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Obamacare and Middle-Wheel-Wheelbarrows 199

Posted by timothy
from the well-here's-where-your-problem-is dept.
davecb writes "The Obamacare sign-up site was a classic example of managers saying 'not invented here' and doing everything wrong, as described in Poul-Henning Kamp's Center Wheel for Success, at ACM Queue." It's not just a knock on the health-care finance site, though: "We are quick to dismiss these types of failures as politicians asking for the wrong systems and incompetent and/or greedy companies being happy to oblige. While that may be part of the explanation, it is hardly sufficient. ... [New technologies] allow us to make much bigger projects, but the actual success/failure rate seems to be pretty much the same."
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Obamacare and Middle-Wheel-Wheelbarrows

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  • Article is +1 (Score:5, Informative)

    by noh8rz10 (2716597) on Sunday December 22, 2013 @12:05AM (#45757915)

    Most articles linked to on slash dot aren't very interesting or are pushing something, but this article was interesting and a good use of my time . +1

  • by tpstigers (1075021) on Sunday December 22, 2013 @12:28AM (#45758025)
    This isn't the only place we've seen this. The Pentagon and FEMA have been up to their necks in it for years. The process of getting government contracts is so bizarre and complicated that companies have evolved with "getting government contracts" as their only business model. So the companies that actually get the contracts are the companies that are good at getting government contracts (because they focus so much of their resources on the process), NOT companies that are good at delivering what the contracts specify. This is a natural by-product of bureaucracy.
  • by nbauman (624611) on Sunday December 22, 2013 @12:31AM (#45758033) Homepage Journal

    Kemp is being unfair. I understand what this section is about, and he doesn't. A patient decision aid could just be a well-written article or web page. The UK NHS has patient information pages that would satisfy these requirements. There's no requirement for artificial intelligence.

    "(1) PATIENT DECISION AID—The term patient decision aid' means an educational tool that helps patients, caregivers, or authorized representatives understand and communicate their beliefs and preferences related to their treatment options, and to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences."
    "(2) REQUIREMENTS FOR PATIENT DECISION AIDS—Patient decision aids developed and produced pursuant to a grant or contract under paragraph (1)—
    "(A) shall be designed to engage patients, caregivers, and authorized representatives in informed decision making with health care providers;
    "(B) shall present up-to-date clinical evidence about the risks and benefits of treatment options in a form and manner that is age-appropriate and can be adapted for patients, caregivers, and authorized representatives from a variety of cultural and educational backgrounds to reflect the varying needs of consumers and diverse levels of health literacy;
    "(C) shall, where appropriate, explain why there is a lack of evidence to support one treatment option over another; and
    "(D) shall address health care decisions across the age span, including those affecting vulnerable populations including children."

  • Re:Shock! (Score:4, Informative)

    by Jane Q. Public (1010737) on Sunday December 22, 2013 @01:18AM (#45758163)

    "It looks to me like his interpretation of the law is extremely ridiculous."

    You're pulling only part of what he wrote, out of context. He also quoted several other sections that referenced (1), and described some of the other things it must do... greatly expanding on that one paragraph.

    Having said that, I agree that he doesn't say much of anything that hasn't already been said. His analogy with the Chinese wheelbarrow is certainly interesting (and rather funny, really). But I think all of his points were made before in The Mythical Man-Month and other writings.

  • Re:It's simple... (Score:2, Informative)

    by Anonymous Coward on Sunday December 22, 2013 @01:21AM (#45758169)

    So a massive goverment take over of insurance regulation, with tens of thousands of pages of regulations, with constantly changing rules because what they came up with originally isn't working is "capitalism".

    I think you need a dictionary.

  • by haruchai (17472) on Sunday December 22, 2013 @01:39AM (#45758225)

    Here's what Obama himself said about that - "And once it's working really well, I guarantee you, they'll not call it Obamacare. Here's a prediction for you - a few years from now, when people are using this to get coverage, everybody's feeling pretty good about all the choices & competition that they've got, there are going to be a whole bunch of folks saying "I always thought this provision was excellent, I voted for that thing".
    You watch, it will not be called Obamacare," - []

  • by peragrin (659227) on Sunday December 22, 2013 @08:07AM (#45759171)

    Here is the trick. something like 80% of large projects fail on the first try.

    From business linux deployments, to website creations, to new weapon systems for the military(M-16 anyone)

    The federal government does nothing but large projects so it gets lots of failure, but the every large company in the USA has at least one large boondogle project fail annually. Or at least fail the first couple of times.

    BING, FBI database, iphone 4 (you're holding it wrong) all suffered from design failures of the real world.

    Forget cronyism, bureaucrats are the real issue with every large project. Real leaders can reign them in and control them. unfortunately real leaders can't get elected very often.

  • by haruchai (17472) on Sunday December 22, 2013 @11:33AM (#45759941)

    Not only is Obamacare solidly based on Romneycare - (remember Tim Pawlenty referring to it at Obamneycare during the debates?) - but it's not much different from Bob Dole's plan from the '90 and it's pretty much the Nixoncare proposal of 1974.

  • Re:No dude... (Score:4, Informative)

    by phantomfive (622387) on Sunday December 22, 2013 @12:31PM (#45760205) Journal

    . But from what I know about websites, especially ones like that one, is that it's a simple matter of input from the user, and then a matter of storage of that input, and maybe some calculations along the way - all very basic stuff for today's world.

    The problem was 'some calculations along the way' because the site was designed to be integrated with several other systems.

    If you don't understand why integration with other systems can be so difficult, you should read Mythical Man Month because it explains it in detail.

  • by sumdumass (711423) on Sunday December 22, 2013 @08:05PM (#45763281) Journal

    From what I can see, even very barebones plans can be grandfathered so long as they don't change much, which is the basic definition of grandfathering.
    So while I still think it was not a very bright strategy to for Obama to sell the "keep your plan" so strongly, the decisions to cancel them falls squarely on the insurers.

    Not really.. There are two ways an existing plan can remain, one is if it does not change at all and the other is if there is some hardship.

    There is a hardship exception that allows insurance providers to keep or even create the barebones plans and the plans that do not meet the requirements under the ACA, but in order to qualify, the insurance provider has to show how changing the plan will create an economic hardship for them or a class of people defined by the actuaries. Now class is defined by an actuary group and not what we would think like with working class, poor middle and so on.

    It should be noteworthy that the DHHS just recently (within the last week or so) released new guidelines on the hardship exceptions that they claim "clarified the law" that expanded the ability to use the hardship exceptions. If it was squarely on the insurance providers, we wouldn't have seen that.

    The true grandfather clause meant that if no changes were made, the policy could remain until any change is made, then it would have to follow all the new rules. A subsidy given by the government would qualify as a change and so would changes in the risk pools made by the actuary (which would by default have to be made with people moving to subsidized plans and medicare/medicaid roles).

    So yes, you can blame the insurance providers if you ignore the fact that they would be penalized for not updating their policies to meet the new guidelines despite the class pools changing and the penalties they would face. But all this is sort of like arguing if the room is painted white or eggshell. This stuff was being brought up before Obama made any of the statements and the statements were specifically to address those situations. You act as if it is not Obama's fault for making the claims when the claims were specifically made to counter the reality that materialized. Add to that that Obama knew [] before he said it once that it wasn't true but kept on saying it in order to sell the product. In fact, the delay he put for the employer coverage mandates was specifically to address the fact that "66 percent of small employer plans and 45 percent of large employer plans will relinquish their grandfather status by the end of 2013," and "156 million Americansâ"more than half the populationâ"was covered by employer-sponsored insurance in 2013."

    Please stop repeating party line BS and either look into the facts or be quiet about it. There is no real reason why we are even having this conversation right now. The bottom line is that Obama knew before he ever mumbled those words that they were not true and he said them specifically to counter punch the people who claimed it was going to happen only for the American people to be deceived and then shocked when it is happening. I don't trust what most other politicians say either, but rarely do we have such obvious examples as to why we should be skeptical of them.

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