WASHINGTON — Democratic Rep. Rick Nolan was dishing out some tough talk after a Wednesday conference meeting over the poor Affordable Care Act health insurance exchange rollout this month.
Democrats heard from administration officials on the technical difficulties that have left many would-be insurance shoppers unable to search for or buy plans on the federal exchange website healthcare.gov. President Obama appointed an administration official to tackle the problems earlier this week as congressional Republicans, freed from the drama of a government shutdown, began sharpening their rhetoric on the health care overhaul law.
After the Democrats’ meeting, Nolan told the Associated Press that Obama “needs to man up, find out who was responsible, and fire them.”
He expanded on the matter in an interview with MinnPost later Wednesday.
“What they keep saying is there are glitches,” he said. “Their response is, ‘Well yeah, we know there are problems and we’re working on them and we’re going to get them fixed as they come up.’ Well, when are you going to get them fixed? ‘Well, we’re working on them.’ And what are the problems? ‘Well, we’re working on them’ …
“There are people in this country who have been putting together websites, national websites, and putting them together successfully for quite a number of years now,” he said. “Unfortunately none of them apparently were working on this website. I support the Affordable Care Act, it does a lot of good for a lot of people. They’ve done a lot of damage to the brand and to the Act.”
Republicans have slammed Health and Human Services Secretary Kathleen Sebelius for the website’s troubles. She declined to testify on the matter before a congressional committee this week — she’ll do so on Oct. 30 instead — and a handful of Republicans have said she should resign because of the problems.
Nolan didn’t say who he wanted fired, but that someone would have to pay for the website’s problems.
“The president and his chief of staff, they know who is the point person and who is in charge, and I don’t know that,” he said. “Whoever that was, and whoever was reporting to them and giving the president bad information, I think should be dismissed and I think he should put a new team in there.”
Devin Henry can be reached at dhenry@minnpost.com. Follow him on Twitter: @dhenry
I’m still waiting to hear
from someone with IT experience designing a similar system. I very much doubt that Rep. Nolan or any other politician I’ve read on this subject knows a bit from a byte.
FWIW, I’ve had clients with what would appear to be much simpler systems needs pay fortunes to well known vendors only to end up scrapping the attempt or succeeding only after a very long debugging process.
For that matter, is no one familiar with the concept of a shakedown cruise?
You won’t…
find an IT person with experience designing a similar system. Why?
This is incredibly complex (and too ambitious) in scope for an initial rollout. You’re taking a complex product (health insurance), multiple state variations, bought by people largely unfamiliar with the product, with interfaces to many disparate systems, an inflexible (and short) timeline, changing requirements, no effective pilot, a national rollout, and “go live” on a single day.
That’s not to say it could have been done better or that better developers couldn’t have been chosen. But the “best and brightest” weren’t among the bidders. And government contracting is an art unto itself where a vendor’s skill in the contracting process often outweigh their skill in the subject matter.
I hear many references and comparisons to Amazon.com. Fair enough. Amazon.com claims to “offer millions of unique new, refurbished, and used items in categories such as books; movies; music & games; digital downloads; electronics & computers; home & garden; toys; kids & baby; grocery; apparel; shoes & jewelry; health & beauty; sports & outdoor; and tools, auto & industrial”.
But what did Amazon.com sell when they first rolled out: books. Just books. What you see on Amazon.com today is the result of 17 years of continuous improvement.
It’s too early to declare the health care exchange a success or failure. And the success or failure of the initial implementation neither validates nor invalidates the underlying premise of the ACA.
But this isn’t Iraq. We’re talking millions of $, not trillions of $. And more importantly, no innocent lives were lost.
Agree 100%
This is CYA from politicians trying to keep their lead in polls. Can’t think of anything better than firing the people who made it before it is debugged- NOT. Maybe if they stuck to fixing problems on things they are supposed to do I would respect their opinions.
Rollout
James, I’m also an IT person and my thoughts on the subject largely mirror yours. While I wouldn’t have designed the site the way it looks and operates now, it’s easy to see there were a lot of systems to tie in from various insurance companies. Until you’ve been through an implementation where you’re trying to get disparate databases to talk to each other in real time, you have no idea the amount of complexity involved.
Thank god for alcohol or those coders wouldn’t have got the system done as fast as they did.
Another point regarding complexity of the system…
…was late-breaking requirements changes, which couldn’t be properly tested. This is a well-known risk multiplier. (http://www.cnn.com/2013/10/24/politics/congress-obamacare-website/)
The flaws of the “EIDM” (Enterprise Identity Management) tool have been blamed by witnesses in the current hearings. EIDM was developed by Optum – owned, or previously owned if not presently, by local giant United Health Group. Optum defends itself against the role of scapegoat.
One witness testified,
“Unfortunately, in systems this complex with so many concurrent users, it is not unusual to discover problems that need to be addressed once the software goes into a live production environment,” Campbell’s advance testimony says.
“This is true regardless of the level of formal end-to-end performance testing — no amount of testing within reasonable time limits can adequately replicate a live environment of this nature,”
I’m not so sure about that statement, but it’s leaning towards the truth – not in an ideal environment, but in an environment where all kinds of corporate and government heavies are making demands on the project and its managers, including late requirements changes.
The total heft and complexity of the project required the close cooperation and effective, timely communication between numerous contractors, all under heavy pressure internally and externally – a very tall order.
Pretty disappointed with Nolan. This is a statement made to be referenced during his next campaign, not any sort of constructive recommendation. I have sympathy for the difficulty in rolling out the healthcare.gov website, for all the reasons outlined above. But it also illustrates how the big weakness of the ACA is that it builds on a fractured, inefficient, and highly redundant private insurance system, which has the highest administrative cost of any method of delivering care. There is a reason most developed countries use some version of a single-payer system: the simplicity of it slices enormous amounts of administrate costs, allowing them to spend less than us and yet get better outcomes. The ACA was a step up from the status quo (easy), but unfortunately delays the real reform that is needed: a single-payer system for all Americans.
The wave of managed care organizations which arose…
…some years ago trumpeted that they would reduce costs, and particularly so on their administrative efficiencies and by curtailing the use of economically ineffective treatments, defensive medicine, etc.
Over the years they have morphed into organizations that have shifted the alleged economies into their profit column. Just take a look at United Health Group – and don’t overlook their executives’ compensation – for an example of where those savings went.
Have the managed care organizations helped or hurt us, – overall and in the long run ?
The biggies in the local non-profit health care sector, which is non-profit in name only, has also done little to accomplish their promise.
Initially, these organizations reduced payouts to health care providers, but the provider organizations, hospitals, medical device manufacturers, etc. have more than gained back any lost ground.
Nothing can cure this except a single payer system, or else price controls on key health care services, which amount to pretty much the same thing.
Medicare has an extremely high favorability rating with the public. Simply expanding it to cover all would be a fantastic boon to the public health.
Some argue that if we do so, “no one will want to be a doctor anymore” or “all the doctors will stop providing services”. This is a load of crap. The salaries of doctors have already had a haircut, and did they all become stockbrokers or turn to writing books ? No, they’re still practicing. With single payer, where else would they go to find a market ? I mean, right now, the patients are trapped in a market that is not designed fundamentally to protect their health, but to fundamentally protect the revenue streams of all the organizations feasting on the health care revenue. Why not reverse this dynamic and put the interests of the public first ?
Besides, it wouldn’t hurt us if a new generation of medical practitioners emerged who were not expecting to become wealthy, but rather to simply make a good living while providing a valuable service.
Some key provisions of the ACA are good, long overdue, but the act does not go to the heart of the problems of our health care system.
I completely agree with Steve. Also, to address the concern that physicians would hate single payer: I’m one, and I would welcome such a program. As would over 800 MN physicians and medical students who have signed a resolution calling for such a program (http://www.pnhpminnesota.org/signers.php).
Finally, a 2008 survey of all US physicians found 59% supported such a program (Carroll, A.E. and R.T. Ackerman, Support for National Health Insurance among U.S. Physicians: 5 years later. Ann Intern Med, 2008. 148(7): p. 566-7).
The resistance to single-payer is largely from the insurers, and from some sub-sets of physicians (primarily highly-reimbursed specialties, like radiology and orthopedics). Which is why we have the ACA, and the website, and Rep. Nolan calling for heads to roll…
But…
“Initially, these organizations reduced payouts to health care providers” Which is what the ACA is does to doctors to help pay for itself.
“Medicare has an extremely high favorability rating with the public. Simply expanding it to cover all would be a fantastic boon to the public health. ” And it is presently bankrupting the country.
“Some argue that if we do so, “no one will want to be a doctor anymore” or “all the doctors will stop providing services”.” No, they will just accept private insurance much like doctors have stopped taking Medicare patients. The ACA will provide jobs to new grads and doctors from foreign countries while the established doctors will go into the private market. Check out Great Britain to see for yourself.
You seriously need more information
“Medicare accounts for about 17 percent of U.S. health expenditures” http://www.nber.org/digest/apr06/w11609.html
Also, see the CMS figures at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf
Which is more important, 17% or the other 83% ? It’s not Medicare that is driving up the cost of health care in the U.S. , it’s inordinate profit in the private sector that’s killing us. Your own statement recognizes this: “…the established doctors will go into the private market.” – i.e., they’ll go where the money is !!
Dr. Richard Wender, a leader in U.S. family medicine, says “Using health care as a driver of corporate economics as opposed to a public good is the fundamental cause of our medical inflation.”
Dr. Lee Green, an American who is now a family medicine leader in Canada, adds: “The U.S. health care system is not designed to get you the care you need, it is designed to get you the care that someone can make a profit giving you.” http://www.khi.org/news/2013/jul/30/high-cost-us-health-care-profit/
As to the case of Great Britain, David Cameron’s government has come up with the standard solution of conservatives everywhere – funding cuts to the NHS, in particular primary care cuts, causing the health care crisis, according to some. http://www.mirror.co.uk/news/uk-news/david-camerons-cuts-leading-nhs-2332522
ACA follows Microsoft marketing model
The ACA followed the marketing model of Microsoft (and most software companies) for marketing to set a product release date and the developers are told to make the date. Most Microsoft 1.0 releases were essentially nicely packaged beta releases and it took until a 2.0 or 3.0 release to be almost bullet proof.
The ACA website essentially followed the big bang theory of product development, do everything you can think of at once.
Rick Nolan is innoculating himself
against Obamacare so when the time comes next fall when Stewart Mills points out what a disaster Obamacare is, he can say “Don’t blame me!”
Now at least six democrat senators have signaled their willingness to back a bill that delays the implementation of the individual mandate … the same thing Ted Cruz and the tea partiers were asking for that led to the shutdown.
What’s instructive, and what Nolan obviously noticed, is that six senators who are now going to sign on to a bi-partisan plan with the senate republicans are all in seats that could be in jeopardy for the democrats.