Streams

Update on Obamacare

Friday, October 18, 2013

HealthCare.gov Website

Andrew Rasiej, founder of Personal Democracy Media, which focuses on the intersection of technology and politics, and Ezra Klein, columnist at The Washington Post and MSNBC contributor, explain why the tech-savvy Obama administration encountered difficulties launching the online healthcare exchanges.

Guests:

Ezra Klein and Andrew Rasiej

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Comments [66]

Denial of Service attack vs Health Exchanges ? from Why is online exchange access so slow?


Given the Tea Party's strong opposition to
"Obamacare" - is it possible that the SLOW
to HALTING service on the Health Exchanges
is due to a "DNS-attack" (denial of service
attack) possibly by a fringe group of Tea-party
affiliated hackers ?

Has a DNS attack been investigated as a cause of
the slow and decreased access to these online exchanges ?

Oct. 21 2013 10:54 AM

@Mr. Bad

"I have no idea why there is so much conservative backlash against single payer"

My guess would be fear of change. The citizens that are well-served by the healthcare system in its present form don't want the risks that changes will make it worse and don't much care that our national healthcare bill runs 1/6 to 1/3 MORE than any other developed country - with the added knock that 14% of us are not covered by any insurance plan at all. 2.5% of $16T is $400B. That's A LOT of BMW or Mercedes lease payments.

ACA 2.0 - and the shortcomings of forcing people to participate in a for-profit system that must (on average) consume 12-15% of family income will doom ACA 1.0 - can be much more rationally engineered. The country needs to get over its 'fear' of socialized medicine first.

Cynicism aside what the country does with the $400B-$900B "healthcare dividend" makes a difference. Just like the wage earners surplussed by the off-shoring of American manufacturing...If the idled workers are retrained for more gainful work, it's a plus. If instead, we just shuffle them into permanent unemployment - many of the are now getting disability payments - we should have left it alone...Does the 'saved' money get invested or do we just consume it in new flat screens?

Oct. 20 2013 11:13 AM
Mr. Bad from NYC

"The freest economy in the world has national health care

It is no secret conservatives and libertarians in the USA ♥ Hong Kong. After all HK has Ricardian free trade, low levels of regulations, no capital gains tax and an individual flat tax. Every year when the Heritage Foundation releases its Index of Economic Freedom, HK always tops the list.

However, HK has a dirty little secret. It has a very good national health care system. HK citizens have some of the highest life expectancies in the world but their government health care system only costs about three percent of their GDP to operate (a sharp contrast to the 20 percent of GDP that USA health care costs are expected to be in the next decade).

The point of the HK example is that this beacon of capitalism manages to operate the freest economy in the world while offering and providing a British-style national health service. if one listens to rightwing shock radio or the rhetoric of the Tea Party, it is impossible for that to happen. After all government health care would turn America into a giant Gulag Archipelago.

American conservatives are free to believe that a single-payer system in America will lead to a road to serfdom. Just don’t tell the citizens of Hong Kong, OK? You may embarrass yourself. "

http://www.freerepublic.com/focus/news/2896163/posts

Oct. 19 2013 10:31 AM
Mr. Bad from NYC

PNHP, a group of doctor's advocating for single payer lay out more persuasive argument for this than I can because they are doctors:

http://www.pnhp.org/facts/what-is-single-payer

But the bottom line is that single payer would control costs both now and in the future (reduce healthcare inflation) and immediately reduce costs by between 20% and 35%. This is not a dispute or an argument, it is a fact and everyone who has studied the problem recognizes, from the GAO to RAND to the US Chamber of Commerce (hardly a bastion of "progressive thought).

There is a reason why the mandate for businesses to provide Health Insurance was waived this year.... it's makes these companies less competitive in the same way private health insurance makes people less healthy.

Oct. 19 2013 10:29 AM

On a tangential but related note:

"Shares of Internet giant break through the $1000-per-share mark"

(? rumored that government health insurance portal will sign half a trillion dollar contract with Google to resolve problems and manage site going forward ?)

Oct. 19 2013 05:35 AM

Are there any provisions of the ACA that are intended to increase the available per capita medical services, or is it only intended to lower access barriers to the services that presently exist?

Oct. 19 2013 04:43 AM
Mr. Bad from NYC

@ RUCB_Alum

You wrote:

"There are far better solutions to the problem of too many Americans without healthcare than what the government has engineered."

Yes, exactly, which is why I have no idea why there is so much conservative backlash against single payer. Yes, it will mean another tax and yes it means the government will control costs (intervene in a market) but it is a streamlined model of efficiency compared to Obamacare.

Think about how much time and money goes into getting your Dr. paid? Even small offices usually have to have an administrative staff member to process claims. That adds HUGE costs to healthcare.

A Dr. could not even open a solo practice (hang a shingle) nowadays because the costs involved are enormous just to provide a service with a built in market that never goes away. WTF.

A Dr. could run his own practice and pass the cost savings to his patients since a.) he will always get paid as long as he follows the rules b.) he submits the claims to the government. Dr's could double the amount of patients they treat in a day. In the digital age you're talking about something that can be done in 10 minutes of a Dr.'s day as opposed to hiring a staff to liaise with a dozen or so different insurance Co.'s who all have different rules, types of coverage, don't or won't pay claims on time, require pre-authorizations, documentation, endless red tape, etc.

Add to that Patients whose insurance has lapsed, collections costs .... it could all go away overnight. The Dr. treats the patient and is paid by the government. What's not to like?

Oct. 18 2013 04:30 PM
Frank from NJ

"I'll try. Insurance (and banking) are regulated most closely at the state level, therefore each state would know best what the needs of its own citizens is/are and design a system that works best in their state".

Granted insurance regs are different in each state, but wouldn't it have been better if a set of common core software were developed, and then customized for each state. Similar to how corporations use off the shelf enterprise packages such as SAP, and then customize to meet each company's needs.

I would also point out that a good model already exists in the federal government for health insurance enrollment: medicare.gov This is a single system and is run by the federal govt, not the fifty states. If medicare.gov can deal with insurance companies in 50 states, why can't healthcare.gov?

Oct. 18 2013 04:24 PM

@Frank from NJ

"Could someone tell me why it would have been better to have each state (50 of them) design..."

I'll try. Insurance (and banking) are regulated most closely at the state level, therefore each state would know best what the needs of its own citizens is/are and design a system that works best in their state.

Obamacare amounts to little more than pointers to private insurance companies at a price that individuals can afford. The scary part about Obamacare is that affordability will (for most) mean HIGH DEDUCTIBLES which (unless you have a hospital stay to pay for) will mean that most folks pay a premium for insurance they will almost certainly never use.

Sucks...don't it.

Oct. 18 2013 03:20 PM
Salp from Manhattan

the self regarding motor mouth negativity of Ezra Klein was insufferable.
He needs to lay off the coffee and get with the real world and how things work.

Firstly the he states that the government should adapt 21st century ways.
How does he suppose that should happen when the minority party has an 18th century mentality and refuses to budge when it comes to building any sort of effective government.

Without putting the roll out in the context of the right wing in this country
whose main priority is that 40 million citizens shouldn't have health care
makes his criticism totally invalid.

You should have him back a year from now
when the bugs have been worked out
and the majority of people
are benefiting from the Affordable Care Act
so he can eat his arrogant words

Oct. 18 2013 02:34 PM
Frank from NJ

Could someone tell me why it would have been better to have each state (50 of them) design, develop, test and implement their own systems, rather than have the federal government do it once? Invent the wheel fifty times rather than just once?

Oct. 18 2013 02:10 PM

@Mr. Bad

"People would be taxed for their healthcare according to a progressive tax structure, just like the income tax. Healthcare providers (as opposed to health insurance sellers) could be helped with targeted subsidies and tax incentives."

Too true. But that would have required a truly Progressive approach rather than BHO offering what the Republicans said they needed to get on board and then NOT voting for it anyway.

I presume if BHO had it do all over again -- and knowing the GOP would laugh and point fingers regardless -- he would have gone for something that would please the people rather than the pile of poo we now have.

There are far better solutions to the problem of too many Americans without healthcare than what the government has engineered.

Oct. 18 2013 12:45 PM

@Martin Chuzzlewit from Manhattan

"LOL …… I’m sure that if the Democrat Party members in Congress, their staffs..."

So what is your opinion about the governors who have OPTED OUT of creating their own statewide healthcare exchanges yet are pushing their states sick and poor into Federal exchanges? I.e. Rick Perry. How sleazy can they get?

The faster this attempt fails, the faster the country moves to healthcare coverage for ALL. There is no going back to 'the way it was'. The GOP ought to get the message and help to make this work or STFU when a REAL government plan is voted up.

Oct. 18 2013 12:12 PM
Martin Chuzzlewit from Manhattan

"Dr dave from LES-
Why didn't they just hire Google or Amazon to
Create the website?"

Excellent Question!

A: Because the leftist ideologues in the Obama administration couldn't make an embarrassing exception to their "the government will take care of everything...and you."

Oh, gee, and that would also upset THE GOVERNMENT UNIONS. (It would go under the evil "outsourcing" heading that Democrats fight hard against in order to get union money and votes.)

Oct. 18 2013 11:46 AM
Martin Chuzzlewit from Manhattan

LOL …… I’m sure that if the Democrat Party members in Congress, their staffs, OBAMA himself and the crack policy makers in the White House had the courage of their convictions to VOLUNTARILY go on Obamcare themselves as models ... THE ROLL OUT WOULD HAVE GOTTEN MUCH MORE CAREFUL ATTENTION.

The apparatchiks always take care of themselves very well.

Oct. 18 2013 11:36 AM
Peter Simpson from Red Bank

Brian,

Thanks for taking my call this morning. Peter from Red Bank here. I expressed my shock and dismay over the 33% increase in my monthly premium from $1,500 per month to $2,000 per month. Your guest raised three points in defense of Obamacare: 1) no exclusion for pre-existing conditions, 2) competition on pricing and 3) available subsidies.

Pre-existing conditions:

By state statute, insurers in New Jersey have not been able to deny coverage for pre-existing conditions since the early 1990. The federal law does not broaden coverage in New Jersey and hence, should not lead to a premium increase.

Competition:

Although comparing plans between insurers is not easy, I did look at what each of the plans the three companies offer in New Jersey. I could reduce the new premium to $1,800 per month, at the cost of replacing each and every doctor my family has used for the past 20 years.

Subsidies:

We do not qualify. So, a New Jersey family of four, earning $94,300 per year is expected to pay $24,000 in pre-tax dollars (before deductible and co-pay) for health insurance?

Oct. 18 2013 11:30 AM

"The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design."
(F.A. Hayek, The Fatal Conceit)

It's almost too precious that one of you threw out the "It's Bush's fault" or even "Clinton's Fault". I realize now that the "glitches" will not render this wet dream moot. The people in charge of the narrative will not allow it.
The real failure was the lack of "press/pundit" preparation, together with the inability to keep the shoddiness of the program from the wider public.
(and of course "if only someone had informed the President")
Indeed, what Mr. Klein really wants say is how effective 6 months of "nudging" the public would have been - had the public been relentlessly "prepared" / "nudged" to to experience the program's "glitches" as personal failings in their own education and understanding there would not be this "perceived dissatisfaction" with the program's sign-up phase. Even now the regime, its media allies, and it's "paid-for" shills are trying to keep the public from information about the current workings, beyond the shortcomings of their own individual experience. http://www.nationalreview.com/campaign-spot/361559/now-administration-claims-it-never-had-monthly-enrollment-targets-jim-geraghty

I'm sure the problems are created by "the wreckers".
http://en.wikipedia.org/wiki/Wrecking_%28Soviet_crime%29

If only the opponents of Obamacare had been forced to work as hard for its success as they worked for its failure.

After all, they lost the presidential election.
http://www.pinterest.com/pin/318207529892705763/

"Pulling together is the aim of despotism and tyranny. Free men pull in all kinds of directions.” --Lord Vetinari

" . . . Above this race of men stands an immense and tutelary power, which takes upon itself alone to secure their gratifications and to watch over their fate. That power is absolute, minute, regular, provident, and mild. It would be like the authority of a parent if, like that authority, its object was to prepare men for manhood; but it seeks, on the contrary, to keep them in perpetual childhood: it is well content that the people should rejoice, provided they think of nothing but rejoicing. For their happiness such a government willingly labors, but it chooses to be the sole agent and the only arbiter of that happiness; it provides for their security, foresees and supplies their necessities, facilitates their pleasures, manages their principal concerns, directs their industry, regulates the descent of property, and subdivides their inheritances: what remains, but to spare them all the care of thinking and all the trouble of living? . . . " (Alexis de Tocqueville, "Democracy in America", http://xroads.virginia.edu/~HYPER/DETOC/ch4_06.htm,
"WHAT SORT OF DESPOTISM DEMOCRATIC NATIONS HAVE TO FEAR" )

Who are you going to believe - you're lying eyes or Ezra Klein?

Oct. 18 2013 11:25 AM

@PeppermintandCinnamon.com from NJ

"The buck seems to be stopping everywhere--except with President Obama."

You cannot *seriously* think that Obama should be held accountable for the state of the healthcare.gov website. Maybe, if it still sucks in 90 days. But not when the thing is eight days old.

Commonsense? The problem is bigger than simply providing consumer information. We have a bolus of uninsureds who are driving up costs for EVERYONE. What's wrong with a government plan to have them start paying - giving subsidies for those who truly cannot afford it?

My beef is that it shouldn't have gone to the 'for profit' insurance industry. MediCare for all that want it - is simpler still.

Oct. 18 2013 11:20 AM
Kathleen Whelen from Norwalk, CT

That poor Emperor is still running around with no clothes and still no one will tell him. I've seen this scenario countless times over the past 20 or so years. As an IT professional, I know what happens when you tell the Big Muckety-mucks "NO". You get labeled as a troublemaker at the very least.

One serious suggestion I have is to get the ICC (the international body that is responsible for EDI standards) involved. They know how to develop common definitions for all kinds of transactions - why not Health Insurance? That might solve one of the thorniest problems. These folks know what they're doing.

Thanks for the BL show!

Oct. 18 2013 11:04 AM

@jgarbuz

"That is the way it worked when I was a kid."

Well, most professions top out the pro-bono commitment to a couple hundred hours per year not thousands.

We can agree that there is a profound lack of price information for the consumer in healthcare here in the U.S. Most consumers don't care because 'insurance covers it'. Therefore, we get things like $6,000 leg casts and $22 aspirins.

However, much of healthcare is delivered when the consumer has no chance to shop - they are unconscious, or in an ambulance or just been told they have cancer and all they want to do is get well.

Oct. 18 2013 11:01 AM

It seems to me that the "problem" with Healthcare.gov was 80% access/response time, and 20% navigation/user experience. Both the capacity/response time and User Experience problems can be solved -- although the UX problem may be more difficult to redesign. The capacity/response time should be solvable with more hardware, assuming a scalable technical design was implemented to start with.

As a technical manager for several large companies (Google, Adobe, Bloomberg), I know these problems are both fixable and testable. That's just software engineering 101. But these problems are also not fatal. They can (and presumably will) be fixed and soon.So fixable, but also inexcusable.

Looking at the contractors for ACA on http://reporting.sunlightfoundation.com/2013/aca-contractors/ one thing that is immediately apparent is that there are 28 contractors with awards in excess of $1 Million. That's crazy. The organizational and managerial integration of that is insane, let alone the technical challenges.

(I should also note that the total contract awards exceed $450 million! Also an astonishing number.)

Old adage -- never enough time or money to do it right, but always enough to do it over. So say we all.

Oct. 18 2013 10:56 AM
PeppermintandCinnamon.com from NJ

1.) The tech savviness of the campaign didn't transfer well to a federal program. 2.) Shocked, I'm shocked to learn that some Republican governors opposed this and did not build their own state systems, thus leading to pressure on the federal system. 3.) The president was not properly "informed" about the feasibility of the roll out timeline.

Shouldn't a good leader and manager recognize and plan for such situations. The buck seems to be stopping everywhere--except with President Obama.

I think a common sense step to increase coverage and reduce costs, without a giant program, could have been to require healthcare providers/sellers to publicly post prices for all products and services, like nutrition information labels. Deductible plans, transparency, competition (with assistance for some, e.g. low income, disabled) would have gone a long way.

Oct. 18 2013 10:48 AM
jgarbuz from Queens

To Seth

I'm not advocating for the status quo. I am advocating a return to an earlier age when the government was only marginally involved in the health care business. However, doctors and nurses would have to contribute some of their work time to charity hospitals, and the gov't might help out with taxpayer money to see that such hospitals have good equipment.

Oct. 18 2013 10:45 AM

@wd

"Maybe the obama administration should call upon the ceo's of companies..."

Well asking the CEO for help on this is EXACTLY what not to do...These guys don't know how their systems work! Even less how they were built. They COULD ask for input from their IT Management but even then how do you know you don't have a 'quisling' in the coding shop throwing wrenches into the design?

The best solution I've seen suggested in this space so far is for healthcare.gov to COPY a known good system - MA's firstchoice website. Stress the hell out of it, and then expand it for your own needs.

Oct. 18 2013 10:38 AM
seth

jgarbz -- thanks for advocating the status quo, but unforturnately, that's why the US is currently paying way more on healthcare than any industrialized country and is far less effective at keeping people for dying -- Republicans hate such cost-ineffectiveness.

Oct. 18 2013 10:37 AM
jgarbuz from Queens

RUCB_Alum.

That is the way it worked when I was a kid. If a doctor wanted a licence to practice, they had to donate so many hours to take care of the poor for free! They rest of the time they could make all the money they wanted to, that the market could bear. Competition. Kept rates within reason. A lot less complicated than all this gov't BS.

Oct. 18 2013 10:34 AM

jgarbuz -

Who (aside from the incompetent) would donate one-half to one-third of their weekly work-hours? Did you do it in your job?

Why do you keep peddling a fantasy solution? Just as likely we beam them into the future and let Bones McCoy heal them and send them back.

Oct. 18 2013 10:31 AM
jgarbuz from Queens

Why is America going broke? Government intervention into everything.

Oct. 18 2013 10:31 AM
Heleen from Brooklyn

It is NOT fine to extend the enrollment period. In anticipation of Obamacare my family has been kicked out of our current Healthy New York individual plan effective Jan 1 2014 and we just CANNOT be uninsured.

Oct. 18 2013 10:31 AM
Seth Peckstiff

"why can't we just keep our healthcare system intact"
--- because Dem's did not take the 2010 election seriously, and lost, so conservatives arrived in a census year and wrote the re-districting as they pleased. So, there will be no single payer, and that sux.

Oct. 18 2013 10:30 AM
Scott

Way to stick to your party talking points with no regard for the truth. I applaud Ezra for admitting this is a complete mess.

Oct. 18 2013 10:28 AM

Yes, there is a certain 'crippling you and then making fun of you for limping' quality to some of the criticism, but rolling-out a giant website is not a new problem. A large-scale commercial website could have been used as a basis, or even more simply the source code for Massachusetts 'Health Connector' site which has been enabling equivalent functionality for about half a decade, could have been purchased and altered--- it's always easier to take an existing working site and modify it when thete is no major extension if functionality involved.

Oct. 18 2013 10:28 AM
jgarbuz from Queens

Gee, when I was a kid living in the housing projects, we had no websited, we had no medicare or medicaid, and yet my family doctor came when I was sick! Now how did that happen?Hmmm.

Oct. 18 2013 10:28 AM
Truth & Beauty from Brooklyn

1. Website architecture is quite complicated, and further complicated by the number of sites that have to be integrated. The various insurers have different sites and to convert all that for use in a front end that is user-friendly boggles many minds. Granted, whoever is in charge of putting the site together should have gotten this done better BEFORE it was tried out on an unsuspecting public, but this happens routinely even, as Brian mentioned earlier, to Microsoft. That's why there's Beta-testing and feedback.

2. The nature of insurance requires personal information prior to policy selection. This is not comparable at all to Amazon. If a television on Amazon is $299.00, it will be that same price for everyone, unless someone has a coupon, and that is revealed at checkout. Insurance policies and plans differ so much based on age, health status, region of the country, smoking, number of family members - so many variables - that the user must provide personal information up front just to pare down the number of choices. After you find the plan you want or need, then you can determine which you can afford and how much of a subsidy you may - or may not - get.

I agree that this is a massive undertaking, but it does not mean that the Obama administration or the Secretary of Health and Human Services is incompetent. It just means that they wound up with more interest than the Republicans thought they would have - including their own constituents, who would like health insurance even if they don't like Obama - and they are trying to meet this enormous challenge.

In addition, I think that Republican opposition and commentary on this program at this time is merely designed to distract people's attention from their responsibility for the government shutdown. They need to stop the PR ploys and get down to business: provide health insurance - of the quality they get - for everyone in the US and keep government running. Period.

Oct. 18 2013 10:28 AM
Joseph Bell from Downtown

One Guest and several commenters here have the essence of the story, namely the functionality of the website is entirely separate from the issue of whether or not Obamacare is good for the country. Insurance is not SOLD on websites. Most actual enrollment transactions are either done off line or with assistance thru individual insurance company phone centers, why should Obamacare be any different. The Medicare plan enrollments are done online at medicare.gov. Typically that website has a number of glitches every year that eventually get solved. The media should stop obsessing over the Obamacare website it's no big deal. Unless you oppose Obamacare itself.

Oct. 18 2013 10:25 AM
wd

Maybe the obama administration should call upon the ceo's of companies like amazon, google, microsoft, oracle, etc... to get advice on how to fix the system. When Lehman Bros. was about to fail, the treasury secretary (or was it the head of the fed?) called the chiefs of the major banks to meet and within hours they were all in a room trying to work out a solution.

Oct. 18 2013 10:25 AM
Dr dave from LES

Why didn't they just hire Google or Amazon to
Create the website?

Oct. 18 2013 10:24 AM
Steve from Queens NY

I worked as software consultant for many companies in the US with over 30 years of computing. Working on development teams also gets very political. It’s not just Washington that’s political. With so many states that don’t want to build the web site, how will this work smoothly? Software/Hardware development and roll out is not easy fly by night project. I can bet that they got their friends and cronies to do the work.
They should have rolled it out state by state. Big Bang roll out usually fail. They should have outsourced the software development to Bangalore.

Oct. 18 2013 10:24 AM
Scott

How about holding the administration responsible for a debacle instead of making excuses and blaming republicans.

Oct. 18 2013 10:24 AM
John from NJ

What do we expect when a British firm Serco was contracted for the rollout?
http://www.nytimes.com/2013/07/05/health/british-company-is-awarded-contract-to-administer-health-rollout.html?_r=0

Now it's being reported on the internet in the Weekly standard that some of the software was pirated.
http://www.weeklystandard.com/blogs/obamacare-website-violates-licensing-agreement-copyrighted-software_763666.html

Someone needs to resign or be fired.

Oct. 18 2013 10:23 AM
jgarbuz from Queens

To Mr Bad

How about everyone just paying for themselves, and those who have nothing going to charity hospitals? Those in the middle class who have something to lose, but fear getting wiped out, so they buy their own insurance. How is that?

Oct. 18 2013 10:22 AM
Nigel from Summit

Why was the IRS eFile model not used?
Seems like that works well enough.

Oct. 18 2013 10:21 AM

Errr...because building a website that is going to satisfy 45 million buyers and probably be at least looked at by another 180 million is not an easy thing to do??

At last something I know about...Spent a lot of time stress testing websites prior to their rollout.

The fact that the web end does not work properly does not surprise me. Their consultants and coders are probably decidedly 'second tier' but will get it right (eventually).

Working the use-cases through to their successful conclusions carries with it a sh*tload of wishful thinking. The attitude that gets IT problems solved is best from the point of view 'How will the user eff this up?' rather than presuming the use does the right thing next. It's an easy trap to fall into.

A bigger existential threat to Obamacare are states like Texas who are casting their own poor into the ACA healthcare exchanges NOW. They are throwing known sick into the pool FIRST! in hopes that the exchanges will fail because the cost run up too fast. Pretty sneaky BS on Gov. Perry's part, I would say. Why does the GOP want to keep the national healthcare bill 30% HIGHER than it otherwise needs to be?

Obamacare is NOT a failure because it got the country OFF of the 'healthcare insurance for the employed only' model. I do not think it will have this form in ACA 2.0. I love the fact that the 45 million of us who are not covered can buy insurance. A rational Round Two solution - hard to imagine a rational next step but here I go - expand existing MediCare systems to everyone who wants in.

(Or we can get all conspiratorial and think that the Koch Bros. did the hiring for the coders and IT mgmt!. MartinC are you working on this?)

Oct. 18 2013 10:21 AM
Steve

This seems like a one-trick-pony interview subject - OK, so the site isn't working as well as hoped/promised/expected. So what - it will get fixed. Why are we making such a big deal about this? This info is nothing new.

Oct. 18 2013 10:20 AM

Explanation why users must log in FIRST is bogus.

If I make 100K or 300K or 20K I still want to see the other rates.

(It has tax implications, among other things. Do I want to declare 99K or 101K if it means 10K in health costs?)

Transparency.

Oct. 18 2013 10:19 AM
jgarbuz from Queens

What a boondoggle! Just get the government out of the healthcare business!

Oct. 18 2013 10:19 AM
Mr. Bad from NYC

The government does some things pretty well. One of those things is cutting checks. Why, sweet jeebus why can't we just keep our healthcare system intact, cut out the insurance companies and have the government pay the bills for everyone's healthcare? So so simple. So much cheaper for everyone including taxpayers... Doctors would get paid 100% of the time. They might make less but they could always collect.

People would be taxed for their healthcare according to a progressive tax structure, just like the income tax. Healthcare providers (as opposed to health insurance sellers) could be helped with targeted subsidies and tax incentives. Am I insane to think that the economic benefits to our country of having a healthy population would be enormous?

This stupid country.

Oct. 18 2013 10:18 AM

so we demand our government do things on the cheap to save tax dollars then some whine when the cheaper product isnt up to his standards. that doesnt seem justice.
chilex u have until march to sign up. and too bad your state doesnt run its own exchanges. those are working great. chris christy sux! good weekend to all!

Oct. 18 2013 10:17 AM
Tom from Griggstown, NJ

The State University of New York will be running a seminar on Big Data and Technology in ten days. Their "guest of honor" is Obama's former Chief Technology Officer. I wonder how he will respond, let alone if he is even asked by this group about this technology ineptitude..

Oct. 18 2013 10:17 AM
Joyce from NYC

You say that the problem is too many states did not build their own systems.

THIS IS BALONEY!!!!!!

If this were the case, they could say: 1st day of the week, states 1, 2, and 3.

2nd day of the week, states 4, 5, and 6

Etc.

Oct. 18 2013 10:14 AM
Amy from Manhattan

No, Ted Cruz didn't quote Ezra Klein--he *mis*quoted him. Why don't you just come out & say he *lied*?

Oct. 18 2013 10:14 AM
Sheldon from Brooklyn

I was never the biggest fan of Obamacare but this is partly manufactured hysteria by the right. It's disingenuous to link the issues with the federal website being the same as Obamacare itself not working.

That being said, the rudimentary coding issues with the website has been a joke. It fits into the narrative that the federal government can't do anything right and another example of the Obama admin's detachment from reality, when things go south. People need to be fired and quickly.

Oct. 18 2013 10:13 AM
Bob from Huntington

Perhaps something as vital and complex as health insurance requires more than a website. Perhaps something on the order of the Social Security Administration is required: a system which provides interaction at some level with real people.

Oct. 18 2013 10:13 AM
Pete from Queens

I work on a nyc union job and I don't have to enroll for obamacare but would like to have other options for dental as our dental plan is marginal. Do I have an opportunity to only use obamacare's processes for just dental?

Oct. 18 2013 10:11 AM
Dee from Montclair

The company that was building this website, was apparently fired by the Ontario government for not being able to build their healthcare website. Canada with it's one payer system would be easy, if they couldn't manage that how could they manage this. The costs have also ballooned. The real problem is we hire contractors (NYC 911) instead of employees these days. Contractors, come and go, are paid hourly and have a vested interest in accruing as much overtime as possible. My job was made into a contract position 5 years ago, because companies don't want to pay benefits. The irony is overwhelming.

Oct. 18 2013 10:11 AM
Jim in Brooklyn from Brooklyn

Please, please ask your guests who are the contractors who actually designed and built the Web sites and who was responsible for validating their performance before the rollout.
THank you.

Oct. 18 2013 10:09 AM
jgarbuz from Queens

Get the government out of the health business, except for funding some research and helping charity hospitals out.

Oct. 18 2013 10:09 AM
Joyce from NYC

We know that the New York system works.

Could we please have on the show ONE PERSON WHO HAS SUCCESSFULLY SIGNED UP ON THE FEDERAL SYSTEM.

Oct. 18 2013 10:09 AM
antonio from baySide

I'd love Robert Gibbs or the current guests to figure out what a closure is, what global scope means and tell me what a conditional is....
Of course I am being snarky, but it's hard to launch such a complex website...You're not buying a 'harry potter book' or a fair-isle sweater folks...

And please don't start squawking 'See what happens when the government does something the private sector should be doing.'

Oct. 18 2013 10:06 AM
jc

Does anybody remember the "excruciatingly" inept rollout of the Medicare Part D drug benefit under the Bush administration? I worked for a Medicare contractor at the time. Things eventually sorted themselves out.

Oct. 18 2013 10:04 AM
Robert from NYC

Funny I thought the very same thing; had they shut their mouths and let it ride Obamacare would have done their work for them. Of course the reasons for this are different on either side but it still turns out that Obamacare is a disaster. GET SINGLE PAYER OPTION ON THE TABLE.

Oct. 18 2013 10:03 AM
jgarbuz from Queens

I say, go back to capitalist medicine, where doctors charge whatever they want, but poor people go to charity hospitals staffed by doctors who have to contribute 20 hours a week for free.

Oct. 18 2013 09:57 AM
J. Reilly from Bellmore, NY

Just to help you update - I went to the 'nystateofhealth' website yesterday to explore options for our small business. There were only three insurance companies listed under the bronze options and when I realized I had some questions I called the help line. The person I spoke to reminded me of the WNYC ad with the 'Let it heal by itself' show - this guy answered every question with "Sir we don't sell insurance, we only provide information, for details you must call the insurance company." I eventually cooled off and called Oxford (who we already have a policy with) and they told me to contact 'nystateofhealth' of course. When I told them that they had told me to call the insurance company, they told me that that was "the wrong information, we don't know why they told you that". So, at the moment, I don't know if there are any more affordable health options, but, I will try and contact a broker today sometime. As soon as I'm ready for five minutes of fragmented Beethoven again.

Oct. 18 2013 09:54 AM
Mr. Bad from NYC

Update! ALERT ALERT!

Obamacare still sucks. It's the one thing EVERYONE can agree on.

Whether you're a right wing tea bagging corporate lackey or a sensible classical liberal who understands that universal healthcare (as implemented in such backward anglophone nations as Canada and the UK) is the only way to control medical costs. We can ALL agree that this huge tax payer funded corporate handout to the health insurance companies is rip off of historic proportions that will drive up costs, reduce the quality of care for everyone and is in fact a confirmed boondoggle that has signed up a grand total of, wait for it....36,000 very, very sick people in the first week! 99.6% of visitors to healthcare.gov did not enroll in a plan. Could it be sticker shock? Maybe $300 a month with a taxpayer added $200 kickback for a HDHP with $2000.00 annual deductible isn't such a great deal after all?

Oct. 18 2013 09:38 AM

Glad to see that this is being covered.

I'm sure that there is more to this story that hasn't come to light yet -- political, budgetary, perhaps contractor in-fighting.

Still, the Information Technology trade press has done an abysmal job of covering the technical aspects, blithely blaming government "bureaucracy" and contracting problems. These facile conclusions ignore past major software project successes within NASA, the Department of Defense (yes, both agencies are not without failures, but this is true of all major software vendors - look at the recent Gmail outages, and that is a mature platform.

Lowlights: Some reporting suggests that requirements were still unsettled late in the game -- a risk factor that can be mitigated by earlier design freezes. Even so, a design that employed, in part, software already proven in production, plus new work built in pieces along the way, and using a minimum of new code. Open source? -- maybe, or pieces of code already owned by the government on other projects.

More transparency in the design process. The opinions voiced at Reddit on day 1 could have been useful to all concerned if provided a couple of months before the launch date.

Simulation? Load testing? Design competition with load-tested bakeoffs? These are Project Management 101 in major Dept of Defense software projects.

Worst of all, the designs employed seemed to ignore the possibility that there would be overloading, and at least provide for graceful degradation UI if not resilience.

On a bigger scale, it seems that we have become complacent about major IT system failures. Failures have rocked Google, Amazon, Xerox, Rogers Communications, Sony, HP (original developer of the troubled NYC emergency software), Intergraph (responsible for this year's 911 outages), the MTA (systemwide ticket outages), NJ Transit -- these enterprises have all experienced failures on a large scale affecting many.

My two blog posts on this look at the transparency angle and why other expertise within the Government was not better (if at all) utilized.

http://bit.ly/GVSL77
and
http://bit.ly/1gunENr

Mark @knowlengr

Oct. 18 2013 09:05 AM
Martin Chuzzlewit from Manhattan

"......explain why the tech-savvy Obama administration encountered difficulties launching the online healthcare exchanges."

Er, because when leftist ideology and statist authoritarianism combine to eclipse good government, the ambient intelligence level decreases?

Or is it that they are addicted to the Democrat Party's vision of the people as ignorant and easily bought off by a few goodies, even if poorly constructed? (The Soviet people were happy with ANY refrigerator.)

Oct. 18 2013 07:59 AM

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