Signing up for Obamacare
My political career (for lack of a better word) began in 1967 just one year before my professional career as a programmer/analyst. The software career came to an end in August 2012 but I am still going strong politically. With such a background, I probably had a keener interest in the lead article in the NY Times today titled “From the Start, Signs of Trouble at Health Portal” than the average person. The lead paragraphs should give you an idea of the depth of the problem. While it is too soon to say if the technical flaws of the Obamacare website will doom a flawed policy, it cannot be ruled out.
In March, Henry Chao, the chief digital architect for the Obama administration’s new online insurance marketplace, told industry executives that he was deeply worried about the Web site’s debut. “Let’s just make sure it’s not a third-world experience,” he told them.
Two weeks after the rollout, few would say his hopes were realized.
For the past 12 days, a system costing more than $400 million and billed as a one-stop click-and-go hub for citizens seeking health insurance has thwarted the efforts of millions to simply log in. The growing national outcry has deeply embarrassed the White House, which has refused to say how many people have enrolled through the federal exchange.
Even some supporters of the Affordable Care Act worry that the flaws in the system, if not quickly fixed, could threaten the fiscal health of the insurance initiative, which depends on throngs of customers to spread the risk and keep prices low.
“These are not glitches,” said an insurance executive who has participated in many conference calls on the federal exchange. Like many people interviewed for this article, the executive spoke on the condition of anonymity, saying he did not wish to alienate the federal officials with whom he works. “The extent of the problems is pretty enormous. At the end of our calls, people say, ‘It’s awful, just awful.’ ”
I got my first inkling of how screwed up the system was from my FB friend Ted Rall, the well-known leftist editorial page cartoonist who started off as an engineering student at Columbia University and who is technically proficient. You can find his scathingly witty account of trying to enroll here. I got a particular chuckle out of how the system responded when he entered his SS number:
Once he got past the SS number snafu and began the enrollment process he was shocked at the rates he would have to pay for “affordable” health care.
For this 50-year-old nonsmoker, New York State’s healthcare plans range from Fidelis Care’s “Bronze” plan at $810.84 per month to $2554.71 per month. I didn’t bother to look up the $2554.71 one because if I had $2554.71 a month lying around, I’d buy a doctor.
$810.84 per month. $10,000 a year. After taxes. Where I live, you have to earn $15,000 to keep $10,000.
Not affordable. Did I mention that?
I was surprised to see that the primary consultant for the Obamacare website was CGI, a Montreal-based company that was one of the chief competitors of Automated Concepts Inc., the consulting group I worked for in the late 70s and early 80s. I have no idea when ACI went out of business but CGI has obviously become a major power. What I found most shocking was the late date at which programming began: “The biggest contractor, CGI Federal, was awarded its $94 million contract in December 2011. But the government was so slow in issuing specifications that the firm did not start writing software code until this spring, according to people familiar with the process.”
For a project of this size, it would be difficult to meet a target date of Fall 2013/Winter 2014 if it had started in Spring 2012 let along Spring 2013. I am amazed that it is even 70 percent complete, as the Times reports. My guess is that is probably only half-done.
There’s a lot of ass-covering going on now. Oracle, the company whose registration software gave Ted Rall such headaches, says, “Our software is running properly.” Oracle’s CEO is Larry Ellison, the third richest man in America whose yacht just won the America’s Cup in San Francisco. After 9/11 Ellison offered to supply a National Id card system to help weed out terrorists. With all of Ted Rall’s SS number woes, we can be thankful that his offer was turned down. Or else half the population would be in Guantanamo right now.
Like Bill Gates, Ellison got rich exploiting the intellectual breakthroughs made by others. Oracle was one of the first relational database systems marketed to corporations in the early 80s, along with Sybase, the proprietary software I supported for twenty years at Columbia University. Relational databases (basically a rows/columns approach similar to the spreadsheet concept) were invented by the mathematician E.J. Codd who made much more of a contribution intellectually than Ellison but never had ambitions to be a billionaire.
The Times has a graphic to illustrate the problems of the Obamacare website at http://www.nytimes.com/interactive/2013/10/13/us/how-the-federal-exchange-is-supposed-to-work-and-how-it-didnt.html.
This particular feature would seem to explain not only the technical challenges that make the system difficult to implement but also a fatal policy flaw:
The government is offering what is called a “many-to-many” relationship in database terms: many applicants choosing from many plans. This is historically a challenge to implement in financial systems such as the kind found typically in investment plans.
It would have been a lot easier to simply extend Medicare to the entire population. Not only would the private insurance companies be eliminated, the existing software would have only required a relatively minor change—eliminating the 65 year old criterion.
And going one step further, what is the purpose of having a bunch of different insurance companies competing with each other to provide the same service? Why not a single payer like in Canada that can be run on a nonprofit basis? And, then, to make it even more manageable why can’t we implement a public health system like in France with doctors functioning more as servants of the public rather than entrepreneurs? This sounds rather utopian, I realize, but only in terms of the resistance we would meet rather than the feasibility. Instead of policies that are economical and rational, we get jury-rigged, Rube Goldberg systems that can barely get off the ground like Howard Hughes’s plywood super-plane.
As long as we are talking in utopian terms, managing an economy would be a whole lot easier if we eliminated the profit motive that pits private enterprises against each other basically offering the same goods and services. I defy anybody to tell me why he or she picks one detergent against another. There will always be a need for small businesses such as restaurants (something the Cubans unfortunately did not realize until too late—not too late, one hopes) but the commanding heights of the economy?
If you think in terms of spreadsheets (or relational database systems), planning an economy is not that big a deal. You think in terms of resources, labor, and social needs that can be arranged in rows and columns. From that you allocate on a rational basis and according to the priorities a democratically elected government deems wise—such as spending more on public transportation than automobiles.
Of course, until an aroused population takes control of the economy and puts people like Larry Ellison and Barack Obama on a secluded island where they will be stripped of the power to exploit and to destroy, those hopes will remain utopian. For me, the need to defend such an orientation will remain with me with every living breath.