Thursday, October 24, 2013

Obamacare and the Real World

The roll-out of Obamcare and the insurance exchanges offer a look into how government works. By comparing this with how private business handles major projects, we can see why the government is unsuited for handling projects on this scale.

This was a huge project. It should have had a three-year implementation. Instead it was created in less than a year. This was because of politics. Major decisions were postponed until after the election.

Other major decisions such as forcing people to create an account before being able to compare rates were made late in the process forcing a redesign of the web site.

When it was close to the implement date, the company doing the work warned the government officials that there were likely to be major issues but it was decided that a delay in implementation was unacceptable. In fact, the site was not fully operational at launch with important parts such as the security questions waiting for values and problems interfacing between the dozens of agencies involved have not been solved. This was another political decision.

Finally, warnings that the site was going to fail were kept from the President.

As a result of all of this, we had the President of the United States stood before the American people and claimed said that the site would be as easy to use as a travel site. Three weeks later he said that he had found out the problems from the news reports and that they were a combination of glitches and demand.

How would all of this play out in the real world?

First, a product launch date is determined by an estimate of how long the project will take. No one starts with an implementation date and works backwards.

Once a release date is set, other dates are set. Major design changes are frozen far enough ahead to prevent them from interfering with the release date. As the date grows closer, smaller decisions are frozen. As the date approaches, all changes are frozen except for bug fixes.

The features should be frozen by the testing phase. A few feature can restart the testing phase from scratch. The system should also go through a load test to see what will happen under the expected load.

Projects do inevitably fall behind. When that happens, either the release date is moved or features are cut or both.

Upper management is given a realistic appraisal of the status.

Finally, if a bad product does make it out, the person at the top apologizes and people are fired. When Apple implemented a bad maps replacement, their chairman apologized. When Microsoft had a bad roll-out with Windows 8 and the Surface tablets, several top managers lost their jobs and the top man, co-founder Steve Balmer, was forced to accept early retirement.

With Obamacare, major decisions were made based on politics and no one has been held accountable. And this is just a web site.

Friday, October 18, 2013

The Hidden Facts about Obamacare

For the past two weeks, the government shutdown drowned out the coverage of the Obamacare roll-out. It was a disaster but even if that had been covered, there are a host of deeper problems. In increasing importance they are:

The exchanges are a mess. Outside reviews say that the exchanges were written with 1990s technology. They are slow partly because they are exchanging data with dozens of other sites.

The Affordable Care Act isn't. The policies offered are much more expensive that prior coverage. The subsidies help some for people who qualify but even so, many people who managed to get through the software are experiencing sticker shock. The assumption was that healthy people would cover those with pre-existing conditions. It appears that the healthy people still need to pay an unhealthy surcharge to cover the pre-existing people. There was a reason that insurance companies refused to cover pre-existing conditions. It was not that they were heartless or greedy, it was that they couldn't do it and stay in business.

The biggest problem is that Obamacare is going to crash and burn. Between the difficulties in signing up, the poor rates, and the modest penalties for not buying coverage, Obamacare is not going to get enough people signed up. The only people who are motivated to sign up are the ones with pre-existing conditions. Without a large proportion of healthy people subsidizing them, the exchanges will come up short and the rates will rise astronomically. Fixing the software will not fix the problem with the rates. That's baked into the system.

All of this will become self-evident in the next few months. Opponents of Obamacare have until then to think of a workable solution to the problem of the uninsured with pre-existing conditions.

Friday, October 11, 2013

Why Did They Do It?

For weeks, possibly months, leading up to the government shutdown the White House and the Left openly wished for a shutdown. They learned the lessons of the shutdowns under President Clinton - that no matter what really happens, the President can use his bully pulpit to blame his opponents and will come out of it politically strengthened.

At the same time the far right made a hysterical appeal to defund Obamacare. They insisted that President Obama would abandon the program that he sees as his legacy. This played well with fund-raisers and raised the visibility of some Tea Party favorites but is counter-productive.

The result of all this is that the Republican brand has been diminished. Republicans are polling at their lowest numbers in years.

Worse, they helped Obamacare. Last night, NBC's top story was on the shutdown and it's effect on the Republicans. It was not until 8 minutes in that they spent time covering what a total failure the exchanges are. Without the Tea Party, the top story would be how unprepared the programs are. If the Republicans had stayed out of the way then public pressure to delay and replace Obamacare would have grown on its own.

That was a squandered opportunity.

It's time for this vocal group to admit a few realities. They are not the only ones in this fight and other strategies are more likely to succeed. They need to stop attacking compromise and learn from President Reagan who never attacked a fellow Republican in public, no mater what.

Obamacare needs to fail on its own. It is not instantly addictive. Lots of people have been hurt by it. The exchanges are not ready and the rates are too high. Instead of distracting people from these problems, the right needs to be highlighting them.

They also need an alternative. Obamacare passed because of a real problem - the fear of being being uninsured with an expensive illness. The Republicans need a solution to this that they can sell.

Shutting down the government will only hurt Republicans in the 2014 and 2016 elections. The only hope of replacing Obamacare lies in taking the Senate and the White House.

Monday, October 07, 2013

What's Wrong With the Exchanges?

When the insurance exchanges went live last week, people all over the country tried to access the system. Almost none of them got in? Almost none of them got in. The official explanation was that the opening day crowd overloaded the system.

The few who did get in discovered that they had to create an account before they could browse insurance rates. Creating an account includes answering some personal questions based on information from credit agencies. This would be similar to Amazon requiring you to enter your credit card and shipping information before it shows you the top seller list.

Several things are going on. The first is that the system just wasn't ready. Three years is a short amount of time to create a system like this from scratch. The system has not been properly load tested and there are numerous bugs left in the system. It is an alpha release rolled out as a finished product.

The Obama Administration should have admitted that the exchanges weren't ready and delayed implementation. They did not for political reasons.

The requirement to create an account before you see rates is different. It turns web sites on their head but it makes sense if you remember the Obama Administration's history of being to clever by half.

I suspect that the designers had two thoughts in mind. The first was that everyone has to sign up for insurance so they might as well force them to create an account at the beginning.

The second consideration is that the policies in the exchanges aren't that good. If you allowed someone to just browse, they might see this and give up, especially when presented with a complicated enrollment process. By putting the enrollment up front, it means that people have already invested time in the process. Even if they don't like the policies offered, they are more likely to choose one to justify the time and effort they have already put into the exchanges.

Thursday, October 03, 2013

Shutdown Follies

Various thoughts on the government shutdown:

The most important one is "What was the Tea Party thinking?" Did thye really think that President Obama would give up what he sees as his legacy? Yes, Obama is willing to cut deals with murderous dictators and rogue theocracies but his heart isn't in those fights. His only interest in foreign affairs was getting out of Bush's wars.

The shutdown was a disaster for the movement to repeal and replace Obamacare. It enforced the belief that, once in place it can't be removed. The headlines should have been about the breakdown of the exchanges and how few of the people who actually get through are signing up for coverage. Instead the top stories are about people hurt by the shutdown with a subtext about heartless Republicans.

What is not getting covered is that it takes two sides to have an impasse. Obama and the Democrats are refusing to negotiate, period. They need to throw the Republicans a bone for the good of the country. Instead they are too busy looking at the harm the shutdown is doing to the Republican brand and counting on that for winning the 2014 elections.

The Democrats are being ingenuous about the dispute. Obama and others emphasize that it is over just one law without acknowledging the massive scope of that one law.

I've also seen the argument that representative government requires that the Republicans accept the law. There is some truth to that. Obamacare was not a major issue in the last election and the Republicans have only managed to take one house of Congress. The flip side to that is that Obamacare was passed with the slimmest of margins, only by using legislative tricks and opinion polls showed that it never had a majority behind it.

The worst thing about the showdown is that Obamacare is not ready but it was implemented anyway. If not for Obama's reluctance to deal with the enemy (Republicans) it would have been delayed for at least a year.