Report: White House Warned In March About Health Care Website Problems

The mounting troubles of the PPACA continue.

Healthhcaredotgov

A new report indicates that an outside consultant was warning the White House that the website that was being designed to host  the Federal Obamacare Exchange was fraught with potential problems that could lead to a disastrous launch:

The Obama administration brought in a private consulting team to independently assess how the federal online health insurance enrollment system was developing, according to a newly disclosed document, and in late March received a clear warning that its Oct. 1 launch was fraught with risks.

The analysis by McKinsey & Co. foreshadowed many of the problems that have dogged HealthCare.gov since its rollout, including the facts that the call-in centers would not work properly if the online system was malfunctioning and that insufficient testing would make it difficult to fix problems after the launch.

The report was provided to The Washington Post by the House Energy and Commerce Committee.

This risk assessment, which was encapsulated in a 14-slide presentation, was delivered to senior White House and Department of Health and Human Services officials in four briefings between March 28 and April 8, the committee said.

HHS Secretary Kathleen Sebelius; Marilyn Tavenner, then acting administrator of the Centers for Medicare & Medicaid Services (CMS); and White House Chief Technology Officer Todd Park attended a session about the report on April 4 at HHS headquarters. Obama health policy adviser Jeanne Lambrew and then-White House Deputy Chief of Staff Mark Childress received a briefing April 8 at the White House.

Rep. Tim Murphy (R-Pa.), who chairs the panel’s subcommittee on oversight and investigations, said the presentation suggests that, in the run-up to its fall debut, the enrollment system was more troubled than administration officials have let on.

“Despite assurances from Secretary Sebelius, Marilyn Tavenner and [CMS official] Gary Cohen that all was well and on track with the launch of the Affordable Care Act, we now have documents dating back to April that call into question the assertions made to this committee,” Murphy said.

The CMS said in a statement that the McKinsey assessment was “part of a standard process to identify potential risks and develop mitigating strategies.” It added that “the review was completed six months before the beginning of open enrollment, was in line with industry best practices and was followed by concrete action to address potential risks — as was intended.”

White House spokesman Eric Schultz said “flags were definitely raised throughout the development of the Web site, as would be the case for any IT project this complex. . . . But nobody anticipated the size and scope of the problems we experienced once the site launched.”

Administration officials noted that the assessment was not a technical review of the Web site’s functionality. They said a number of the recommendations were acted upon, including stepping up communication with states and funneling more resources to in-person helpers and the call center.

The document did not predict whether the project’s problematic design stage would hamper its rollout but instead made it clear that programs of this scale are ideally pursued in a more orderly process, with “significant testing and revision” before they launch.

This news follows up on an earlier report that the Administration was aware of problems with the website in the weeks prior to the launch, We’ve also learned that the Administration received warnings from CGI, the main contractor responsible for building the site, that the Federal website was not ready to go live.  Last week, we learned of emails from as early as July that expressed similar concerns that don’t seem to have been followed up on. What all of this indicates, obviously, is that there was at least some warning going back as far as the start of this year that there were potential problems with what was obviously going to be the technological centerpiece was troubled to say the least, possibly fatally so, and that there seems to have been very little effort made to ensure that those problems were dealt with. Indeed, as I’ve noted before, some reports have indicated that the contractors involved in creating the site complained that they were not being given adequate time to test the site prior to launch, although its worth noting that statements from these contractors that were made after the launch may be seen as self-serving given that they are likely to be somewhat self-serving in an effort to forestall any legal efforts to hold the contractors liable for costs of repair or other losses.

Meanwhile, as the November 30th deadline that the Administration itself imposed for the point at which the website would be fixed, there seems to be a conscious effort to downplay expectations:

One person said a more realistic goal was that four out of five people “have a positive experience,” which could include being redirected to customer service agents.

White House officials said on Monday that many of the remaining users would turn to call-in or counseling centers because their insurance situations were complicated. But specialists involved in the repair effort said technical issues may frustrate more users than administration officials suggest. And it is unclear how many fixes remain to be made, because the list keeps changing

That’s a far cry from saying that the website would be “fixed” by November 30th, though, and if we get to the beginning of December and people are still having problems using the site then the political woes both for the President and his signature legislative accomplishment are just going to continue.

Another problem that the Administration faces is the fact that there may be less time than may people anticipate to get this system up and running:

An editorial in last week’s USA Today repeats the common belief about the deadline: “The deadline for signing up for insurance that begins Jan. 1 is Dec. 15.”  However, “signing up” for insurance is not enough.  As the Healthcare.gov website states [emphasis added]:

If you enroll in a private health insurance plan any time between October 1, 2013 and December 15, 2013 and make your first premium payment, your new health coverage starts January 1, 2014.

(…)

However, paying the premium is not necessarily a simple matter.  An online chat with a Healthcare.gov representative revealed that the site is not recommending using the exchange to make the initial premium payment. The representative was not even completely sure the option was being offered.  Here is an excerpt from the chat [emphasis added]:

Healthcare.gov Representative:  To have coverage effective January 1, 2014, you must make your first premium payment by December 15, 2013. Your health insurance company can tell you how to make your premium payment. If you do not make a payment on December 21, 2013, you may have to fill out another application.

TWS:  I can’t make a payment through healthcare.gov?

Rep:  It may give you that option when you complete your enrollment.

TWS:  If I don’t pick a plan until 12/15, won’t it be too late for my info to go to the insurance company, them to bill me, and me to make a payment by 12/21?  Seems pretty tight.

Rep:  You must make your first premium payment by 12/15/13 for your coverage to begin January 1, 2014. If you make your payment by the 21st, your coverage will begin in February 1, 2014.

TWS:  You said above “It may give you that option” to pay on healthcare.gov.  Does that mean it’s not available yet?

Rep:  We are still experiencing some technical difficulties with the website, which is why it would be best to possibly go through the insurance company to make your first premium payment.

This throws yet another wrench into the process, at a point at which there would be only 15 days after the November 30th deadine for anyone who wants to have their insurance kick in by January 1st to make their first premium payment. Given that this part of the deadline isn’t being widely reported, it’s not even clear that enough people will be able to act in time, especially if website difficulties continue past that date. If that’s the case, can we expect more delays of the PPACA’s deadline? I wouldn’t be surprised at all.

FILED UNDER: Barack Obama, Bureaucracy, Health Care, Politicians, US Politics
Doug Mataconis
About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May 2010 and contributed a staggering 16,483 posts before his retirement in January 2020.

Comments

  1. C. Clavin says:

    I think it’s important…before the ODS folks show up…to provide this public safety announcement:

    When your inevitable hyperventilation begins it is useful to find a plastic bag with absolutely no holes…put the bag over your head…pull the opening tight around your neck…and tie the loose ends into a double or even triple knot. Eventually your hyperventilating will stop…as will your ODS.

  2. SKI says:

    A risk assessment isn’t a warning of what actually happenned.

  3. Rick Almeida says:

    This is the first time in the history of our Constitutional Republic that warnings were issued that a major project had very real potential flaws 6 months before launch. INPEACH!

  4. SKI says:

    For those that want to read the actual analysis

    It summarizes the risks of the approach but does NOT analyze actual performance and conclude the website would fail.

    Risk Assessment != warning of a specific problem.
    Headline Fail.

  5. grumpy realist says:

    (Pounds head against wall)

    Didn’t ANYONE involved in this entire fiasco have any experience running a project of this kind?! From what I’ve heard of the contractors, they were total nogoodniks. Now we find out that at least SOMEONE sent up a signal for help six months before lift-off and nobody on the government side did anything about it?! And who was it on the contractor side who was promising oh yes, everything will get done in time, no problem? (Had these guys ever done a programming project that didn’t fall apart under stress before?)

    This is crazy. I ran projects in Japan and could have done a better job than these bozos. Time, manpower, money. You can put limitations on two of the factors and as long as you have enough of the third factor, the project will get done with sufficient quality. You however absolutely CANNOT try to put constraints on all three of the factors. Will. Not. Work.

    So here they didn’t have enough time, manpower, or money. Result: a crappy website system.

    P.S. This has engineering FAIL written all over it in large glowing numbers. As much a disaster as the Challenger launch.

  6. JKB says:

    They said a number of the recommendations were acted upon, including stepping up communication with states and funneling more resources to in-person helpers and the call center.

    What we have here…is a failure to communicate.

    Classic community organizer response. Problems? We need to talk more. “Let me be perfectly clear…”

  7. rodney dill says:

    I guess seeing sign that there is a cliff ahead isn’t an actual warning that you might fall over it.

  8. john personna says:

    @grumpy realist:

    I think anyone in engineering has been through a cycle in which the deadline was offered first, and then the specification was completed, and then the detailed engineering schedule was made.

    In that situation what the engineering managers do is divide the available time into tasks and then say “if all goes well, we’ll hit the date.” They know, of course, that nothing ever goes that smoothly. They know their schedule is BS. It’s just the ONLY thing they can say to management, who has given them a fixed delivery date, and offered them no flexibility.

    Did anyone have the guts to send back to the White House, “sorry, we can’t hit that date?”

    I doubt it.

    And so … perhaps at all levels of the project they did what is always done on this kind of project … they did what they could, knowing they’d have to fix it later.

    This kind of process definitely makes development worse, but it happens again and again.

  9. john personna says:

    @rodney dill:

    It wasn’t rocket science to do a “risk analysis” that said “if their effort fails, they will fail.”

    The question is whether this report actually put a number or a certainty on it.

    Something like “90% chance of fail” might actually have been reasonable, given the short testing time, but can you find that in the report?

    Or was it all wiggle words?

  10. C. Clavin says:

    I’ll go back and read this post again…but I seem to have missed the part where the success of the PROGRAM was discussed. Again…Obamacare is far more than a WEBSITE. The fact is that in the first month applications for more than 1.5M people have been completed. Hundreds of thousands of people have been made eligible for Medicaid…many that had no idea they were eligible even before Obamacare. Here in CT, and other Blue States that were pro-active, satisfaction with the State Exchange is extremely high.
    In the meantime I find it cute…precocious even…that you and the choir to which you preach are so afraid of the program succeeding that your glee at any problem can barely be contained. On the other hand I find it troubling that you and the choir to which you preach are so excited at the possibility of excluding people from health care.

  11. C. Clavin says:

    @grumpy realist:
    Sorry…I typically agree with you…but the Challenger? People died on the Challenger. This is a website.

  12. john personna says:

    @rodney dill:

    In other words, it’s entirely possible that the report played the same game, with “if they hit all those dates, they’ll succeed, though there is a risk they will miss the dates and fail.”

  13. C. Clavin says:

    From the NYT story on the same topic as the WaPo story:

    The latest evidence detailing the Web site’s troubled startup came amid signs of progress in repairing it. As of mid-November, more than 50,000 people had selected an insurance plan — up from 27,000 in the entire month of October, people working on the project said.

    From the LATimes:

    California — which enrolled about 31,000 people in health plans last month — nearly doubled that in the first two weeks of this month….Several other states, including Connecticut and Kentucky, are outpacing their enrollment estimates, even as states that depend on the federal website lag far behind. In Minnesota, enrollment in the second half of October ran at triple the rate of the first half, officials said. Washington state is also on track to easily exceed its October enrollment figure, officials said.

  14. Pharoah Narim says:

    Anybody with any real-world experience knows that outside “consultants” are really a CYA tactic empolyed by management. Even the consultant is playing a CYA game in that their report is written in such a matter that they can claim credit for facilitating success or warning of failure. These outside “reports” offer the management team top cover in case things go wrong where they can point to the report and say “we knew– we just didn’t get enough time or resources to fix it” They are, in a word, worthless. This post plays into the ignorance that allows the outside consulting farce to continue to be lucrative. Thanks Doug! {eyewink}

    Interpreted at the time it was given, I’m certain this report raised nothing new beyond the mandated reports required from the contractors. Bottom line is they got a late start, they ran into data sharing roadblocks common with trying to tie together multiple data sources from multiple organizations, and they ran out of time with a politically imposed roll out dates pushed by people anxious to demonstrate to critics that progress was being made. Why this is as big a story as it is shows the IT ignorance of media folks. But then again, you don’t have to be one of the sharpest pencils in the pack to get a reading degree(s). Its a website folks, as long as the underlying process that the website automates are good, the program will be a success.

  15. Pharoah Narim says:

    please release my comment from moderation.

  16. JKB says:

    @rodney dill: I guess seeing sign that there is a cliff ahead isn’t an actual warning that you might fall over it.

    Well, it really isn’t. To get from the fact that there is a cliff ahead to an understanding that you might fall over it, you have to THINK. Obamacare is the product of a bunch of Liberal Artists, who just couldn’t understand probabilities. Nor the need to develop contingencies.

    “Failure is not an option” is not a contingency or even a plan, it is hyperbole. Failure is not an option, it is a foreseeable outcome if you don’t plan for every conceivable problem and then it still lurks awaiting unconceived problem. “Plans are nothing; planning is everything.”

  17. 11B40 says:

    Greetings:

    Say it ain’t so, O.

  18. JKB says:

    @JKB: “Plans are nothing; planning is everything.”

    By the way, the originator of that quote, invaded two continents and conquered a well prepared, murderous modern army in less time than they had to create this failed website.

  19. bandit says:

    I gotta thank all you guys – watching you twist yourselves into knots making excuses for the incompetent lying assclown is hi-larious

  20. grumpy realist says:

    @JKB: Dude. I’m a liberal. I also happen to have an effin’ Ph.D. in Physics. So don’t talk to me about risk and probabilities. I EAT those for breakfast.

  21. grumpy realist says:

    @john personna: Especially when you have a bunch of companies/contractors supposedly all working together. You go around the table, ask everyone whether they’ll be able to hit their targets, yup, yup, yup, no problem. Of course, they’re all lying between their teeth and are about two months behind on sched and their prime programmer just quit out of disgust but let’s not mention it. Everything’s PERFECTLY fine.

    The assumption is that someone at some point of the cabal will finally screw up all the plate juggling and crash and burn, at which point all the delays of everyone else can be blamed on him.

    I got dumped into managing one of these messes. It involved a LOT of screaming on my part at everyone. In multiple languages.

  22. Ron Beasley says:

    The problem this exercise in health care reform was always going to have was that a majority of the population got their health either from their employer or like me medicare. Most people don’t know how bad their employer health care is until they have to use it. In states like Texas that refused medicaid expansion the population is soon going to have a rude awakening when hospitals and clinics start closing. The much maligned web site is now apparently running at 90%.
    Don’t get me wrong, I think this reform is not very good. I can see no reason why the health insurance industry should be able to suck 20+% out of our health care budget while supplying no health care. Medicare has 3% overhead – Medicare for all and it will save us all money.

  23. george says:

    @john personna:

    I think anyone in engineering has been through a cycle in which the deadline was offered first, and then the specification was completed, and then the detailed engineering schedule was made.

    That’s certainly common. Its also very common for a company to publically announce it will meet the deadline, while almost all its engineers are saying the deadline is doubtful at best. But its been a couple of decades since I’ve been in project where the engineers aren’t internally reporting that the deadline is unreachable – the culture now is, if anything, to state loudly and clearly – to the point of complaining about unreasonable workload – that the target is impossible. The basic idea is to create a safety margin; then if you achieve the target anyway, you’ve done the impossible. Think Scotty in Star Trek.

    I wonder if what happened is that the engineers were saying it was unreachable, and the management interpreted that as typical engineering pessimism, and didn’t pass the info on for a variety of reasons. A scenario I’ve seen quite a few times.

    Another variation of that is that the engineers will say they can build the basic product in the time frame by cutting out the normal quality assurance procedures, including stage and final testing. This is very common in software (much less so in civil engineering for obvious reasons), with the result that what goes public is beta version at best. I probably don’t have mention names of companies famous for that approach.

    Unfortunately the consequences are much worse in this case than they are in the announced release of a computer game, or operating system.

  24. john personna says:

    @bandit:

    No, you nitwit, I’m saying I’ve seen this kind of failure before. Others agree.

    That is not at all the same as saying there was no failure.

  25. john personna says:

    @george:

    The push-back is much easier when everyone is in the same building.

    Pushing back all the way to the White House … probably harder.

  26. Todd says:

    One of the biggest, and hardest to solves problems with healthcare.gov is that the website’s database doesn’t reliably “talk” to all the various private insurance company systems.

    Many of the private insurance companies were quite happy with the pre-obamacare status quo.

    What incentive do they have to help make this work?

    I still don’t understand why there even needed to be a government run website to register people. It seems to me that without a public option, it should have been left to the insurance companies to register people, and calculate their subsidies. Healthcare.gov would have done better as a “shopping mall” type site. Let people shop and compare, but then link out to the specific companies to process the data. Trying to make it more like Amazon.com was just way too ambitious (IMO).

  27. john personna says:

    @Todd:

    Remember, my proposed fix was that insurance companies be required to dump static rate tables to the ACA site. Then the whole comparison shopping thing becomes a local database look-up.

    But as long as insurance companies require a live query, they have the ability to not respond to any particular request, yes.

  28. john personna says:

    @Todd:

    BTW, I believe Amazon hosts static price tables. They don’t ping Sony with your profile to get back a price for that TV.

  29. JKB says:

    @grumpy realist:

    Are we to understand you were a shot-caller on the Obamacare rollout?

  30. David M says:

    @Todd:

    There are privacy issues with having the insurance companies calculate the subsidies, at least in a way that did any verification.

    Still, it’s a website, and it’s mostly working now. Enrollments are increasing, although it still looks like the state exchanges will continue to outpace the federal one for a while longer. It’s not the end of the world.

    If you enroll in a private health insurance plan any time between October 1, 2013 and December 15, 2013 and make your first premium payment, your new health coverage starts January 1, 2014.

    This probably means nothing more than if you sign up for coverage but never pay the premium, you aren’t covered. The partial chat transcript doesn’t make a lot of sense.

  31. Mikey says:

    @Todd:

    Many of the private insurance companies were quite happy with the pre-obamacare status quo.

    What incentive do they have to help make this work?

    “The government is basically going to order people to buy our product” is a pretty good incentive, don’t you think?

  32. george says:

    @john personna:

    The push-back is much easier when everyone is in the same building.

    Pushing back all the way to the White House … probably harder.

    Good point.

  33. JKB says:

    @Mikey: “The government is basically going to order people to buy our product” is a pretty good incentive, don’t you think?

    Especially when you realize that “order” means under threat of government violence for choosing otherwise.

  34. john personna says:

    @JKB:

    I’d like to reduce war spending, but the threat of government violence keeps it in place!

  35. Pharoah Narim says:

    @grumpy realist: You think that’s something? Try eating pieces of shit for breakfast. Wait a minute……. nevermind.

  36. grumpy realist says:

    @JKB: The same argument can be made about a) paying taxes b) obeying stop signs c) any other regulation or law you choose to not adhere to.

    Please–just move to Somalia. You’d be happier, we’d be happier.

  37. Rafer Janders says:

    @JKB:

    Especially when you realize that “order” means under threat of government violence for choosing otherwise.

    Yes, just like the threat of government violence that compels me to stop at stop signs.

  38. Mikey says:

    @JKB:

    Especially when you realize that “order” means under threat of government violence for choosing otherwise.

    That’s rather excessively hyperbolic, isn’t it? I mean, as a former card-carrying Libertarian, I’ve heard (over and over and over…ad infinitum, ad nauseam) the equation of government taxes and fines with “violence,” but really, it’s just a pointless and false exaggeration.

    Of course, in the event armed agents show up at my house to compel me at gunpoint to purchase a health insurance policy, I’ll happily admit I’m wrong…although I consider the possibility vanishingly small.

  39. Todd says:

    @Mikey:

    “The government is basically going to order people to buy our product” is a pretty good incentive, don’t you think?

    I admit, I’m not looking at any projections of future profits, but I seriously doubt that most insurance companies will prefer the new ‘Obamacare’ regime to the old status quo. Sure, you can say that they have a “guaranteed” customer base, but they also have a lot more rules to follow .. and they’re rules that will be a lot harder to maneuver around.

    I have a hard time getting at all worked up by this whole current brouhaha over a few people not getting to keep their current policies. Prior to ‘Obamacare’ there were just too many stories of people who thought they had “good” insurance, and in many case had been paying premiums for years, only to find out that the coverage wasn’t anything close to adequate once they actually got seriously ill. While conservatives trumpet about silliness like maternity coverage for men, I strongly suspect that many of the “non qualifying” policies that are being canceled are because they can’t meet the yearly caps for out of pocket expenses required by the PPACA .. and with no more pre-existing condition exclusion it would also be much harder for companies to find a reason to cancel policies before they have to pay out.

    … so no, I don’t think ‘Obamacare’ was/is the insurance industry’s preferred health care reform path.

  40. grumpy realist says:

    Given the comments by people like JKB, one gets the feeling they don’t want to have to deal with civilization, period.

    “Taxes are the cost for living in a civilized society.” Or would you prefer to have the equivalent of the Mafia busting in your door and grabbing whatever they can get their hands on?

    (BTW, can anyone explain to me how anarcho-libertarianism is supposed to work? What’s going to keep it from immediately collapsing into standard Thug rule?)

  41. grumpy realist says:

    @george: That why I was reminded of the Challenger accident–the engineers being told to “take off your engineering hat and put on your management hat.”

    Of course, since the Republicans haven’t come up with an answer for rescission or pre-existing conditions, if Obamacare goes down over this effed-up website thingie, the chances are high that we’ll go to single-payer. After more screaming.

    But I bet hard cash that if Obamacare gets repealed and we go back to the old status quo, the next thing you’ll be hearing from the reporters is a horde of stories about How People With Pre-Conditions Can’t Get Coverage, or How People Discovered Their Health Insurance Didn’t Cover Them, or How The Evil Health Insurance Company Rescinded Coverage During Cancer Treatments. Face it–the only thing the media is interested in is getting eyeballs glued to the set. They don’t care which side of the issue they take.

  42. JKB says:

    @grumpy realist: “Taxes are the cost for living in a civilized society.”

    This is true and those taxes are exacted by threat of government violence. Now the question before us, is how much taxation and for what they are to be used. Logic would dictate limited taxation and limited government, thus limited use of the threat of government violence.

    And the Mafia as you call it was organized as a government for criminals operating in differing territories. While they ran direct operations in their territories, the “family” did more to regulate those who could extract from their territories. Being thugs and sociopaths the troubles started when they decided to extract to much making resistance more profitable than “paying the tax”.

  43. george says:

    @JKB:

    This is true and those taxes are exacted by threat of government violence. Now the question before us, is how much taxation and for what they are to be used. Logic would dictate limited taxation and limited government, thus limited use of the threat of government violence.

    Actually I can’t recall either party running on really limiting the gov’t. The Republicans want a large gov’t (military, drug war, Patriot Act etc), the Democrats want a large gov’t (public health, social services etc). But at least the Democrats are honest about it. I find the Republican position (talk small but implement big) annoying.

    And given that tough on crime is a Republican position, I’d argue they’re no strangers to using government violence either.

  44. Mikey says:

    @grumpy realist:

    (BTW, can anyone explain to me how anarcho-libertarianism is supposed to work? What’s going to keep it from immediately collapsing into standard Thug rule?)

    Putting on my libertarian hat…most libertarians are not anarchists, because they recognize the reality of what you point out. They understand the need for government, law enforcement, etc. but think these should be far smaller, less expensive, and less intrusive, and funded differently.

    Libertarian heroine Ayn Rand (who did not consider herself a libertarian and was certainly no anarchist) made some extensive arguments against anarchy, calling it “a naive floating abstraction” that would inevitably devolve into rule by the brutal and ruthless.

  45. Othello says:

    This is a real gift for Hillary. She can now spend her first term blaming everything everything on Obama. And her second term.

  46. David M says:

    @george:

    The tough on crime, drug war, etc has a vastly different impact on most people’s lives than something like environmental regulations or even something like Obamacare.

    I’m still waiting for the explanation how I will have more freedom when I can’t purchase health insurance for any price. Sure there are more regulations on it now, but the decision isn’t difficult if the options are regulated (not junk) insurance or no insurance at all.

  47. Rafer Janders says:

    @grumpy realist:

    “Taxes are the cost for living in a civilized society.” Or would you prefer to have the equivalent of the Mafia busting in your door and grabbing whatever they can get their hands on?

    Guys like this always imagine that they’re going to be the tough ones. They can’t imagine someone else stronger than them coming by to knock them down and take their stuff.

    Unless that someone else is black, oddly enough. Then their imagination has no limits.

  48. Mikey says:

    @Todd: Insurance companies are already heavily regulated and quite well-acquainted with how to deal with the government. They’ll have no problem adjusting to whatever is added to the regulatory framework. It may not be their “preferred” system, but I’ve no doubt they looked at a whole bunch of compuslory additional customers as a positive.

  49. David M says:

    @Mikey:

    More customers is probably a positive, but it’s offset by not being able discriminate against people who most need health insurance and the requirement to spend a minimum percentage of premium revenues on health care.

  50. C. Clavin says:

    @JKB:

    Especially when you realize that “order” means under threat of government violence for choosing otherwise.

    What f’ing nonsense.

  51. grumpy realist says:

    @JKB: The problem is–if you have limited (weak) government, it doesn’t do that good a job of protecting its citizens from whoever wants to stomp all over them–whether that be a multinational corporation or your neighbor to the North. I suggest Libertarians seriously read a volume on Renaissance Italy. All those nice little local governments in the form of city-states? Great, until you had a) the Hohenzollerans coming down from Germany or b) France sweeping in with its army. Or the Habsburg Empire. So much for the benefits of “local power” at that point.

    So basically what you want is a government that is strong enough to stomp all over everyone else, but it stays out of the way of the businessmen and allows them to do what they want, right?

    I prefer not to have my rivers catch on fire. Or discover that there’s toxic waste in my backyard. I’m pretty sure that at least some of the physical complaints affecting my mother’s side of the family were due to toxic metal poisoning. Since they didn’t have zoning where she grew up.

    From all that Libertarians natter on, you get the feeling they think it’s perfectly fine for a company to dump mercury in people’s drinking water provided they paid enough cash to the people suffering nerve damage.

  52. george says:

    @David M:

    The tough on crime, drug war, etc has a vastly different impact on most people’s lives than something like environmental regulations or even something like Obamacare.

    No argument here, I said that the Democrats and Republicans want different aspects of government big, and that means different impacts.

    But its annoying when the Republicans pretend to want a small gov’t (whether that’s a good thing or not) when in fact they want big gov’t. If you say you want something, shouldn’t you at least take small steps in that direction, instead of increasing gov’t size (again military, war on drugs, Patriot Act and the like are definitely elements of big gov’t.

    If I make a point of saying I like small cars, and then drive around a Hummer, its going to get on peoples’ nerves whether they like Hummers or not. I think they’d be better served by admitting they like big gov’t themselves, and then argue about what kind of big is good.

  53. C. Clavin says:

    @grumpy realist:

    So basically what you want is a government that is strong enough to stomp all over everyone else, but it stays out of the way of the businessmen and allows them to do what they want, right?

    What JKB thinks he wants is a fantasy. A delusion.
    There is not a single private sector fortune that wasn’t built on the back of Government. Romney, Trump, Perot, the Koch’s, Buffet…all benefiting from and dependent upon Public Sector Spending. Paul Ryan…an heir to a fortune built upon Government Contracts. Walmart and McDonalds…they can’t run their stores without paying poverty-level wages to their employees who must then go out and get foodstamps and public assistance.
    When people like JKB say the things they say it only shows the profound level of their ignorance.

  54. grumpy realist says:

    @C. Clavin: I really wonder about this halcyonic Libertarian Utopia they think they’re going to return the US to. From all their writings, it sounds like 1890 is where they want to return.

    The fact that it had child labor, the government sending out its police force against union strikers, no votes for women, very few rights for women if they were married, and “blacks knew their place” is of course, just a minor detail….

    Libertarians: the drug of the young white male. Who pounds his chest “I got here completely by myself! I don’t owe anything to anyone!” Totally ignoring the fact that a bunch of other people fed him, nurtured him, housed him, clothed him….all the way up to adulthood.

    Be careful, libertarians. You may discover in your total freedom world no one will bother to have children.

  55. john personna says:

    @grumpy realist:

    I don’t think libertarians are that well informed about tribal culture, all that stuff that came before civilization and taxes.

    Their starting point is man as a solitary beast. That is very bad anthropology, but it does let them indulge in a fantasy of “man” predating “the state.”

  56. john personna says:

    (Reminder, my people were Bloody Vikings before they were members of the European Union.)

  57. An Interested Party says:

    Medicare has 3% overhead – Medicare for all and it will save us all money.

    Exactly right, but who would oppose that? The same people who opposed the ACA…the same people who have obstructed the president at every turn…the same people who are cackling about this mess but have absolutely no solution for it other than to go back to the way things were…

  58. rodney dill says:

    @john personna: mine too

  59. anjin-san says:

    Their starting point is man as a solitary beast.

    I think they missed the part where solitary men before the rise of organized societies with people working for the common good lived short, violent, miserable lives.

  60. Pharoah Narim says:

    @JKB: Look clown, the same can be said of “Private Property”. That’s also enforced under the threat of goverment violence. So lets be clear that you have no problem with Gov violence. Or do you have a command post set up in your house and divide up Watch duty between you and the family? Grow up.

  61. Pharoah Narim says:

    @grumpy realist: Shorter description: Fascist

  62. al-Ameda says:

    @Ron Beasley: Most people don’t know how bad their employer health care is until they have to use it. In states like Texas that refused medicaid expansion the population is soon going to have a rude awakening when hospitals and clinics start closing. The much maligned web site is now apparently running at 90%.
    Don’t get me wrong, I think this reform is not very good. I can see no reason why the health insurance industry should be able to suck 20+% out of our health care budget while supplying no health care. Medicare has 3% overhead – Medicare for all and it will save us all money.

    —- Exactly.

  63. grumpy realist says:

    @Pharoah Narim: Yes, that’s the amusing thing, isn’t it? Libertarians scream about bloody property rights, conveniently forgetting that in order to maintain those property rights you’ve got to have a large powerful government with a) a legal system and b) clout to impose the authority of the legal system.

    Plus you’ve also got such wonderful modern inventions as “intellectual property”. Let’s just say that as more and more stuff gets hoovered up under trademark, copyright, and patents, the harder it is to develop anything that doesn’t somehow infringe someone else’s IP rights, elsewhere. Or at least they can claim it infringes (or is confusingly similar, etc.)

    I think that in a “purely Libertarian” economy, as soon as all the property protection was added in, people would discover that they had developed something just as hedged around with regulations and bureaucrats and nitpicky rules as our present system.

    Sorry, dudes. Unless you think Somalia is the utopia to which all aspire, I’m afraid your non-regulation world doesn’t exist.

  64. John425 says:

    @C. Clavin: “Hundreds of thousands of people have been made eligible for Medicaid…”

    Cliff will be less than thrilled when he finds out that HE will be paying for them.

  65. David M says:

    @John425:

    You’re a little behind the curve here, aren’t you. Exactly who do you think has been paying for them?

  66. mannning says:

    I do agree with Grumpy Realist when he cites time, staff and money as three factors you cannot constrain simultaneously in a large project. In software developments, there is a certain twist on the staffing problems. Usually there is one, or perhaps a few, absolutely key and brilliant developers in the program that dictate the actual pace of the effort, regardless of the time or money allocated.

    Then, too, the architecture decided upon, and the implementation language selected typically follows from decisions made by the leaders with the advice of those key people. As the work is partitioned out, and the staff grows exponentially, it is inevitable that many of the newcomers are not up to the level of knowledge the key guys have, and newbies thus put a drag on the whole effort until they are properly educated and read into the design and implementation.

    Managers are used to establishing a series of milestones throughout the planned effort and to judge progress by meeting the milestones on time. In the software world it is extremely difficult to get a firm handle on incremental progress of the programmers, and the larger the effort the more difficult it becomes.

    If the upper management of a major project attempts to pressurize the programmers, one of three things will happen, none of them good: 1) programmers will take shortcuts that may or may not work; 2) they will resent the arbitrariness of the schedule and slack off their optimal pace; or 3) they just might quit, and to lose one of the key developers is a grave turn of events. It is often the case that non-technical Managers tend to be intimidated by the programming experts, and do not know how to manage them, which results in the entire crowd hurtling toward huge time losses and even program disaster.

    Many projects are saddled with a moving set of requirements. Many of the changes start out being small in themselves, but they soon begin to require complete rewrites of whole sections of code, revision of the test programs, and the documentation, etc. and some changes could have more serious effects on other, more distant, parts of the code.

    It appears that the ObamaCare development has tasted these ills to the full and more besides.

  67. bill says:

    @grumpy realist: bureaucrats can’t make things run smoothly- should have hired real geeks who know what they’re doing. the former are too engaged in defensive planning and finger pointing. still, they knew long ago that it wouldn’t work and didn’t deal with it.

  68. John425 says:

    @David M: It’s the additional “hundreds of thousands” that have yet to hit the taxpayers that you should factor in. New reports tonight also suggest that written proof of the Administration’s intent to crash into large employer health plans have businesses concerned. And…certain crony unions of Obama are now seeking “exemptions” to the self-insured surtax.
    End result: the middle class should prepare themselves…BOHICA

  69. David M says:

    @John425:

    If they are eligible for Medicaid, everyone else has already been paying for their health care.

  70. Mikey says:

    @David M: I think he’s talking about the additional people that will be brought on in the states that expanded Medicaid when they implemented the PPACA.

  71. David M says:

    @Mikey:

    Even among the newly eligible, if they are going to sign up for Medicaid, it means that we have already been paying for the vast majority of their health care, just less directly.

    Obamacare pays for that care by giving them health insurance and paying for it with taxes.

    Prior to Obamacare it was unpaid care that was partially reimbursed by governments along with higher medical bills and insurance premiums.