Louis Proyect: The Unrepentant Marxist

October 13, 2013

Obamacare’s Achilles Heel

Filed under: computers,health and fitness,technology — louisproyect @ 7:14 pm

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:

Screen shot 2013-10-13 at 2.08.01 PM

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:

Screen shot 2013-10-13 at 2.38.01 PMThe 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.


  1. Those small business owners can eventually become a Walmart, which started as a 5 and 10 store in small town Arkansas. The same is true with pretty much any chain , many of which now occupy the commanding heights.

    It’s not so easy to limit capitalists once you open the door for them at the lowest levels. They get bigger, buy influence and eventually start taking over the state.

    Comment by jeff — October 13, 2013 @ 11:00 pm

  2. Jeff, when state-owned enterprises that are the size of Walmart or Amazon come into existence after a revolution, it is very unlikely that some schmoe will be able to build up something from scratch to challenge them. On the other hand, no restauranteur ever has the aspiration to become a billionaire unless they want to create a fast-food empire. The typical restaurant in NY is a Thai joint or a pizza parlor. Those kinds of people would never be a counter-revolutionary threat.

    Comment by louisproyect — October 13, 2013 @ 11:11 pm

  3. Appreciate your take on the ACA roll-out debacle. Thanks, Louis. My union — UE — did not endorse this scheme at any point, for a host of sensible reasons. The bulk of the labor unions did uncritically endorse this impossible-to-comprehend scheme, and one can now watch the sad spectacle as many of them try to back-up. Three years ago it was obvious that this program was seriously challenged, if only because it was written by insiders who presumed that the bulk of the population had access to very new high speed computers for the enrollment process. Once this problem was “discovered” the huge — and growing — ranks of “navigators”, insurance agents, and contract staffers are now hitting the street to try to find customers for their over-priced insurance. That’s just for starters….
    I have followed the de-evolution of ACA from its inception, and there has never been a single time that I was considering this program where I did not at some point think or say out loud that, “This is nuts. Completely nuts.” There are so many aspects to this that should confirm for any half educated adult that the ACA is never going to be able to accomplish its task. Let’s start by reminding everyone that its prime architect was former Wellpoint-Exec-turned-Max Baucus-Senate-staffer Elizabeth Fowler. Liz bailed-out last December to lobby apparently for J&J. Baucus is retiring and he has washed his hands of the ACA he helped create. The promoters and defenders of ACA are about as crazy as the detractors. And that’s saying something. But this entire fiasco is merely the daily story of Washington, D.C. at this stage of the Empire. Those who claim to be trying to fix some massive corporate-caused problem — like health care — go right to the source of the problem to seek the solution. Repeat that insanity on issue after issue and hence we get serious problems that grow exponentially — because the forces trying to solve them are the same forces profiting from the crisis in the first place.
    In any event, thanks, and keep following this.

    Comment by Chris Townsend — October 14, 2013 @ 3:45 am

  4. “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.”

    Some of us could use a little more explanation why many applicants’ choice of many plans is a challenge. One plan per column, one applicant per row. Simpler than each fatcat allocating x% of his money to stock A, y% to stock B.

    Comment by Charles — October 14, 2013 @ 3:58 am

  5. Some of us could use a little more explanation why many applicants’ choice of many plans is a challenge.

    The challenge is in programming the system, not in using the system.

    Comment by louisproyect — October 14, 2013 @ 12:19 pm

  6. Yes, the so-called Affordable Care Act is a fine health insurance program – for the insurance industry. For human beings, not so much. Where I live the liberals say it’s “a step forward” but when you point out that it will still leave tens of millions uninsured they sigh. Even as an anticapitalist, I’m sympathetic to the anger of the Right about the mandate. Obama campaigned saying he wouldn’t force people to buy insurance they couldn’t afford. Now we have the federal government penalizing those who don’t purchase a private product that by it’s nature doesn’t return what consumers pay into it – there will always be a pressure from insurance companies to reduce the actuarial value to increase their profit. A government forcing its citizens to buy private products – it’s like totalitarian capitalism, the worst of both worlds! The subsidies offered to citizens to help buy these flawed products (which, even if you have insurance, don’t necessarily ensure adequate healthcare or protect from medical bankruptcy) is in effect a massive transfer of tax revenue to the insurance industry. My last modicum of interest in electoral politics at the national level disappeared when Bernie Sanders and Dennis Kucinich voted for the ACA. I highly recommend the policy analysis put out by Physicians for National Health Care, who lay out the case for a single payer system. -MB

    Comment by MB in Massachusetts — October 14, 2013 @ 3:16 pm

  7. The failure of Obamacare launch is not a programming problem. The programmers at Amazon wrote and maintain a website that matches up buyers, products, and vendors with ease.

    The launch failure is a sign of some contradiction in the Obama administration. He and those around him cannot do a credible job on his signature piece of legislation. It’s a piece of crap for the people, but that is irrelevant; they are incompetent as oligarchs.

    Comment by Charles — October 14, 2013 @ 4:01 pm

  8. The programmers at Amazon wrote and maintain a website that matches up buyers, products, and vendors with ease.

    But not if they started in the spring to meet a September target date. I worked on a system at Columbia to provide a web-based front end to a 10 year old financial system. It took 18 months to implement. It was a lot less sophisticated than Obamacare.

    Comment by louisproyect — October 14, 2013 @ 4:12 pm

  9. Why don’t you Americans introduce something simple like the National Health Service(NHS) we have had here in Britain since it was introduced by a Labour Government away back in in 1948? (The present UK Coalition government – Tory/Liberal Democrat – seem hell-bent on privatising aspects of it, but that’s a different story). The basic idea is simple: you go to a doctor, he or she treats you (primary care), if necessary you get referred to a hospital/specialist (secondary care).You have an operation or something. Hopefully come out feeling better again. How much do you pay for all this care and attention and surgery etc? ? Zilch- totally free at the point of service. (Free when you need it). (In England and Wales working people pay about £7 for a prescription from a doctor, in Scotland which has a devolved government and controls our Health Service separate from the overall UK government, we pay zilch for prescriptions)
    . So how is our NHS funded? Yes, you’ve guessed it, from general taxation. In other words, we pay INDIRECTLY for this magnificent SERVICE.. If people in Britain want to go “private” they are perfectly freee to do so, either by signing a cheque (check) after treatment in a privately-run hospital, few and far between, or by taking out an Insurance policy with a health insurance company like BUPA. The vast majoriy of Britons rely entirely on our wonderful NHS. Now this is what many people would call “socialism in action” . So simple, so efficient, so effective, so egalitarian. .

    Comment by Gordon from Shetland Isles, UK — October 14, 2013 @ 7:54 pm

  10. Why Gordon?

    The 2 party kleptocracy in the US successfully disenfranchizes the masses for starters.

    As Tony Benn from your neck of the woods put it in the film “Sicko”:

    Comment by Karl Friedrich — October 15, 2013 @ 2:07 pm

  11. The permanence of the petty bourgeoisie doesn’t have quite the same ring to it as Marx’s “revolution in permanence,” does it? Strange for a “Marxist” to talk of small business “always being around” when key pillars of the communist programme have always been the abolition of commodity production and money itself.

    What’s happening in Cuba isn’t so much a correction or an abandonment of socialism as it is a shift away from the nationalist state-owned development model toward globalized capitalism, something no late-comer to the scene has been able to resist, no matter how hard they’ve tried (China, Vietnam, Myanmar, with North Korea coming along as soon as it can). Money has always existed, markets have always existed, classes have always existed, commodity production has always existed; it was just done a different way than it has been in the US and England.

    The first step is for Marxists should be to read Marx.

    Comment by Martin Saber — October 18, 2013 @ 7:39 am

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