalent in the private sector would be a disaster-recovery plan that doesn't work out as you'd hoped when a disaster of rare scale hits. Maybe the plan wasn't sufficiently robust, and maybe there weren't enough tests, or the tests didn't think of everything. But you don't really know for sure until the disaster hits.

This management failure didn't have to happen, and it didn't unfold overnight with a hurricane - it unfolded slowly over a period of years, while everyone who should have had oversight was asleep at the switch.
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  #64  
Old 10-30-2013, 04:24 PM
Colibri Colibri is online now
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Since this has predictably moved into politics, let's move it over to Great Debates.

Colibri
General Questions Moderator
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  #65  
Old 10-30-2013, 05:11 PM
Martin Hyde Martin Hyde is offline
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I would agree with the idea Sam Stone is pushing but not the specifics.

Namely:

1. I disagree the PM should have been appointed by Obama and report directly to Obama. This was a big IT project, costing hundreds of millions of dollars. But he is the POTUS, overseeing a trillion+ dollar budget, managing the world's most powerful military, millions of Federal employees, regularly meeting with world leaders, regularly dealing with a troublesome Congress etc. I'd argue a couple hundred million dollar project, even an important one, shouldn't be headed by a guy that Obama talks to on a regular basis.

2. Sebelius should have appointed an overall PM for the project. He/she should have been independent of everyone other than Sebelius. Not a bureaucrat from CMS with no experience managing software projects. Further, Sebelius should have been told (by the President) early on, "Consult with the Chief Technology Office of the United States to select the person to run the HealthCare.gov project." When Sebelius decided on her pick, it should have been with the help of the CTO of the United States who would have also selected a group of IT savvy people to come up with recommendations that would be presented to Sebelius.

I should note the current CTO of the United States is a pretty qualified guy, who founded and ran two healthcare IT companies in the private sector before going into government. He seems quite ideal to fulfill this chief advisory role on this project.

3. Once Sebelius had picked the PM with the help of the CTOUS, Sebelius should have created a standing meeting with the PM, where the CTOUS and a staff of his choosing would be there. This staff would be kept fully aware of all that was going on with the project through regular inclusion in meetings/email chains etc with the PM. Their job and the CTOUS' job in the standing meeting with Sebelius would be translating the technical information into something she'd understand so she could ascertain what was going on.

4. The President should be asking Sebelius and the CTOUS to brief him "occasionally" on what's going on with the project, but again, he need not be regularly involved. Part of the instructions the President should have given to the CTOUS when he assigned him this job would have been that one of his primary roles would be to report to him (POTUS) if he had any inkling the project was in danger of missing the deadline. Because at that point the President might have to make decisions about what to do (phased rollout, delaying the mandate etc.)

Both Sebelius and Obama know they are not IT people, both of them should have been reaching out to high level Federal IT people to help them with this in terms of briefing them and keeping them informed. The fact that the President didn't instruct Sebelius to work with an expert like CTOUS (or someone similar) to help pick a PM and help run exercise oversight of the project is a management failure.

The fact that Sebelius herself didn't know to go to her own DHHS CIO and get advice and instead put it in the hands of bureaucrats at CMS instead of employees of the DHHS Office of Technology is crazy. Why does DHHS have its own IT office dedicated to stuff like PM and oversight if it wasn't going to be doing something like overseeing this?

The fact that Sebelius has no idea of even how to exist in an organization with IT shows she's an unfit administrator. She was selected by the President, so ultimately responsibility falls onto him.

In this day and age, any big time administrator or executive needs to at least know how important IT is. The CEO of Exxon or Wal-Mart doesn't need to know the dirty details of IT, but he absolutely does need to understand how IT fits in the enterprise and he needs to understand it's important to have smart, qualified people in the IT department and a smart CIO/CTO reporting to him. It's no different than the expectation that a CEO be at least conversant enough in issues like finance, law, sales, r & d etc that he can perform CEO tasks in relation to those departments.

As President you run for election because you think you're better than anyone else in the world at sitting on top of a really big pyramid. You don't get the option of copping out that "I'm not into this IT stuff."
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  #66  
Old 10-30-2013, 05:45 PM
Sam Stone Sam Stone is offline
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Originally Posted by Martin Hyde View Post
I would agree with the idea Sam Stone is pushing but not the specifics.

Namely:

1. I disagree the PM should have been appointed by Obama and report directly to Obama. This was a big IT project, costing hundreds of millions of dollars. But he is the POTUS, overseeing a trillion+ dollar budget, managing the world's most powerful military, millions of Federal employees, regularly meeting with world leaders, regularly dealing with a troublesome Congress etc. I'd argue a couple hundred million dollar project, even an important one, shouldn't be headed by a guy that Obama talks to on a regular basis.
Yes, I agree. I shouldn't have said that the President would directly appoint a project manager. He doesn't have the skills for that. Neither does Sebelius. The point I'm making is that the project plan HAS to include escalation and status updates that go straight to the top of the chain. There are several reasons for this. One is that the CEO should not be allowed to escape responsibility for such a critical project. The other is that if you stop at a level that doesn't ultimately go to the top, it allows for too much confusion and buck-passing between the numerous people at the level below. Responsibility always has to go right to the top.

This is especially true because there were many departments involved, and government infighting and buck-passing between them is a constant source of problems. The only person who can deal with that is POTUS.

This is what cabinet meetings are for. Obama should have said to Sebelius: "You go stand up the project team. Talk to who you need to to help you figure this out, but we need an excellent project manager on this with experience in these kinds of large projects. I'll expect status updates during our cabinet meetings - it may just be a single "on track" comment, but I expect to be told if anything comes up that poses a possible threat to this project. If you have trouble communicating with or getting cooperation from any other department, you bring it to me and I will crack heads."

Then each cabinet meeting involving Sebelius should have had an agenda item "Obamacare Rollout status" and it should have been discussed.

Instead, it appears that Obama just handed off authority to Sebelius, and assumed his job was done. And she did the same with CMS. And they did the same with the contractors... There don't appear to be any clear lines of communication going back to the President.

The bottom line is that Obama claims to have first heard about the failure of the first major rollout of his signature legislative accomplishment by watching it on TV with everyone else. I'm not sure he even realizes what a gross admission of failure on his part that really is. He honestly seems to think he's the victim of someone else's screwups.

The other possibility is that he knew all about it, and he was the one who screwed it up by sending confusing signals, arbitrary demands, or by ignoring warnings, and now he's deflecting blame by lying through his teeth and throwing his people under a bus. Frankly, I could believe either one of those options.

The only thing that's not possible here is that Obama is blameless. If he was a CEO in the private sector, this is the kind of thing that would threaten his career. Not the failure of the project, but his admission that as CEO he had no interest in or knowledge of the status of that project.

Even more amazing was Kathleen Sebelius's admission, documented here:

Quote:
After two weeks of review, the HHS secretary concluded, "We didn't have enough testing, specifically for high volumes, for a very complicated project."

The online insurance marketplace needed five years of construction and a year of testing, she said: "We had two years and almost no testing."
Coming from any private company executive, this would be an admission of gross negligence. She knew it needed five years of development and a year of testing, but agreed to roll it out after two years and two weeks of testing? Crazy. Or, she needed to have a 'two week review' to discover this? No one else in house knew that this project was grossly behind schedule? No one had an inkling of how much testing such a system would require? That's just not credible.

A public admission like that in the private sector would open you up to lawsuits by anyone damaged by this mess. For her to admit what they did should result in her immediate termination for gross dereliction of her responsibilities.

But then, Obama should have known all this too. And he didn't do anything about it either. And if he didn't know, he's inept. There's just no getting around it.

Hell, in the private sector a CEO can be held responsible if a lowly ship captain does something stupid like drink on the job and run his oil tanker into the rocks. Investigators and lawyers will want to see what policies were in place to prevent it, what training was done, whether anyone else in the company should have reasonably known the employee was a problem, if they did whether that information was communicated to the people in charge, and if it was and they did nothing whether there was a culture of ignoring those issues.

And even if legal liability is not established, the investors might punish the company and remove the CEO if they feel he or she was in any way partly responsible for what happened - or even if not, if they felt that confidence in the company required a new leader.

Last edited by Sam Stone; 10-30-2013 at 05:47 PM..
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  #67  
Old 10-30-2013, 06:00 PM
Really Not All That Bright Really Not All That Bright is offline
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You are assuming that the PM would be an inferior officer (and thus subject to the POTUS' discretionary appointment power).
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  #68  
Old 10-30-2013, 06:12 PM
Fear Itself Fear Itself is offline
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But then, Obama should have known all this too. And he didn't do anything about it either. And if he didn't know, he's inept. There's just no getting around it.
Should he resign?
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  #69  
Old 10-30-2013, 07:23 PM
PhillyGuy PhillyGuy is offline
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If I'm happy with a catastrophic care plan with a very high deductible because I have a million dollars in assets and can afford a $20,000 deductible and would rather maintain lower rates, that's my business. But when the government says that such a plan is not acceptable . . .
The modest increase in taxes for such a person, represented by the Affordable Care penalty, is obviously affordable. But people with high deductible policies generally combine the with a health savings account, and will thus avoid the penalty.

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Originally Posted by Sam Stone View Post
My understanding is that Obamacare no longer allows price discrimination between smokers and non-smokers, so they've removed an incentive for healthier behavior.
I wonder what your information sources are.

See:

How Much Will Obamacare Cost? Try Our Calculator

and

Higher insurance rates may cause smokers to flee Obamacare coverage
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  #70  
Old 10-30-2013, 07:29 PM
Martin Hyde Martin Hyde is offline
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You are assuming that the PM would be an inferior officer (and thus subject to the POTUS' discretionary appointment power).
Why wouldn't he be? Specific titles within the Federal government, and certain powers associated with those titles are defined in Statute and those titles are further defined as Senate-confirmed titles. But I doubt there is any legal requirement that "person we decide to make our go-to PM for HealthCare.gov has to be the Assistant Undersecretary of Thisandthat which is a Senate confirmation position."

It'd be more like the "czars" which are usually just high level positions "without portfolio" that the President is allowed to unilaterally hire for and fill.

It doesn't even have to be a Federal employee, which would make it even simpler. We had money budgeted for HealthCare.gov and all those contracts, definitely more than enough wiggle room in all that to let the Fed carve out a spot at around $150k/yr from some of the contract money for a PM.
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  #71  
Old 10-30-2013, 07:31 PM
Claverhouse Claverhouse is offline
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Rumblings of Impeachment

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Originally Posted by Sam Stone View Post

When Obama said "No one is madder than me!"


"Than I" --- Than I.
__________________
The efficiency and success of the Italian aviators in Tripoli are noteworthy, but must not be overvalued. There were no opponents in the air.

v. Bernhardi ---- Germany and the Next War

Last edited by Claverhouse; 10-30-2013 at 07:34 PM..
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  #72  
Old 10-30-2013, 08:23 PM
PhillyGuy PhillyGuy is offline
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A risk mitigation plan should have been put in place, recognizing that the portal was a critical portion of the overall law.
Risk mitigation features range from reinsurance to the paper application process, which is working.


Quote:
The project plan should have been developed, and signed off by all stakeholders from the President on down to the leads of the development teams.
These standard project management processes are more a matter of opinion than something scientifically proven. The Empire State Building went up quickly without modern project management, and with high safely standards.

Having said that, there probably was a lot of use of project management techniques in building the web portal. As for the President signing off, he is legally disallowed from shifting funds from one department to another without congressional approval. Because of this, he lacks the normal power of an executive sponsor, and his signature would have been a stunt.

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Bad CEOs are the ones who berate their subordinates for bringing them bad news, or respond to requests for help with answers like "Just get it done", or who constantly assign blame or deflect responsibility to the layer below them.
Then we should vote against any candidate who campaigns against Washington bureaucrats. What kind of CEO berates his subordinates before meeting them? A bad one.

This will disqualify most conservatives from holding high office.

Re project management, maybe someone should do a survey of the state portals to see if there is a correlation between strict adherence to the PMBOK and how good the site is. I preduct victory for the null hypothesis!

Last edited by PhillyGuy; 10-30-2013 at 08:26 PM..
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  #73  
Old 10-30-2013, 10:00 PM
Magiver Magiver is offline
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Originally Posted by Fear Itself View Post
There is one word to describe what happened the last time we had a president with executive experience:

Katrina.
OH HELL FUCKING NO. The President and emergency agencies bent over backwards to call everybody in New Orleans and tell them exactly what needed to occur. That included the Mayor, the Police, and Fire departments. They were called directly By Federal agencies. The federal responsibility was to to put in place emergency shelters and supplies OUTSIDE of the expected zone of destruction and that's exactly what was done. I know this was done because I had to set up trucks to deliver emergency supplies for this process.

Mayor Nagin chose not to run the PSA he created expressly to deal with such an event. This PSA was the result of a series of mock drills from the Hurricane Pam exercise). Not only did he not inform people of the gravity of the situation he invited them to a party at the Super Dome. Only he neglected to furnish it with supplies. Which wasn't possible after the hurricane hit because the roads and airport were trashed.

The governor then made this worse by not activating the national guard for days. This could only be done by the governor and again, this was explained to her in real time.

The people trapped in New Orleans were there because of the express failure of Mayor Nagin to properly warn them and evacuate those who needed it. And because of this sorry excuse of a human being the Federal Government had to redirect 1/3 of their entire fleet of rescue helicopters to that one city. Nagin made a bad situation exponentially worse.

Last edited by Magiver; 10-30-2013 at 10:03 PM..
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  #74  
Old 10-30-2013, 10:27 PM
NonaSequitur NonaSequitur is offline
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Don't know if anyone mentioned this but United Heakthcare acquired one of the software contractors QSSI in 2012.
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  #75  
Old 10-31-2013, 11:59 AM
Blakeyrat Blakeyrat is offline
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I don't see where you can blame the software company when the government who ordered it continually made changes.
You didn't read my post at all. I wrote the exact opposite of what you seem to think I did.
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  #76  
Old 10-31-2013, 01:31 PM
Damuri Ajashi Damuri Ajashi is online now
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Quote:
Originally Posted by Magiver View Post
It is impossible for rates of established policies to go down when additional levels of insurance are raised.
No its not. For several reasons.

Once you get rid of expenses of underwriting and claims adjustment and profit, you can lower premiums across the board by about 10-15% right off the bat (why do people keep forgetting that profits cost money).

Once you make it mandatory for everyone to get insurance, you don't have to skew your actuarial tables for adverse selection (IOW, the only people who used to get individual insurance plans before Obamcare were either very high risk or very risk averse). And you can charge a MUCH lower premium. 1% of the people below 65 in this country account for the majority of all medical expenses incurred by people below 65.

Then after that you just end up shifting costs. The low risk insured end up subsidizing the high risk insured. Sure the 25 year old is only going to pay $50/month in premiums (without a subsidy) but the overwhelming majority of them are likely to go to the doctor once a year for an annual check up. The rest of the money goes to help pay for their uncle's dialysis. But there has always been a socialistic element to insurance, heck, there's always been a socialistic element to civilization.

Quote:
Originally Posted by Sam Stone View Post
It's also not true if bringing millions of more people into the healthcare market drives up prices of services out of proportion to the percentage of people added.
Health care is not a free market and hasn't been for a long time. Prices do not float with the supply/demand curve.

Quote:
Of course, you can respond to that by capping prices, but that only ensures that you will get shortages and have to start imposing long waiting times. Which is what happens in most other health care systems.
We end up importing doctors and nurses and giving them provisional licenses to practice primary care medicine in underserved areas. Go to Appalachia and the one immigrant Indian family will be the doctor's family, very few US trained doctors choose to set up shop in places like this.

Quote:
And let's be honest here - a lot of what is driving up the rates for some people is little more than a clever way to raise taxes on the middle class. When a 60 year old man is required by law to have maternity coverage, the effect is the same as raising his taxes by the cost of that coverage and giving a direct subsidy to women of child-bearing age. They're just using the insurance model to redistribute wealth and to make sure that the redistribution is tasked to health care.
Ermm ALL insurance redistributes. From those who don't have the expense to those that do. There is a socialistic streak to all insurance.

Quote:
The problem with that is using insurance is a very blunt instrument - you're likely to raise rates on a young middle class person just starting out in life and trying to save for a home and building a family, and give a subsidy to a wealthy older person who happens to have a pre-existing condition and who never bothered to pay for his own insurance until now but who could still afford the (much higher) rates for his condition.
And that is why we have tax credits... to income adjust the permium payments.

Quote:
If I'm happy with a catastrophic care plan with a very high deductible because I have a million dollars in assets and can afford a $20,000 deductible and would rather maintain lower rates, that's my business. But when the government says that such a plan is not acceptable and forces me into a much more expensive plan that has a $5,000 deductible, it has made my health care more expensive, AND it's lowered the incentive for me to be a wise steward of my healthcare choices including my health.
Really??!?! So you think people engage in poor health behaviour because they think "fuck it, I have health insurance so I'm going to live an unhealthy lifestyle" Maybe at the margins a little bit but not to any significant degree and they can STILL choose catastrophic coverage with $6000+ deductible for ~$125/month (you actually get ~$100/month net gain after tax credits if you are poor enough).

Quote:
That's one of the biggest things going wrong here - the very people being forced out of their plans are the ones who have been doing the most to contain healthcare costs by paying for their own minor treatments out of their own pockets and by controlling their behavior.
This is an almost non-existent constituency and for many of them, the Obamacare catastrophic plans are just as cheap if not cheaper, while providing much better benefits. None of these guys were getting a good deal on the individual market before Obamcare, see adverse selection comments above.

I've been pricing healthc are plans for years and the Obamacare plans are better and cheaper than what was previously avaialble on the individual market by a LOT. My 60 year old housekeeper can get reasoanbly silver coverage for ~$300/month (and thats BEFORE any tax credit she might be eligible for, my friend with a small with a small business can get healthcare for herself and her employees and their families for ~$500/month per primary insured. These numbers are half to a third what they were before Obamcare so even if she ends up subsidizing some pregnant woman somewhere, she is paying less than she was before.

Quote:
For example, non-smokers get a big break in insurance costs when they are in the individual market, but not so much if they're in a large group plan. My understanding is that Obamacare no longer allows price discrimination between smokers and non-smokers, so they've removed an incentive for healthier behavior. That also drives up absolute costs of health care.
And the prices are STILL cheaper for the non-smoker under Obamacare than it was in the individual market.
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