No, Governor, this is not an “inconvenience.” The failure of the state’s health care Connector website and application process is actually endangering lives. Read John McDonough’s blog, where he quotes someone who’s seeing things as they are unfolding at the place where the rubber hits the road:
Governor Patrick Turns on the Lights – Health Stew – Boston.com.
“There is currently no solid process to get urgent medical need cases processed in a timely fashion. Uninsured consumers that have applied and are waiting an eligibility determination have two options to get needed health care right now: 1) Delay your appointment or 2) Pay out of pocket. To give you an example, a man with cancer had a kidney and part of his liver removed in December at a major hospital in Boston. He had a post-op appointment scheduled in early January and was told by his surgeon’s office that he couldn’t come for the appointment until he ‘got his MassHealth figured out.’ The ‘solution’ he was given was to delay his appointment or pay out-of-pocket. We’re hearing stories like this regularly at the advocate and provider tables.
“We have been given ‘contacts’ at the state to help us ‘resolve’ issues and get people coverage, but the system is so, so broken, to the point where these contacts take many days to find applications and then many days to process them. Also, we are seeing erroneous eligibility determinations come out of the new clunky systems they’ve built.”
What the fresh hell. “Inconvenience”?? Dying of cancer is an “inconvenience?” This requires an absolute full-court press, and a sense of urgency straight from the top. Glad to have the attention, but setting the right tone would really help.
Don’t boot this, Governor.
I applaud John McDonough and Senate President Murray for bringing some attention to this problem. But, we are 6 weeks into the new year. Where have the consumer health advocates been? Where is Health Care For All?
You can read http://blog.hcfama.org/ to see how HCFA has been following the botched implementation. I have to confess to not paying adequate attention in the confidence that it would fix itself … but the truth is that when you have a car wreck like this, you just have to wait for the twisted metal and broken glass to be cleared up.
I hope we sue CGI into the ground. And we need to have an wide-ranging, open conversation about contracting and oversight … again. The thing that has changed since the Big Dig Culture is that at least we have a single point of pressure, which is the Governor. It’s his problem. Legislative oversight of executive branch implementation, while it’s happening … is that even a good idea? Possible? Good question.
This a million times:
I shudder to imagine how much we as taxpayers have overpaid for CGI’s trainwreck, and what we will now proceed to pay to fix their mess. Indeed we should sue, but in the meantime we will pay out of pocket to fix it because folks who need health coverage right now can’t wait for a court case.
This kind of thing makes me insane — people hold up this kind of stuff as examples of why government doesn’t work or government shouldn’t be involved in health care. Meanwhile its private industry that has caused the train wreck.
Consultants are a cancer on our public and private institutions more often than not, in my experience. They should be used as infrequently as possible and only when there’s no other option — and then the oversight and penalties for screw ups need to be super severe.
Could do a thing without one. Even resurfacing the high school’s tennis courts required a $25K study.
would have to explode its budget to hire all the engineers and architects and specialists it currently contracts for.
And they would have nothing to do most of the time.
The Commonwealth may outsource expertise it ought to have in house, but I doubt many municipalities do.
Furthermore the problem here is oversight.
I’m a consultant. My firm works for lots of government agencies — a few federal, lotsa state, some local. We have expertise that they simply don’t have, because it’s a niche that wouldn’t justify any of them having a team of full time staff. By spreading our time across 100s of clients, there’s enough work in total to keep us employed.
I’m not arguing that all consultants are worth their weight in gold, but methinks you’ve swung the pendulum a wee too far in the other direction.
But it costs a million dollars to cost out a school building project.
Everyone can justify anything. Private or public enterprises alike use consultants. The difference in the public sector is that everyone wants air cover and the consultant fits the bill.
have been great. My town voted down the last school building project, but that was on the Town. I have some reservations about the MSBA requirements.
Over the past few weeks, I’ve found myself wondering if we’re all taking it too easy on Pres. Obama and Gov. Patrick on health care issues. I supported both of them before it was popular to do so, and I argue in support of them on a regular basis to my many conservative friends and colleagues. What’s going on at the federal and state level plays into the worst stereotypes of progressives and government—bureaucracy, mismanagement, waste, etc. My guess is that behind the scenes they are both cracking heads, and are completely frustrated by what’s occurring. But, it’s unacceptable. We cannot have public policy that we are unable to administer. We wouldn’t take this type of incompetence from GWB, Romney, or any other Republican. I’m not turning my back on either of them and in my view they are both doing a good job under difficult circumstances but I think they have to be as accountable as possible. I do worry about the democratic/progressive brand. Food for thought……..
and in general dismisses problems as “not systemic.”
To echo dasox1 above. I believe wholeheartedly that government can and has played a major role in advancing society and steadying the gyrations of an erratic market economy (progressive/liberal policies over the last 100 years has saved capitalism, not crushed it).
With this belief, I have an equally strong aversion to bureaucracy–whether it is a private sector insurance company, a non-profit hospital or a government agency. Bureaucracy Happens! should be a bumper sticker.
Progressive/liberals have a responsibility to be the watchdogs against bad government. We can’t advocate for more government, if it evolves into bad government.
I’ve been hearing to many excuses about the online exchanges, the DCR problems, the DPH’s Compound Drug lapses, the endless backlog at the VA that only gets worse…and on and on and on. “Fox talking points” liberals counter…sometimes, yes. But often we dismiss valid points as “Fox talking points” and do a disservice to ourselves and our principles.
By dismissing problems as anecdotal or to blame lack of funding (the DCR didn’t do a home visit on the Fitchburg child for at least 6 months–that had nothing to do with lack of funding, but incompetency) when the real problems are elsewhere, progressives are handing our opponents the ammunition they need to destroy what we have built. And unfortunately when enlightened progressives suggests bureaucracies need improving, they are viewed by other progressives as being an opponent of the program, when in fact they want to improve it.
Disturbing.
The Herald has reported on this ongoing disaster for months including this: http://bostonherald.com/news_opinion/local_politics/2014/02/documents_infighting_delayed_states_rolls_royce_obamacare_site
So while Mass residents were spending hours and hours in frustrating pointless attempts and the director of the project was assuring residents that all would be well, the reality was something quite different. “… infighting between MassHealth and Commonwealth Connector Authority officials became so intense that the state asked CGI to hold separate meetings with them”
The deception, the lack of attention to the problem and the willingness to let Mass residents experience the fear and frustration of not knowing if they would get health insurance is appalling.
That the Herald has done good work and the Globe’s reporting on this massive issue has been spotty and intermittent.
And we here have been slow to react as well. I’ve been retweeting some things, but haven’t held forth much on the front page, in hopes that it would sort itself out. But the Governor’s use of words, “inconvenience” — which he also used in the State of the Commonwealth address — shows rather too much detachment. And the Herald article does indicate that someone needed to be personally responsible for taking control of the process — probably the Governor personally or his senior staff.
Ugly stuff.
As the Globe points out today in an article on the unemployment insurance website debacle, it took practice.
The management and on-time delivery of ANY huge project like these — the federal ACA system or the local health connector — is a staggeringly difficult problem. Managing processes like these for difficult problems is even more difficult than managing the technical challenges themselves. Programming systems like these are “fractally complex” (meaning that they are complex at the largest abstractions, and complex in the tiniest details). Hence, they are fractally difficult, and hence fractally costly.
The delivery of a system like this will be risky and expensive whether it’s done by a public agency or a private company. The only way to reduce risk is spend MONEY — gobs and gobs of money. Money that taxpayers claim not to have (I guess those taxpayers prefer Patriots tickets to reasonable health care).
For just about any new system, getting the system to do what it’s supposed to *in the absence of errors* is never more than about twenty percent of the cost. For complex systems with many moving parts (like these), it is seldom more than about FIVE percent of the cost.
The rest of the very real cost is getting that system to do predictable (never mind desirable) things in the presence of errors. In real life, bad things happen. Cats walk on keyboards. Contractors cut cables. Sprinkler systems flood disk racks. Admins start backup programs at unexpected times. Credit cards expire. “Charge-backs” happen (customers claim a charge is fraudulent). Stuff happens.
Programmers make mistakes. Really “interesting” mistakes are the mistakes that inevitably happen in code attempting to handle OTHER mistakes. Without ENORMOUSLY EXPENSIVE edge-case testing, that error-handling code will be asked to run *for the very first time* when the real-life system handles its first real-life credit-card charge reversal. Most code does NOT run correctly the first time.
These rollouts are no worse than rollouts of similarly complex systems. I’m actually surprised that they haven’t been worse, because they’ve been so underfunded, and because the government side of the contract is so — well — inexperienced in managing contracts like these.
Similarly, the breathless hysteria of the news coverage is embarrassingly. A term I like to use is “cyber-crud” — media depictions of computer behavior that *can’t possibly happen*. The canonical example is the scene in so many bad (and even some otherwise good) science fiction movies where the bad guy does something and the *MONITOR* of the good guy blows up. You know, nice big bright pyro-technic display that just can’t happen. Like when the SOUND of the Death Star exploding echos through (the vacuum of) empty space. Can’t happen.
Too much of the coverage of these rollouts is, well, cyber crud. Today’s Globe article is, sadly, an excellent example. The hilarious headline is “$46m jobless benefits system has over 100 defects”. The headline on the jump is “Benefits system has over 100 defects”. Wow. One hundred “defects”. I guess that sounded really bad to whoever composed these headlines and wrote this story. A quick look at the buglist for your favorite browser (a far more simpler system than this) will reveal THOUSANDS of defects.
I hope that when the dust settles, ALL of us recognize that systems like this are complex, hard to get right, and hard to build and maintain. Unlike, for example, the Big Dig, the requirements of a system like this ALWAYS change while the system is being built.
The desire to have best-of-class rollouts of systems like this is a great example of why we need higher taxes. When we starve our government, we get LOUSY specification, LOUSY management, and LOUSY oversight of systems like this.
and I take no issue with the complexity associated with the programming—you clearly know more about it than I do. However, I cannot regulate my breathing any more. At the end of the day, complexities and dollars don’t matter. What matters is if it works for the users. If it doesn’t, it compromises what progressives stand for and damages our brand. That results in fewer votes for a progressive agenda. I can tell you that the people who post on this site would be going nuts if Romney or Bush were overseeing these train wreck rollouts (me included).
What’s particularly awful about the MA Connector situation is that *it used to work.* I bought health insurance through the Connector a few years ago. It was great – I typed in some basic info, got a list of options, picked one, and that was it. Yes, yes, I know that integrating it with Obamacare created a whole new level of complexity. But the overall point remains: you can’t create a system like this, *force people to participate in it,* and then have it suck, and not expect people to be furious at the government.
How can you enact legislation that mandates behavior, and be unable to provide in a timely way the necessary mechanisms for that behavior to occur? And, your point about the Connector is important—it can be done and done right. It drives me to distraction that idiotic Republicans are running around the country right now saying that they will not engage in meaningful legislative efforts on immigration because the administration will be unable to implement it. Now, I know people are going to jump on me for saying it. So, to be clear, what the Republicans are saying is total BS, and their motives are completely impure. But, we have to recognize that we leave ourselves open to this kind of nonsense when we can’t get governing right. We need to win elections in order to advance our agenda. There are voters out there who are so frustrated that they will vote for Republicans because we appear to be incompetent.
This failure is a symptom more than a problem.
Expecting our current state and federal government to successfully launch massively complex systems like this is like planning to drive your falling-apart 20-year old jalopy (with 220,000 miles and rusted frame) from Boston to San Francisco at 110MPH. It will fail. Being furious at the car is just plain wasted energy. More constructive is to be furious about why the car hasn’t been replaced — and to then take action to replace it.
We MUST raise taxes — locally and nationally. We MUST invest those taxes in rebuilding government infrastructure so that programs like this can be accomplished.
If we take the comments of dasox1 and you (David) at face value — and conclude that we ought not to do these things — then we have already lost the war with the GOP.
We need to rebuild our infrastructure. That means our transportation infrastructure, and our government infrastructure that plans and executes projects like this. The problems we face from here on will only get harder. There is no better time than right now.
As the old commercial used to say … we can pay now, or we can pay later.
I’m talking about natural human reaction. If you create a government mandate that everyone has to participate in a system, and then make it really hard for them to do so, they will be pissed off. It’s not the least bit surprising.
For the record, I have never liked the individual mandate, and I still don’t. But that’s a topic for another thread.
I absolutely agree with you about the justifiable anger.
My hope is that we can somehow help those angry people understand the real cause. My fear is that situations like this will occur more and more frequently, because the damage already done by decades of underfunding is so deep-rooted.
I think it’s very hard to avoid an individual mandate on the state. If we can get government-sponsored single-payer at the federal level, I think all this will be much easier. In that world, it is the providers (rather than patients) who will need payment systems like this.
Call me crazy, but I somehow think that Partners or BCBS will be able to find a way to build whatever IT systems are needed if those systems are the only way they get paid.
Your points are excellent, somervilletom and provide needed perspective.
I work in the industry now full time have for years worked part time doing QA for a number of companies. The plain and simple truth is we are spoiled and we have people that have no tech background directing the ship. A contract with a provider does not demonstrate you know what the heck your talking about nor grasp what it takes to do something. Even to the point can it be done. More times then not the dream exceeds the dollars and the ability of programs to work across all platforms. Throw in the fact that government is using tech that is a decade old in some systems and trying to talk to never mind extract info is like sucking an elephant threw a straw.
Lets not forget that companies like CGI are few and far between because of the road bumps to bidding government contracts. This keeps the field very lean which enables companies like CGI to get the foot in the door and keep billing for in some cases substandard work.
The result is a total clutter buck. Dreamers in the state who can’t even turn off a computer correctly or who believe we are still using floppy disks are asking developers for the rolls royce of programming excellence for what financially amounts to jobs that would have to pay minimum wage to engineers to get enough working and producing to get the job done at some point in time.
We are spoiled by the level of advancement in technology that we believe it can do anything. Oh if that were only true.
I want to give you one thing to think about and decide for yourself. How about home users operating system that must talk to the servers they are running Windows 98, 2000, vista, 7, and 8 Apple systems OS 10.0 -10.9 which have subtle differences, then add in Linux users. Ok they need to talk through to state systems using a long list of software then insurance companies and then federal government systems again with a host of different platforms and different generations. Fact is the old competition model of Commerce has left us with some computer systems that just can not talk with each other with out going through third party software. here is a listing that is far more comprehensive now some are long gone but new ones flourish every month http://en.wikipedia.org/wiki/List_of_operating_systems
Now lets think about just windows and the headline last week Bill gates has trouble installing Windows 8. See what I am saying. What can we do about this well nothing real fast that would take 100’s of billions of dollars on just government systems alone to standardize software forget the public PC and MAC. Then think of the fight over who is the winner and loser of which system they decide to embrace. What we need right now and I hope everyone realizes it and I am going to suggest something that will send some Conservatives into fits of rage. We need a department of Technology in both the state and federal government that works to keep system able to talk directly and indirectly to each other and then the portals for the public able to deal with all the public configs. Again if you think these contracts cost a fortune think about bringing in a real IT team to manage all facets of government. What we will get is a group that understands what can and can not be accomplished in a set time frame and will understand the process of workarounds as new features come ready. Companies like CGI and there are a lot of others are simply milking the system with promises they know can not be met, substandard product and lastly off shore support.
I for one am not surprised I would bet that Rolls Royce will take maybe another year and I bet it looks like a Buick when it is done.
I wish I could give this a higher rating.
..that is. The goal of increasing the availability of health care to more Americans is absolutely correct. Some people reason it is to prevent health care costs from consuming families others who look at it as a % of GDP do it out of fear of consuming the economy. We must separate out the goal from the difficulties in getting there since they are a result of assumptions of those who have no business in making the decisions. I will repeat what I have said for some time, that is that we are spoiled in sitting down at a computer and seeing the world it has corrupted the thought process of what it takes to get technology to do our bidding. Under funding over estimating and a general lack of understanding by those make these decisions is to blame. Not the goal that we are trying to achieve. This may have been the best way to help hammer home that point and to understand that we need to understand the process better and we need the people who do more closely involved. We do not need health care experts we need IT experts and more people who actually know what it takes to do what is asked.