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The ten year anniversary of the Healthcare.gov rescue

• brunosan 3y ago
  I fondly remember how a small DC startup subsubsubcontracted to do the front landing page was able to ensure that at least people landed on healthcare.gov page and not a 500 error page. All thanks for a single server (with one backup) using Jekyll, if I remember the story correctly.
  • vippy 3y ago
    As a civic technologist currently contracting, I feel like more Americans should know that procurement rules all but prevent federal offices from doing their own software development and that most of it is, as you wrote, subsubsubcontracted.
    • bmelton 3y ago
      And that generally, the people who've won the contract to build the website or application are not the same people who've won the other contract to manage the databases, which is a totally different someone than those who've won the contract to run the DNS system, oh and also that the DNS contractors and the database contractors definitely bid on the website contract but didn't win so they want the website contractor to fail so they can get a second chance at bidding on the contract when you do
      • nonameiguess 3y ago
        Don't forget the database contractor and frontend contractor aren't allowed to directly talk to each other but have to make contact through their individual contracting officers.
        • bmelton 3y ago
          and that the leads from both of the other teams are on the change control board eagerly waiting for your change to come before them so they can find the least-obvious-but-still-patently-obvious excuses to make your request look unprepared to the govvies who pay them in lieu of having any expertise so "new table" requests can be shot down with lowbrow questions like "But have we thought about the security implications?!?"
        • seanp2k2 3y ago
          what's the penalty like for backchanneling?
          • belltaco 3y ago
            Pissed off contracting officers at the least, losing their trust will ensure you will be micromanaged on all the things to the letter in all the hundreds of pages of contracts you signed. They can make life hell and probably stop you from renewing the contract at the least, or make it an instant recompete at the worst.
    • jessriedel 3y ago
      What does it have to do with procurement rules? I was under the impression that it was just that the federal gov't won't pay salaries that are remotely competitive, so the only way they can get work done by competent people is by hiring a contractor who then pays market wages to a consultant.
      • nonameiguess 3y ago
        Eh, I've worked with a whole lot of incredibly intelligent, talented people in the federal government. If there's a problem they have with wages, it's more that they can't retain the best people any more, but it wasn't so much of a problem 20 years ago before Silicon Valley salaries skyrocketed so quickly. The security of the civil service and a guaranteed pension used to make up for the slightly lower pay, but it doesn't make up for 1/3 the pay. Given it takes a literal act of Congress to change the pay bands and Congress won't even fund the existing budget they already passed, they simply can't adjust at the speed of industry. But they probably will eventually add a compensating bonus for critical work the way they had to do with medical doctors. Physicians that work directly for DoD make an enormous bonus compared to others in the same pay grade but different career field because otherwise they wouldn't be able to hire anyone. They react slowly but eventually react. What you're talking about, though, is a problem with procurement procedures. It's far easier to get through Congress than any change in operational budget that involves increased pay for federal employees, even if the outcome is otherwise identical. And it frankly makes sense to a large extent. Even if they have to pay way more for a private workforce, they only have to justify it for a several year project. Hire the same number of civil servants and you're committing to employing them for the next 30 years. They need to know they'll consistently have work for them to do. They can't just institute mass layoffs and hiring spurs on the other side the way industry can.
        • jessriedel 3y ago
          > but it wasn't so much of a problem 20 years ago I mean, ok? 20 years ago is a long time. As you say, pay is now like ~1/3 that of industry, and the pension doesn't make up for it. > What you're talking about, though, is a problem with procurement procedures. It's far easier to get through Congress than any change in operational budget that involves increased pay for federal employees Wait, is raising the pay of federal employees considered "procurement"? If not, aren't you agreeing that procurement of software consulting services is an end around the main issue, which is that wages of federal employees are too low (a non-procurement issue)?
    • poidos 3y ago
      Do you have a reference handy? Would love to learn more about this.
      • sn9 3y ago
        Recoding America: Why Government Is Failing in the Digital Age and How We Can Do Better by Jennifer Pahlka
    • bubblethink 3y ago
      Should all gov websites move to the recreation.gov model where the contractor is incentivized disproportionately on a percentage basis ? It seems that customers get shafted no matter what; the latter at least creates a better product.
      • snowwrestler 3y ago
        They should move to the gov.uk model where an in-house team of experts sets standards and provides informed accountability. The U.S. federal version is the U.S. Digital Service, which regularly advertises in the HN “who is hiring” threads.
  • snowwrestler 3y ago
    The initial version of healthcare.gov, before the exchanges launched, was a small informative site that was built by Development Seed, a small DC-based web shop. It was built in what would today be called “static page generation” style and therefore was able to be hosted on small hardware. At the time it was considered pretty advanced tactics. I think this may be what you are thinking of. To my knowledge that site was entirely replaced when the federal exchange launched, and there was not a serious challenge serving the landing page since it did not take in or process any personal data. It was only once you started trying to find a plan that everything ground to a halt. Development Seed also developed another project you may have heard of: Mapbox. (To which they eventually pivoted the entire company.)
• fallingknife 3y ago
  Important but not mentioned in the article is the amount that the government paid for that incompetence driven disaster. $840 million!
  • unethical_ban 3y ago
    Right? Don't they know software is free and insurance is a simple industry?
    • ceejayoz 3y ago
      It's not free, but the initial contractor CGI definitely hosed taxpayers.
    • renewiltord 3y ago
      The rescue proved something everyone knows: some software engineers suck; others rule.
    • fallingknife 3y ago
      And that is an excuse for spending damn near a billion for this? > Testing was largely a manual process. Releases and deployment required lengthy overnight downtimes and often failed, required equally-lengthy rollbacks. The core data layer lacked a schema. Provisioning hosting resources was slow and not automated. Critically, there was a pervasive lack of monitoring of the site. No APM, no bog-standard metrics about CPU, memory, disk, network, etc., that could be viewed by anyone on the team.
    • lazide 3y ago
      The “beauty” of contracting for the gov’t - if you know how to play the game - is that their internal management and incentive structure is usually so screwed up (and will never get better) that manipulating the customer is easy and lucrative. If you know how to do it without being indicted anyway. Constant back and forth change orders, pointless delays to serve constantly changing stakeholders, constant demos with no real product, no one in the customer with any power who has experience to call BS on timelines or delivery, etc. And if done correctly, everyone in the ‘customer’ is simultaneously happy and angry and so it’s easy to deflect blame and point fingers back into their own org. Or so I’ve heard from folks who are involved. I try to avoid it like a plague, the BS I deal with hurts my soul enough already.
• PopAlongKid 3y ago
  For context, the original intention was that states would run their own exchanges, only if they refused would residents of the state use the federal exchange. 36 states initially did not set up their own exchanges.[0] It appears that currently, 20 states (including D.C.) have their own marketplace.[1] >The shutdown prevented anyone from outside the main team working on HealthCare.gov from coming in to help That government shutdown in 2013 was instigated entirely by one U.S. Senator, Ted Cruz, expressly for the purpose of sabotaging ACA.[2] [0]https://aspe.hhs.gov/reports/health-insurance-marketplace-premiums-2014-september-2013 https://aspe.hhs.gov/reports/health-insurance-marketplace-pr... [1]https://www.healthcare.gov/marketplace-in-your-state/ https://www.healthcare.gov/marketplace-in-your-state/ [2]https://www.texastribune.org/2016/02/16/ted-cruz-2013-obamacare-shutdown-was-defining-mome/ https://www.texastribune.org/2016/02/16/ted-cruz-2013-obamac...
  • mlinhares 3y ago
    If I was running a state agency and the federal government told me I could just use their system instead of spending my own money I would definitely take on the federal government instead of paying for it. Sometimes the whole "states are their own thing" here in the US goes way too far.
    • fastball 3y ago
      Really depends on if the federal-level system is better or not than what you have, no? Sometimes the stars align and the federal government builds a system that is actually nice to use. But sometimes the system is a steaming pile of shit.
      • tilne 3y ago
        It’s a public-facing IT system owned by some government agency in the United States. “Sometimes” is an understatement. (Though maybe this is a failure on my part to update my priors. I’ve noticed that recently some of the systems that led me to form this opinion in the past have become very functional, if not exactly pleasant to use.)
      • 3y ago
• bjt 3y ago
  I remember at the time there was a "Silicon Valley rides to the rescue" subtext. Though a Silicon Valley person myself, that rubs me the wrong way. I appreciate the author resisting that framing, and admitting that on that first day, the contribution of the new team was basically to ask "Can we install New Relic on the servers?" The response to that question really illustrates the root of the problem, in my opinion. It's not that the people who built the original healthcare.gov were stupid people. It's that they were operating under constraints and incentives that emphasize rules and compliance over making the whole system work well.
  • ceejayoz 3y ago
    Bit of both, really. We got https://en.wikipedia.org/wiki/United_States_Digital_Service https://en.wikipedia.org/wiki/United_States_Digital_Service out of the original Healthcare.gov disaster; if you've used login.gov I suspect you've found it one of the nicer government websites out there (for example: it's one of very few to explicitly advise against SMS 2FA, and to offer U2F support), and it owes its existence to the USDS.
    • fullstop 3y ago
      I was so pleased when I learned that login.gov implemented U2F and advised against SMS. They also make websites which have excellent color contrast and intuitive design, and you can tell that a lot of thought went into each one.
      • nrp 3y ago
        The design system is really well documented: https://designsystem.digital.gov/ https://designsystem.digital.gov/
        • llimllib 3y ago
          I made a template repo for getting started with next.js and the USDS when I worked on Paul's team: https://github.com/adhocteam/uswds_nextjs_starter https://github.com/adhocteam/uswds_nextjs_starter
• srndsnd 3y ago
  While what happened itself was less than ideal, I'd be curious if there are any more detailed explanations other than this account of what exactly happened, and how the issue was resolved. I'll certainly be on the lookout for more posts in this series. It's like a little bit like engineering "competency porn", but I enjoy stories like this. I read The Phoenix Project a few years ago, and while it was fictionalized and a heavy handed introduction to Agile and DevOps (I'm a data analyst so it was new to me), I liked it, and would like to read anything similar, if anyone has any recommendations.
  • nofinator 3y ago
    Time (yes, Time Magazine!) actually had good coverage of this: https://time.com/10228/obamas-trauma-team/ https://time.com/10228/obamas-trauma-team/ Here's one good excerpt: Dickerson quickly established the rules, which he posted on a wall just outside the control center. Rule 1: “The war room and the meetings are for solving problems. There are plenty of other venues where people devote their creative energies to shifting blame.” Rule 2: “The ones who should be doing the talking are the people who know the most about an issue, not the ones with the highest rank. If anyone finds themselves sitting passively while managers and executives talk over them with less accurate information, we have gone off the rails, and I would like to know about it.” (Explained Dickerson later: “If you can get the managers out of the way, the engineers will want to solve things.”) Rule 3: “We need to stay focused on the most urgent issues, like things that will hurt us in the next 24–48 hours.”
• LeanderK 3y ago
  I wonder, how is "obamacare" viewed after those years? Was it a success? Ist there partisan disagreement and a realistic chance that it might get repealed?
  • fullshark 3y ago
    My belief is it was oversold in terms of its transformative impact, both by the advocates and detractors. The major change is no longer refusing insurance for pre-existing conditions, and the various lives that have changed due to having health insurance when in the counterfactual they would not have had it. But there's a reason why all democrats are still running for federal office on a platform of healthcare reform. It won't be repealed after the supreme court upheld it and the republican congress under Trump gave up on trying to repeal it after McCain's no vote on repeal.
    • mrguyorama 3y ago
      But Trump and his congress did succeed at repealing some parts of it, like the individual mandate
  • sidlls 3y ago
    It succeeded in getting more people covered by health insurance. It did so by enriching the private insurers who basically run our health care system. Personally I don’t see that as a success, rather it simply made all our health care system problems worse. Access to insurance just isn’t the same as access to health care, because the insurance costs money, and insurers tend to be roadblocks to care. People who tend to need the most care were either already covered (Medicare/Medicaid) or the subsidies under ACA were paltry jokes compared to their needs. There isn’t a realistic chance of repeal. Both of the main political parties here benefit from it too much: the democrats by claiming a health care win, which our latte liberal class eats up, and the republicans by having an additional hot button issue (like abortion and guns) to whip their lunatic fringe up with. Not to mention all the campaign and lobbying money from private insurers who are profiting immensely off of ACA.
    • 3y ago
• immannino 3y ago
  There is a fantastic "Go Time" podcast episode on this on how they used Go to service some of the site. Highly recommend this episode and this podcast. https://changelog.com/gotime/154 https://changelog.com/gotime/154
  • jamietanna 3y ago
    Thanks for sharing, I couldn't remember which podcast I'd listened to about it
• georgek 3y ago
  HealthSherpa, a YC startup launched right here on HN and built on top of the government’s backend, now enrolls more people in ACA coverage than Healthcare.gov.
  • mistrial9 3y ago
    that is interesting - can you be more specific about markets served, or services offered? versus the HC.gov one.. Sherpa is completely hosted on AWS I would imagine?
    • fragmede 3y ago
      isn't hc.gov served out of aws' govcloud?
      • keypusher 3y ago
        yes
• jeffrallen 3y ago
  I remember hearing on a podcast a story about turning a "backend timed out" failure into "send that data in email and tell the user 'ok, we got it come back and check later' instead of an error". I thought that was really clever, and filed it away as something I'd use in an emergency in the future. It also reminded me of a WebTV incident with a database overload. I came up with the idea of shutting down all our last-hop mail delivery servers, which needed a database connection. That caused email to queue in the SMTP inbound Servers, which we drained later when the database was no longer overloaded. The lesson is: use batch-oriented processing from queues to take load off of systems that are designed to work in a transaction-oriented manner, but are failing to do so.
  • jeffrallen 3y ago
    It's explained in the Changelog podcast mentioned elsewhere, at 36:16.
  • ajcp 3y ago
    Yup, IRC they were using Go to write to flat file on a server. The file was acting as queue for that process.
• davidw 3y ago
  I sure miss the health care system in Italy. You go to the doctor, there is no one else there, because there's no need for paperwork. The doctor just types your name into their system and that's all that's needed. My son was born there. Total cost: 0. Same son had a minor tumble once, but proceeded to have one of these, which absolutely scared us to death: https://en.wikipedia.org/wiki/Breath-holding_spell https://en.wikipedia.org/wiki/Breath-holding_spell - we called an ambulance because his lips were a bit blue. He started breathing again just fine as we called, but they sent it anyway. Total cost: 0. And it was nice not having to think about that when we made the call. It got there very quickly and they took him and my wife in to check him out in any case, just to be sure. There are a lot of things I like about life in the US, and things that didn't work well in Italy too, but the health care system was just nice in that it's just there and you don't have to screw around comparing confusing plans and worrying about it being attached to your job.
  • hotpotamus 3y ago
    In the US, the belief is that some are deserving of healthcare while others are not, and there is an elaborate system to differentiate between them. It's rather a scary system to live under, and it feels like that may be the point.
  • deleted 3y ago
    [deleted]
• cgithrow23 3y ago
  Why doesn’t the CGI wikipedia page [0] include mentions / references to this debacle? And the related cost overruns? That page is unsurprisingly manicured and free of any “controversies” section. [0] https://en.wikipedia.org/wiki/CGI_Inc https://en.wikipedia.org/wiki/CGI_Inc.
  • cgithrow232 3y ago
    See also the Talk page re: CGI wikipedia article [0], particularly this: """ There's lots more at the wikipedia article on healthcare.gov, in particular CGI's poor performance on a Massachusetts state website, which at least one report "characterized as a complete failure... The software created by CGI was of poor quality and unusable" (that from the wikipedia article) That may or may not be true, but it should at least be mentioned here. Instead we have (as you say) what appears to be an advertisement from CGI's PR department--still, years later. Mcswell (talk) 19:22, 20 July 2023 (UTC) """ [0] https://en.wikipedia.org/wiki/Talk:CGI_Inc https://en.wikipedia.org/wiki/Talk:CGI_Inc.
    • ewwhite 3y ago
      I was there and lead Linux engineer with the hosting firm CGI outsourced this effort to...
      • cgithrowaway 3y ago
        Can you tell us more?
        • ewwhite 3y ago
          We had the CGI Massachusetts state exchange business, which led to [additional exchange work](https://www.datacenterknowledge.com/archives/2014/02/25/managed-hoster-logicworks-surfing-sea-change-healthcare https://www.datacenterknowledge.com/archives/2014/02/25/mana...) in the lead-up. There were many last- minute changes and very little load testing, but I was instrumental in getting core VMware infrastructure onto HPE equipment instead of Supermicro. The firm was a private cloud and infrastructure services group, [LogicWorks](https://www.logicworks.com https://www.logicworks.com).
• light_hue_1 3y ago
  The solution is to stop hiring the same companies to do this work. It's clear that CGI, IBM, etc. are not capable enough. Why aren't any they banned from any future similar contracts? You screw up a contract, you're banned from all government contracts for the next 10 years. Simple. We would have actual working technology instead of a churn of garbage.
  • deepsun 3y ago
    > you're banned from all government contracts Just rename the company. Or shuffle the teams.
  • mixmastamyk 3y ago
    Often government ensures failure through nonsensical requirements. Soon there'd be no one left to do the job.
  • kukkeliskuu 3y ago
    My experience for IT consulting for several industries on the public sector in Europe, is that when a competition for contract is organized, you get points or may be even required to have prior experience on large-scale projects from the same industry. This prevents smaller companies from competing.
• codeulike 3y ago
  I wonder how much this was influenced by the Gov.uk site made by the UK Government Digital Service in 2011 and 2012 - which took the same approach of hiring people who could actually build stuff and kicking out all the usual big consultancy firms.
• deleted 3y ago
  [deleted]
• screwturner68 3y ago
  I was on the market place rescue team, keep throwing money at a problem and it will go away.
• john-tells-all 3y ago
  > particular technologies being used, including something called MarkLogic, an XML database XML database ? For a critical service used by 300 M people? Brrrrrr.....
  • glaucon 3y ago
    It was around high-tide of 'no-sql' but surely it cannot literally be true ? I suspect business rules in XML, so effectively read-only, while dynamic data in a rdbms ? Maybe that's just my hopeful heart talking :-)
    • ajcp 3y ago
      I had the same thought
    • mdickers47 3y ago
      nope it was exactly that; transactional customer state in giant xml documents in an xml-document-storing database. Bugs would cause them to grow to 10, 20, 100MB.
      • glaucon 3y ago
        Wow, strange stuff, indeed.
        • deleted 3y ago
          [deleted]
      • qohen 3y ago
        According to Paul Smith, who has an AMA about healthcare.gov at Lobster.rs[0], the database was MarkLogic, which started out as an XML database, according to its Wikipedia page[1] (Paul also mentions this briefly his 10th anniversary post). According to another commenter[2], who says he met a MarkLogic manager on a plane flight, MarkLogic had passed some sort audit/certification that only Oracle had previously passed, which may explain why it was used for healthcare.gov. [0] https://lobste.rs/s/igt4ez/10_year_anniversary_healthcare_gov#c_0fu122 https://lobste.rs/s/igt4ez/10_year_anniversary_healthcare_go... [1] https://en.wikipedia.org/wiki/MarkLogic https://en.wikipedia.org/wiki/MarkLogic [2] https://lobste.rs/s/igt4ez/10_year_anniversary_healthcare_gov#c_f2khfm https://lobste.rs/s/igt4ez/10_year_anniversary_healthcare_go...
• heelix 3y ago
  I remember working with these guys as well all got pulled in to help fix it. Gabe coded in VIM like a like a master violinist. Working with Mikey showed the power of metrics/SRE. Went from having everyone in the room pointing at the next vendor to figuring out part of the bottlenecks. Having a system -- largely broken -- and fixing it without being able to take it off line for major refactoring was like doing surgery on a jogger. What a wild experience.
  • beckler 3y ago
    I saw Mikey give a speech about this back at the Velocity conference around 2014-ish. It was absolutely fascinating to listen to him talk about it!
• dekhn 3y ago
  One thing I will say, from talking to the various people who worked on this and then USDS, they were almost entirely burnt out at the end because they were having just non-stop meetings and doing constant firefighting and trying to get large government contractors to act like tech startups. In retrospect, maybe we shouldn't worship "heros who drop in, save a project, then leave", especially if it leads to non-sustainable lifestyle for the heros, or creates further technical debt that makes it hard for contractors to develop sites.
  • boris-ning-usds 3y ago
    It's a tough job. USDS can often be in a unique position to take the technical lead in a fire situation such that it doesn't happen again, and that can steer enormous positive outcomes for both the public servant, the contractors, and the general public. As for non-sustainable lifestyle, it differs from person to person. It's an appointed position of 2 years, with one chance of renewal for that reason. It's an unique opportunity to see the government from a position of power, so it's expected for USDSers to try to make it count. It's not always the case USDS will create further technical debt for contractors to develop sites. During cutovers, consider creating playbooks and provide context in those non-stop meetings to the contractors, and best of all, provide a phone number and an email for emergency. And some of those people from USDS never left the government. ;)
• alexchantavy 3y ago
  I loved reading this. I remember 10 years ago when HN tore apart the website's source code on GitHub: https://news.ycombinator.com/item?id=6540993 https://news.ycombinator.com/item?id=6540993
• breakingrules 3y ago
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• exabrial 3y ago
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• deleted 3y ago
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• spandextwins 3y ago
  Government isn’t efficient. Because it’s not government, it’s people with civil service protection. And it’s consultants with zero accountability.
  • constantly 3y ago
    Interestingly the change was largely to prevent cronyism where the newly elected leader simply installed their supporters, friends, donors from top to bottom across government. That is a suboptimal way of doing things, and having continuity in staffing and operations are critical. You can read more about this if you look up Tammany Hall.
    • spandextwins 3y ago
      Hahaha you used prevent along with cronyism and government in a serious statement! That's actually really funny! Government is cronyism. Anyone who thinks otherwise hasn't worked in government.
• gumby 3y ago
  I clicked thinking this would be an interesting technical discussion but it didn't get to that until late. Instead it was an unexpectedly very interesting "backstage view" of the process. I really look forward to the next installment!
• fragmede 3y ago
  The story of VaccinateCA, about Patrick McKenzie (patio11 around these here parts), is another story in this vein. https://worksinprogress.co/issue/the-story-of-vaccinateca/ https://worksinprogress.co/issue/the-story-of-vaccinateca/
• dctoedt 3y ago
  Fun fact (tangential): In 2014, the state of Oregon filed a $3 billion lawsuit for fraud against Oracle Corporation and six Oracle employees personally, in the wake of the allegedly-failed attempt to develop Oregon's health-insurance exchange under the Affordable Care Act a.k.a. Obamacare. [0] • The six employees sued included five executives at the vice-president level and higher, as well as a technical manager who was accused of having conducted a fraudulent demo of the new system's capabilities. • The state sought "only" some $45 million from the technical manager, as well as amounts ranging from $87 million to $267 million from various Oracle executives. (It seems likely that the state sued the Oracle people personally to "encourage" them to cooperate in the discovery process in which the state presumably sought documents, etc., from Oracle. This happens a lot on the criminal-law side of the docket, where it's known as getting defendants to "flip" and testify against their co-defendants. The past couple of days have seen examples in the Georgia RICO case against former president Trump.) High-profile lawsuits like this typically settle before trial. Not least, this is because the elected officials who bring or authorize the lawsuits would prefer to trumpet a "victory" instead of rolling the dice with the court. And sure enough, Oregon's lawsuit against Oracle was settled — Oracle agreed to pay Oregon $25 million in cash and to provide the state with another $75 million in technology. [1] (Copied largely verbatim from my course materials.) [0] https://web.archive.org/web/20141014060142/https://www.oregon.gov/docs/082214_filing.pdf https://web.archive.org/web/20141014060142/https://www.orego... [1] https://www.oregonlive.com/politics/2016/09/post_183.html https://www.oregonlive.com/politics/2016/09/post_183.html
  • deepsun 3y ago
    > provide the state with another $75 million in technology. ... securing their future income. If I bought such a bad burrito from a vendor that I had to sue them, I'd probably stop buying from that vendor.
    • dctoedt 3y ago
      Sometimes in such matters, the customer is using the lawsuit as leverage to renegotiate the price after the fact. (I don't know whether that was a motivation in Oregon v. Oracle.)
• dctoedt 3y ago
  A extended account, with a good deal of backstory about the people and state- and federal agencies involved, can be found in Jennifer Pahl's book, Recoding America. [0] [0] https://www.amazon.com/Recoding-America-Government-Failing-Digital-ebook/dp/B0B8644ZGY/ref=sr_1_1 https://www.amazon.com/Recoding-America-Government-Failing-D...
• daniel-cussen 3y ago
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• lifeisstillgood 3y ago
  "Dear Senior Leadership, it's not us, it's you. We build within the framework you approve, if it's too restricting it's your fault not the poor builders"
• lifeisstillgood 3y ago
  And every single part of that "rescue" would never have been needed if the original team had been allowed to "do things the normal standard way" the first time. We can guess the reasons - everyone and their dog wanted to be part of the flagship IT project, a slew of conflicting interests and parties who would not talk to each other or in some cases were actively sabotaging efforts, a failure to recognise that "working complex systems only ever evolve out of simple working systems". Why do we always do this to ourselves ?
• miley_cyrus 3y ago
  If ACA is such a success story, then why is the US lifespan falling faster than any other developed country over the past few years? There was of course a drop for COVID-19, but progress in life expectancy basically stalled after ACA was implemented, whereas life expectancy has kept growing in every other developed country. https://www.washingtonpost.com/health/interactive/2023/american-life-expectancy-dropping/ https://www.washingtonpost.com/health/interactive/2023/ameri... And to be clear: "While opioids and gun violence have rightly seized the public’s attention, stealing hundreds of thousands of lives, chronic diseases are the greatest threat, killing far more people between 35 and 64 every year, The Post’s analysis of mortality data found."
• RickJWagner 3y ago
  I had a small part in that effort. I was a support engineer working with an Enterprise Service Bus. I represented my company and took part in some diagnostic activities. At the time, I had political reasons to oppose the ACA, so taking part in the fire-fighting was against my personal politics. I gave it my very best effort. I regard it as one of the finest moments of my career.
  • pauldenton 3y ago
    So how long did it take you to move away from California?
    • RickJWagner 3y ago
      I'm not sure I understand the question. I didn't live in California then or since.
• eyphka 3y ago
  This was a fantastic read and looking forward to reading more. Also, I’d love to learn more about the “people who were in the room” so to speak. Also I hope that some academic historian has been in touch to catalogue that notebook!
• lsh123 3y ago
  “Behind every hero, there is someone who fucked up”
• kukkeliskuu 3y ago
  One root cause for why health care is so expensive in the US is missing from this discussion. Much of the cost of doctors in the US comes from expensive insurances doctors need to take against malpractice lawsuits. Even when people are informed of the risks when they partake in a medical procedure, they want to blame somebody when the risks materialize. People need somebody to blame when something goes wrong.
• jononomo 3y ago
  The beauty of the two-party system is that we have one party (the Democrats) who are trying to make society better, and we have a second party (the Republicans) who are trying to prevent society from becoming better. This is an ideal balance.
• AnnoyedComment 3y ago
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