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I've been working on healthcare.gov for the last few months alongside a bunch of other Google, Facebook, and Y Combinator alums. I'll always remember what Mike

I've been working on healthcare.gov for the last few months alongside a bunch of other Google, Facebook, and Y Combinator alums. I'll always remember what Mikey told us in December, after the site was back up, could handle a non-trivial amount of traffic, and people who wanted health insurance could finally get it: "1 in 1000 uninsured people die each year. It's not an exaggeration to say that due to the work we're doing here, 5,000-10,000 people will live to see the end of 2014. You should be proud of what you've done, but we should also all be grateful to have this opportunity." We're all grateful to be here, but there's a hell of a lot more work to be done. If any of you out there are an amazing software engineer or SRE, and want to help make our government work better, please shoot me an email: brandon@hcgov.us!

wooter 13y ago
"1 in 1000 uninsured people die each year. It's not an exaggeration to say that due to the work we're doing here, 5,000-10,000 people will live to see the end of 2014. You should be proud of what you've done, but we should also all be grateful to have this opportunity." Hospitals don't let uninsured people die and insuring people doesn't magically save their lives.
- brandonb 13y ago
  An estimated 26,000 people die each year due to lack of insurance coverage. That's part of the reason the Affordable Care Act was passed. For more information, see this Reuters article from 2012: http://www.reuters.com/article/2012/06/20/us-usa-healthcare-deaths-idUSBRE85J15720120620 http://www.reuters.com/article/2012/06/20/us-usa-healthcare-...
  - at-fates-hands 13y ago
    Too bad the people who actually need it, are not signing up. Not to mention the people who HAD coverage are now getting cut off of their insurance and forced into the exchanges. A complete failure anyway you look at it. http://www.forbes.com/sites/theapothecary/2014/01/18/coverage-expansion-fail-less-than-one-third-of-obamacare-exchange-enrollees-were-previously-uninsured/ http://www.forbes.com/sites/theapothecary/2014/01/18/coverag... "Instead of expanding coverage to those without it, Obamacare is replacing the pre-existing market for private insurance. Surveys from insurers and other industry players indicate that as few as 11 percent of those on Obamacare’s exchanges were previously uninsured" But wait a minute! Obamacare was supposed to cut my rates my $2,500 A YEAR right? WRONG. Apparently, it still costs too much for the people who really need it: "Of those that didn’t sign up for Obamacare-based coverage, 52 percent stated that “affordability” was their biggest complaint with the exchanges’ plan offerings. Only 30 percent cited “technical challenges in buying the plans.” "Joan Budden, chief marketing officer at Priority Health, told Wilde and Mathews that Michigan’s health insurers had expected 400,000 uninsured Michiganders to enroll in exchange based plans during the initial enrollment year. According to the latest data from the Obama administration, as of December 28, only 75,511 had “selected a marketplace plan.” Of those, only an unknown fraction had paid their first month’s premium, and therefore were actually enrolled in new health coverage." So if this is such a success, why isn't the White House trumpeting the real numbers of people who've signed up then?? http://www.washingtontimes.com/news/2013/oct/4/white-house-sees-obamacare-working-wont-release-fi/ http://www.washingtontimes.com/news/2013/oct/4/white-house-s... "For the fourth day in a row, the Obama administration on Friday declined to release figures on how many Americans have purchased health insurance through the just-opened online markets tied to the new health care law. White House spokesman Jay Carney told reporters that millions of people have visited the federal HealthCare.gov site, which directs people to coverage options, but he did not have “specific data” at this early stage in the enrollment period." There are better ways to do this than handing over 1/3 of our economy over to the Federal Government. You want competition? You can start by letting insurance companies deal across state lines. More competition, increased quality of care, lower costs and better care for everyone.
    - 3am 13y ago
      Did you read the links in your post? The first doesn't strongly support your points, and the second was out of date almost 4 months ago. And that's really saying something, because the first link is an OpEd by Mitt Romney's former health care advisor who is a senior fellow at a conservative think-tank. Some of the downsides of allowing health insurance to be sold across state lines are addressed at http://www.kaiserhealthnews.org/stories/2010/september/30/selling-insurance-across-state-lines.aspx http://www.kaiserhealthnews.org/stories/2010/september/30/se... - and they include an AEI fellow's views for balance. The auto insurance market is a hybrid, though, and doesn't show a large cost savings for states that effectively allow cross-state lines operations via identical regulations. I think it's also fair to ask also why health insurers that operate in all/most states (UnitedHealth, Aetna, Cigna, Athena, etc) are not substantially cheaper that BC/BS peers that don't.
    - JPKab 13y ago
      My mother in law has worked for the past 15 years at jobs which employ her for 39.5 hours a week and don't give her health insurance. She suffers arthritis in her hands and knees. She signed up and received health insurance for the first time in 15 years last week. She is now receiving the medical care she needs. Had she not, she would have had to apply for disability benefits. Now, she gets to keep working. You don't know what you are talking about. My mother-in-law makes shit money, and yet she has a plan that is extremely affordable for her. Your a partisan hack, and your facts are regurgitated from professional partisan hacks. Your absurd "handing a 1/3 of our economy over to the Federal Govt" comment points out your biased sources of knowledge. How is a website which matches consumers with private insurance companies equate to "handing over" to the Federal Government? What planet do you live on? Alabama?
      - AutoCorrect 13y ago
        anecdotal evidence and ad hominem attacks don't help you argue your points.
        JPKab 13y ago
        Agreed. But partisan hackery is like porn. You know it when you see it.
- kevincrane 13y ago
  But if you know you can't afford it, maybe you'd avoid going to the hospital when you really should.
- jbooth 13y ago
  Hospitals don't turn away uninsured at the ER. However, due to lack of regular care, by the time you show up at the ER it might be too late.
  - beat 13y ago
    I have high blood pressure. Thanks to insurance, I was able to spend a few months with my doctor, experimenting with medications until we found the combination that brought it down to manageable levels. Meds cost me $15 a month or so. Blood pressure medication will almost certainly add many years to my life - decades, maybe. Without insurance, I couldn't have afforded the half-dozen trips to the doctor or the meds. And I'd wind up getting lifesaving treatment for an early heart attack or stroke in the ER. I'll take the insurance, thanks.
    - liber8 13y ago
      Honest, non-snarky question for you: How is it that you could not afford a half-dozen trips to your doctor, but you could afford your medical insurance premiums? Are your premiums subsidized or free? Is the doctor terribly expensive? (I'm assuming that your doctor charges $250 or less per visit. Six visits would cost $1,500. I'm assuming those visits were spread over at least a number of months, so you could see whether each medication was effective. I'll also assume your health insurance is at least $400/month, though that number is likely higher if you're over 30 or female. This means your six visits cost roughly four months worth of insurance premiums.)
      - beat 13y ago
        Honest, non-snarky answer... to be pedantic, for me it's not a question of affordability. I'm a software professional with a very good income, and I could do it on my own. I have a friend a few months younger than me. She makes less than $15k/year, and has two children living at home. Under those financial circumstances, she has totally paid off her home, which should tell you how frugal and responsible she is. She has also experienced extensive hospitalization due to illness. If she had to pay for that (it was paid for by state-subsidized health care), she'd have lost her house. edit: Medical costs are the leading cause of bankruptcy in the US.
- untog 13y ago
  People have to be inside hospitals for hospitals to help them. If you don't have insurance you're less likely to go in the first place.
  - ryanhuff 13y ago
    I question the validity of your statement. In the US, for many uninsured, the hospital ER is their primary care outlet.
    - untog 13y ago
      But by the time they go to the ER it's too late. People with insurance go for regular checkups that will catch things early. Those without will only go to the ER when their situation is desperate.
      - ryanhuff 13y ago
        Perhaps you misunderstood my comment. Many uninsured in the US go to the hospital ER for minor care, such as for colds and other temporarily ailments. I suspect that these sort of cases far outnumber the visits involving serious care cases.
      - Shivetya 13y ago
        you would be surprised how many with insurance don't go or don't listen to their doctor. it has nothing to do with insurance and more to do with fear or just laziness
- Crito 13y ago
  Hospitals do "let" uninsured people die because they are not obligated to provide the full extent of their care capabilities to people who cannot afford it. Come in with a hole in your abdomen, and for sure they'll patch you up even if you don't have insurance. Come in riddled with cancer? Don't expect the same as they would give somebody who could pay themselves or had insurance. This said, it is still a shoddy use of statistics. "1 in 1000 uninsured people die each year" by itself tells us pretty much nothing. What is the rate of death for insured people? Wikipedia tells me that 8.39 in 1000 people die in America every year, so if uninsured people are only dying at a rate of 1 in 1000 every year, it seems to me that either it is beneficial to be uninsured, or uninsured people are not representative of the population (perhaps because many of them are young and healthy?). I suspect that what is going on is this person actually meant to say something along the lines of "1 in 1000 people die every year in ways that could have been prevented if they had insurance" A subtle but important difference. The actual mortality rate of uninsured people is most likely much higher than 1 in 1000, but the deaths of uninsured people in motorcycle accidents would not be counted in that "1 in 1000" figure. Either way, it is shoddy.
  - brandonb 13y ago
    Yes, I meant to say 1 in 1000 uninsured people die each year in ways that could be prevented by insurance coverage. Here's an article that references a few of the reports: http://www.reuters.com/article/2012/06/20/us-usa-healthcare-deaths-idUSBRE85J15720120620 http://www.reuters.com/article/2012/06/20/us-usa-healthcare-...
  - twistedpair 13y ago
    > Come in riddled with cancer? Don't expect the same as they would give somebody who could pay themselves or had insurance. Ah, yes, the classic American healthcare problem. The poor person just gets to go to hospice and keel over. The rich person gets to limp along, endure 3 rounds of chemo, and spend the few remaining months of her life hooked up to machines in what is arguably a Pyrrhic victory and even lower quality of life.
    - Crito 13y ago
- vwinsyee 13y ago
  > Hospitals don't let uninsured people die and insuring people doesn't magically save their lives. Not sure where you're getting this. A quick Google Scholar or PubMed search shows a consensus that mortality rate is significantly higher for uninsured than for insured. [1, 2, 3] [1] e.g. http://jpubhealth.oxfordjournals.org/content/32/2/236.short http://jpubhealth.oxfordjournals.org/content/32/2/236.short -- On multivariate analysis, uninsured compared with insured patients had an increased mortality risk (odds ratio: 1.60, 95% CI: 1.45–1.76). The excess mortality in uninsured children in the US was 37.8%, or 16 787, of the 38 649 deaths over the 18 period of the study. Children who were hospitalized without insurance have significantly increased all-cause in-hospital mortality as compared with children who present with insurance. [2] e.g. http://journals.lww.com/jtrauma/Abstract/2012/11000/Undiagnosed_medical_comorbidities_in_the.9.aspx http://journals.lww.com/jtrauma/Abstract/2012/11000/Undiagno... -- Undiagnosed preexisting comorbidities play a crucial role in determining outcomes following trauma. Diagnosis of medical comorbidities may be a marker of access to health care and may be associated with treatment, which may explain the gap in mortality rates between insured and uninsured trauma patients. [3] e.g. https://www.sciencedirect.com/science/article/pii/S0002961010000115?np=y https://www.sciencedirect.com/science/article/pii/S000296101... -- A total of 1,203,243 patients were analyzed, with a mortality rate of 3.7%. The death rate was significantly higher in penetrating trauma patients versus blunt trauma patients (7.9% vs 3.0%; P < .001), and higher in the uninsured (5.3% vs 3.2%; P < .001). On multivariate analysis, uninsured patients had an increased odds of death than insured patients, in both penetrating and blunt trauma patients.
  - trhway 13y ago
    >mortality rate is significantly higher for uninsured than for insured. correlation doesn't mean causation. >to help make our government work better i somehow doubt that throwing a team of "rockstars" to clean up the mess is making the government to work better. If anything, it enables the typical government behavior we saw in the case of healthcare.gov.
    - aero142 13y ago
      Many people believe that the Oregon Health Study is the best chance we have of teasing causation out of the data. It is still in progress but it is being watched closely. http://oregonhealthstudy.org/ http://oregonhealthstudy.org/
- kyro 13y ago
  You're talking about EMTALA, which is an act that prohibits turning away uninsured patients away who are in need of emergent care. Once the patient is stabilized and either discharged or admitted, they are subject to payments. The patient with metastatic cancer who needs chemoradiation on an outpatient basis must pay for his/her care.
  - dragonwriter 13y ago
    > You're talking about EMTALA, which is an act that prohibits turning away uninsured patients away who are in need of emergent care. Once the patient is stabilized and either discharged or admitted, they are subject to payments. More importantly, as it only requires emergency stabilization and not further care to be provided without regard to ability to pay, once they are stabilized they can be discharged instead of being admitted.
- runamok 13y ago
  They don't let them die right there because of the Emergency Medical Treatment and Active Labor Act (EMTALA). But they patch them up and send them home as soon as they're stable. That absolutely leads to significantly worse outcomes which others have referenced. http://en.wikipedia.org/wiki/EMTALA http://en.wikipedia.org/wiki/EMTALA
- dragonwriter 13y ago
  > Hospitals don't let uninsured people die They don't do as much to stop them from dying. (Other than public hospitals -- of which there are a limited number with limited capacity -- they are only obligated to stabilize them in the ER and then, if they have further medically-necessary care but are stable, they can discharge them and/or transfer them to a public hospital if one is available, whereas those that have resources, insurance or otherwise, to pay would be admitted.) > insuring people doesn't magically save their lives. Strictly true -- it doesn't do so magically. It does so, instead, but the relatively mundane mechanism of providing them the ability to pay for care other than emergency stabilization, which reduces the probability of them having such care denied or delayed.
- PhasmaFelis 13y ago
  > Hospitals don't let uninsured people die Irrelevant, even if true. Uninsured people often don't go to the hospital until it's too late, because they know the expense will ruin them and they're hoping it will get better on its own.
joehillen 13y ago
Why isn't it open source like it was before?
- brandonb 13y ago
  The portion that was open-sourced was actually only the static portion of the site (the 'Learn' side). That was taken down before I got here, so I'm not sure on the complete backstory, but I think it confused a lot of people since they assumed it was the source for the whole site.
jquery 13y ago
What if you'd like to help out but aren't an anointed™ one?
- toomuchtodo 13y ago
  +1 Haven't worked at Google, Facebook, whatever, but would love to help.
- brandonb 13y ago
  You certainly don't have to be anointed™ or have worked at any particular companies. I'd say the two most urgent roles we're looking for now are: * Site reliability engineers * Software engineers, including backend and frontend If you do something else, like design, product management, or data science, feel free to send me an email anyway — I'm certainly happy to check around and see what's needed!
- trhway 13y ago
  just like with any other government contract - being anointed is the deciding factor.
- djKianoosh 13y ago
  what do y'all mean by anointed? I've been a gov contractor for many years. It doesn't take all that much to get into this space. Basically, if you're a citizen and don't lie on applications and resumes and in interviews then there's really not any significant barrier to entry.
  - mbrameld 13y ago
    I think by anointed the parent means a Google or Facebook alum, or other big name from the Valley.
  - rhizome 13y ago
    He asked for "amazing."
deleted 13y ago
[deleted]
aamar 13y ago
> "1 in 1000 uninsured people die each year. It's not an exaggeration to say that due to the work we're doing here, 5,000-10,000 people will live to see the end of 2014." This probably a significant exaggeration. It is based on a 2009 study[1] which examined correlation, not causation. It did not control for many factors that may be relevant (e.g. smoking). The study expressed this in much more careful words: "Lack of health insurance is associated with as many as 44,789 deaths..." (This number was then divided into 45M uninsured in 2009 to get 1 in 1000). Politifact did not rate this claim due to lack of information[2], but they previously rated "Half-true" a number half as big[3]. The latter essay cites work that did control for relevant indicators and found: "the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance." I'm not sure where to place blame: - On the authors of the correlation study, who should never have studied this question without looking at extensive control variables or without more specifically studying causation? - On Alan Grayson and similar folks, who are smart enough to understand the difference but are happy to assert causation? - On Abbott, who implies causation, pointedly rejecting caveats ("it's not an exaggeration") in order to motivate developers? I don't want to blame brandonb, particularly. I very much support his recruiting effort. In fact, I would say that the government probably has a disproportionate number of people who can resist unwarranted self-justifications. But I don't think a statistic like this should be left unchallenged on HN. --- [1] http://www.pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf http://www.pnhp.org/excessdeaths/health-insurance-and-mortal... [2] http://www.politifact.com/truth-o-meter/article/2013/sep/06/alan-grayson-claims-45000-people-die-year-because-/ http://www.politifact.com/truth-o-meter/article/2013/sep/06/... [3] http://www.politifact.com/truth-o-meter/statements/2009/aug/20/bill-pascrell/pascrell-says-22000-americans-die-yearly-because-t/ http://www.politifact.com/truth-o-meter/statements/2009/aug/...
- slurry 13y ago
  Why would you blame the study authors for doing a correlation study? I know "CORRELATION IS NOT CAUSATION!!!" is the go-to takedown on the internet, but correlation studies actually can have significant value - otherwise peer-reviewed journals wouldn't publish them. I'm also skeptical of Politifact's competence to adjudicate public health scholarship.
djKianoosh 13y ago
I'm curious how you're breaking down the work and if you only take full time devs or are bringing in hourly contractors for different pieces. Do you think you'd have better luck finding good devs if you broke it down like that?
- brandonb 13y ago
  So far, it's been on a rotation -- folks go on leave from their jobs for 1-3 months, move out to DC/Baltimore area, and work as hard as possible while they're here. :) It's such a high-intensity project that I think the we'll want to keep it to full-time for the time being. Otherwise, it's hard to even keep up, let alone make progress. (As a technical point, though, even though everybody is working on this for well over 40 hrs/week, we're technically hourly subcontractors. That's just how the government works.)
  - coldcode 13y ago
    What technology knowledge are required?
    - brandonb 13y ago
      No particular knowledge is required, but all of our new code uses technologies like Backbone, Node, Capistrano, and MySQL. We also make API calls into the existing system, which is written in Java, so it helps to be able to grasp a complex Java codebase with way too many layers and enterprise systems. :) But mostly, we're just looking for great software engineers who want to make a difference, not any particular set of acronyms.
      - blendo 13y ago
        Is it the existing system the "bad" kind of Java (J2EE 1.4/EJB 1/xml hell/Abstract Factory madness) or the nicer and more modern RESTy/Dependency Injected/JEE6 (or Spring) variant? And I recall that one of the trickier requirements is correctly sending and acking enrollment info (EDI?) to and from the many (dozens?) of insurance companies involved. Is that piece looking ok?
keithwarren 13y ago
Aside from the rhetoric, the political opinions and people firing at you now over the 5-10K thing, I do have an actual question of substance. My assumption when things melted down so drastically, was that the key problem was integration with the various vendors. Yes we all could look at the Html itself and make assumptions about poor practices but given that you are on the inside - what was the biggest issue?
- brandonb 13y ago
  The biggest general problem is that people thought of shipping the site the same way they thought of shipping an aircraft carrier -- you write the code, hand it over, and you're done. It wasn't treated as a running service. So, for example, when the site went down, there wasn't a group of people responsible for bringing it back up. That's what Mikey and the other Site Reliability Engineers fixed. They set up a war room with an engineer from each and every subcontractor, and the war room had three rules: 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." Rule 3: "We need to stay focused on the most urgent issues, like things that will hurt us in the next 24-48 hours." Once you have that process working, it's the same as optimizing software: you find the current bottleneck, fix it, find the next, etc. The Time article mentions two -- the lack of DB caching and the bad ID generator. There were dozens of things like that. And still are!
  - keithwarren 13y ago
    What is the biggest issue right now architecturally?
    - brandonb 13y ago
      Complexity. We have 10x more code, 10x more components, and 10x more layers than we need. If the initial architecture had been dirt-simple, I don't think the site would have had so much trouble scaling or staying up. But, of course, removing complexity without breaking things takes longer than adding it in the first place. The other big problem is operations — many steps are done manually which should be done with tools like chef or puppet. When you have a lot of manual steps in your deploy process, it makes the whole system harder to scale, test, modify, and keep running. "Devops" has become a buzzword but it's definitely needed here.
spikels 13y ago
Besides the obvious issue that correlation does not imply causation what does the statement "1 in 1,000 uninsured people die each year" even mean given that the overall annual mortality rate in the US is 799.5 per 100,000[1]. Is this in addition to the background rate? If true that would be quite astounding. Or is it just rounding? [1] http://www.cdc.gov/nchs/fastats/deaths.htm http://www.cdc.gov/nchs/fastats/deaths.htm
samstave 13y ago
The least of my worries is government enforced purchasing of over-priced, broken healthcare. How about sending to prison those that paid nearly 1BILLION for this site as well as the bankers and defense industry gluttons who stole trillions from us in the last ten years? If I want to make my government modern - I'd put in place a system of accountability.
efa 13y ago
> people who wanted health insurance could finally get it Maybe I don't understand Obamacare well enough but I don't understand this statement (which I hear all the time on the commercials). Who couldn't get insurance before this website? I know the health care law did add guarantees around pre-existing conditions. So other than that, who couldn't call an insurance company directly (or use esurance or other portal) and sign up for insurance? This website is just a marketplace hooking you up with normal private insurance companies correct?
- mikeyouse 13y ago
  Who couldn't get insurance before this website? Poor people. You can only get the Federal subsidies through the insurance exchanges which was supposed to primarily be online, but had small phone support staff too. The phone support staff was completely overwhelmed due to the website problems, which left thousands with no method to get insurance.
  - efa 13y ago
    Couldn't they have had Medicaid before this?
- mlangdon 13y ago
  You're not allowed to "other than that" preexisting conditions. I'm one and the ACA means I got to quit my shitty telesales job and take a no-insurance-provided-at-a-small-company first software development job. There are millions like me who can take risks for the first time, whether that's working for a small company or starting one. And I don't have to worry about the next 40K hospital bill burying me.
  - efa 13y ago
    I understand (in fact I have a daughter with preexisting conditions). But I'm referring more to the web site. There is not magic about the website. The law itself brought in some changes that will help some. You don't even have to use the website to take advantage of new law.
kalvin 13y ago
(I'm working with Brandon) To clarify, you don't need to be able to commit long term-- if you can take leave from what you're otherwise doing for a few months, that's enough. If you want to work on something with real impact and help change the culture of government technology, email Brandon above! We're actively looking for a few good people.
- joshAg 13y ago
  man, i wish i had come across this offer a few months ago.
- vinhboy 13y ago
  So, out of genuine curiosity, why are you doing it? To help the country? It's exciting? For the money? Or some other reason completely? What about your co-workers. What's everyone motivation to help fix this site?
  - lorenyu 13y ago
    I believe that healthcare is one of the most important issues the country faces, on the same level as education, or climate change. And this was an opportunity for me to help out with that. This is also one of rare times where we have a non-zero chance of pushing the government towards solving technological problems in better ways than hundred million dollar contracts with broken specifications for projects that are doomed for failure. Kalvin is a friend of mine, and when he called me up I saw it also as a chance to work with a good friend and a great group of people, so it is exciting as well. It has been a great experience working with Brandon and everyone else on the team.
    - keyhole_downs 13y ago
      Where do you draw the line on enabling a broken system that awards contracts to ill prepared monolithic RFP generating machines, and start saying, "We need real reform for technology in government and not just half-hearted bloviating about transparency"?
rmrfrmrf 13y ago
"And, as the motley team of software engineers looked on in admiration, a single tear drop departed from Mikey's eye. As the drop hit the marble floor, it suddenly exploded into a majestic bald eagle, who screetched dutifully and flew out of the White House."
rdl 13y ago
Thanks for doing this. I still think completely replacing it from October to ~December, and extending the deadlines, might have been a reasonable choice, and re-architecting to move all PII related stuff away from the "shopping" stage and only into the final request stage, but I guess it's better now. The "replace everything, end all the contracts, etc." option might not have been politically viable, and showing people the pre-subsidy prices with subsidy adjustments later in the process probably would have been a bad political move, too. (I'm not in a federal marketplace state, though, and I ended up having my insurance canceled under ObamaCare and got a 364 day short term $750k policy instead. Still no idea what I'm doing in 2015.)
vassvdm 13y ago
Thanks for the insights. Apparently Accenture has been contracted to help out (or take over) the HealthCare.gov website: http://online.wsj.com/news/articles/SB10001424052702303819704579316944287311118 http://online.wsj.com/news/articles/SB1000142405270230381970... I'm wondering - how is this perceived within the current team? Are you relieved that you will be getting reinforcements, worried that another big contractor could contribute to the complexity, or even disturbed that they could get the credit for fixing the site after all the hard work you put in? I used to work at Accenture, so I'm curious as to how this will turn out.
brandonb 13y ago
Update -- wow, a lot of you out there want to help with healthcare.gov, or the government more generally! That's awesome. I'm trying to reply to each person, but it may take a couple of days. :) If, for whatever reason, you haven't heard back from me by Monday, please email again! (The discussion on the 1 in 1000 fact has also been interesting, and I've personally learned a few new facts about the original study and what is controlled for. I'd rather have rigorous analysis of impact for everything, including and especially "good causes," than to give us a free pass.)
- JustARandomGuy 13y ago
  Hi Brandon, I emailed you on Thursday, haven't received a reply back. Is the Monday expect-a-reply-back time frame still good, or are you just buried under all of the replies? :-) I don't want to spam you with inquiries if you're busy, just wanted to check in on this. Thanks.
gadders 13y ago
>"1 in 1000 uninsured people die each year. It's not an exaggeration to say that due to the work we're doing here, 5,000-10,000 people will live to see the end of 2014. You should be proud of what you've done, but we should also all be grateful to have this opportunity." Using that logic, how many have died due to the botched rollout of the website?
ctdonath 13y ago
Does the extrapolated result include the number of people who are losing their insurance because of this program?
AutoCorrect 13y ago
So you're saying that with the 6 million cancelled policies, the government has killed approximately 6000 people with this new mandate?

wooter 13y ago

"1 in 1000 uninsured people die each year. It's not an exaggeration to say that due to the work we're doing here, 5,000-10,000 people will live to see the end of 2014. You should be proud of what you've done, but we should also all be grateful to have this opportunity." Hospitals don't let uninsured people die and insuring people doesn't magically save their lives.

brandonb 13y ago
An estimated 26,000 people die each year due to lack of insurance coverage. That's part of the reason the Affordable Care Act was passed. For more information, see this Reuters article from 2012: http://www.reuters.com/article/2012/06/20/us-usa-healthcare-deaths-idUSBRE85J15720120620 http://www.reuters.com/article/2012/06/20/us-usa-healthcare-...
- at-fates-hands 13y ago
  Too bad the people who actually need it, are not signing up. Not to mention the people who HAD coverage are now getting cut off of their insurance and forced into the exchanges. A complete failure anyway you look at it. http://www.forbes.com/sites/theapothecary/2014/01/18/coverage-expansion-fail-less-than-one-third-of-obamacare-exchange-enrollees-were-previously-uninsured/ http://www.forbes.com/sites/theapothecary/2014/01/18/coverag... "Instead of expanding coverage to those without it, Obamacare is replacing the pre-existing market for private insurance. Surveys from insurers and other industry players indicate that as few as 11 percent of those on Obamacare’s exchanges were previously uninsured" But wait a minute! Obamacare was supposed to cut my rates my $2,500 A YEAR right? WRONG. Apparently, it still costs too much for the people who really need it: "Of those that didn’t sign up for Obamacare-based coverage, 52 percent stated that “affordability” was their biggest complaint with the exchanges’ plan offerings. Only 30 percent cited “technical challenges in buying the plans.” "Joan Budden, chief marketing officer at Priority Health, told Wilde and Mathews that Michigan’s health insurers had expected 400,000 uninsured Michiganders to enroll in exchange based plans during the initial enrollment year. According to the latest data from the Obama administration, as of December 28, only 75,511 had “selected a marketplace plan.” Of those, only an unknown fraction had paid their first month’s premium, and therefore were actually enrolled in new health coverage." So if this is such a success, why isn't the White House trumpeting the real numbers of people who've signed up then?? http://www.washingtontimes.com/news/2013/oct/4/white-house-sees-obamacare-working-wont-release-fi/ http://www.washingtontimes.com/news/2013/oct/4/white-house-s... "For the fourth day in a row, the Obama administration on Friday declined to release figures on how many Americans have purchased health insurance through the just-opened online markets tied to the new health care law. White House spokesman Jay Carney told reporters that millions of people have visited the federal HealthCare.gov site, which directs people to coverage options, but he did not have “specific data” at this early stage in the enrollment period." There are better ways to do this than handing over 1/3 of our economy over to the Federal Government. You want competition? You can start by letting insurance companies deal across state lines. More competition, increased quality of care, lower costs and better care for everyone.
  - 3am 13y ago
    Did you read the links in your post? The first doesn't strongly support your points, and the second was out of date almost 4 months ago. And that's really saying something, because the first link is an OpEd by Mitt Romney's former health care advisor who is a senior fellow at a conservative think-tank. Some of the downsides of allowing health insurance to be sold across state lines are addressed at http://www.kaiserhealthnews.org/stories/2010/september/30/selling-insurance-across-state-lines.aspx http://www.kaiserhealthnews.org/stories/2010/september/30/se... - and they include an AEI fellow's views for balance. The auto insurance market is a hybrid, though, and doesn't show a large cost savings for states that effectively allow cross-state lines operations via identical regulations. I think it's also fair to ask also why health insurers that operate in all/most states (UnitedHealth, Aetna, Cigna, Athena, etc) are not substantially cheaper that BC/BS peers that don't.
  - JPKab 13y ago
    My mother in law has worked for the past 15 years at jobs which employ her for 39.5 hours a week and don't give her health insurance. She suffers arthritis in her hands and knees. She signed up and received health insurance for the first time in 15 years last week. She is now receiving the medical care she needs. Had she not, she would have had to apply for disability benefits. Now, she gets to keep working. You don't know what you are talking about. My mother-in-law makes shit money, and yet she has a plan that is extremely affordable for her. Your a partisan hack, and your facts are regurgitated from professional partisan hacks. Your absurd "handing a 1/3 of our economy over to the Federal Govt" comment points out your biased sources of knowledge. How is a website which matches consumers with private insurance companies equate to "handing over" to the Federal Government? What planet do you live on? Alabama?
    - AutoCorrect 13y ago
      anecdotal evidence and ad hominem attacks don't help you argue your points.
      - JPKab 13y ago
        Agreed. But partisan hackery is like porn. You know it when you see it.
kevincrane 13y ago
But if you know you can't afford it, maybe you'd avoid going to the hospital when you really should.
jbooth 13y ago
Hospitals don't turn away uninsured at the ER. However, due to lack of regular care, by the time you show up at the ER it might be too late.
- beat 13y ago
  I have high blood pressure. Thanks to insurance, I was able to spend a few months with my doctor, experimenting with medications until we found the combination that brought it down to manageable levels. Meds cost me $15 a month or so. Blood pressure medication will almost certainly add many years to my life - decades, maybe. Without insurance, I couldn't have afforded the half-dozen trips to the doctor or the meds. And I'd wind up getting lifesaving treatment for an early heart attack or stroke in the ER. I'll take the insurance, thanks.
  - liber8 13y ago
    Honest, non-snarky question for you: How is it that you could not afford a half-dozen trips to your doctor, but you could afford your medical insurance premiums? Are your premiums subsidized or free? Is the doctor terribly expensive? (I'm assuming that your doctor charges $250 or less per visit. Six visits would cost $1,500. I'm assuming those visits were spread over at least a number of months, so you could see whether each medication was effective. I'll also assume your health insurance is at least $400/month, though that number is likely higher if you're over 30 or female. This means your six visits cost roughly four months worth of insurance premiums.)
    - beat 13y ago
      Honest, non-snarky answer... to be pedantic, for me it's not a question of affordability. I'm a software professional with a very good income, and I could do it on my own. I have a friend a few months younger than me. She makes less than $15k/year, and has two children living at home. Under those financial circumstances, she has totally paid off her home, which should tell you how frugal and responsible she is. She has also experienced extensive hospitalization due to illness. If she had to pay for that (it was paid for by state-subsidized health care), she'd have lost her house. edit: Medical costs are the leading cause of bankruptcy in the US.
untog 13y ago
People have to be inside hospitals for hospitals to help them. If you don't have insurance you're less likely to go in the first place.
- ryanhuff 13y ago
  I question the validity of your statement. In the US, for many uninsured, the hospital ER is their primary care outlet.
  - untog 13y ago
    But by the time they go to the ER it's too late. People with insurance go for regular checkups that will catch things early. Those without will only go to the ER when their situation is desperate.
    - ryanhuff 13y ago
      Perhaps you misunderstood my comment. Many uninsured in the US go to the hospital ER for minor care, such as for colds and other temporarily ailments. I suspect that these sort of cases far outnumber the visits involving serious care cases.
    - Shivetya 13y ago
      you would be surprised how many with insurance don't go or don't listen to their doctor. it has nothing to do with insurance and more to do with fear or just laziness
Crito 13y ago
Hospitals do "let" uninsured people die because they are not obligated to provide the full extent of their care capabilities to people who cannot afford it. Come in with a hole in your abdomen, and for sure they'll patch you up even if you don't have insurance. Come in riddled with cancer? Don't expect the same as they would give somebody who could pay themselves or had insurance. This said, it is still a shoddy use of statistics. "1 in 1000 uninsured people die each year" by itself tells us pretty much nothing. What is the rate of death for insured people? Wikipedia tells me that 8.39 in 1000 people die in America every year, so if uninsured people are only dying at a rate of 1 in 1000 every year, it seems to me that either it is beneficial to be uninsured, or uninsured people are not representative of the population (perhaps because many of them are young and healthy?). I suspect that what is going on is this person actually meant to say something along the lines of "1 in 1000 people die every year in ways that could have been prevented if they had insurance" A subtle but important difference. The actual mortality rate of uninsured people is most likely much higher than 1 in 1000, but the deaths of uninsured people in motorcycle accidents would not be counted in that "1 in 1000" figure. Either way, it is shoddy.
- brandonb 13y ago
  Yes, I meant to say 1 in 1000 uninsured people die each year in ways that could be prevented by insurance coverage. Here's an article that references a few of the reports: http://www.reuters.com/article/2012/06/20/us-usa-healthcare-deaths-idUSBRE85J15720120620 http://www.reuters.com/article/2012/06/20/us-usa-healthcare-...
- twistedpair 13y ago
  > Come in riddled with cancer? Don't expect the same as they would give somebody who could pay themselves or had insurance. Ah, yes, the classic American healthcare problem. The poor person just gets to go to hospice and keel over. The rich person gets to limp along, endure 3 rounds of chemo, and spend the few remaining months of her life hooked up to machines in what is arguably a Pyrrhic victory and even lower quality of life.
  - Crito 13y ago
vwinsyee 13y ago
> Hospitals don't let uninsured people die and insuring people doesn't magically save their lives. Not sure where you're getting this. A quick Google Scholar or PubMed search shows a consensus that mortality rate is significantly higher for uninsured than for insured. [1, 2, 3] [1] e.g. http://jpubhealth.oxfordjournals.org/content/32/2/236.short http://jpubhealth.oxfordjournals.org/content/32/2/236.short -- On multivariate analysis, uninsured compared with insured patients had an increased mortality risk (odds ratio: 1.60, 95% CI: 1.45–1.76). The excess mortality in uninsured children in the US was 37.8%, or 16 787, of the 38 649 deaths over the 18 period of the study. Children who were hospitalized without insurance have significantly increased all-cause in-hospital mortality as compared with children who present with insurance. [2] e.g. http://journals.lww.com/jtrauma/Abstract/2012/11000/Undiagnosed_medical_comorbidities_in_the.9.aspx http://journals.lww.com/jtrauma/Abstract/2012/11000/Undiagno... -- Undiagnosed preexisting comorbidities play a crucial role in determining outcomes following trauma. Diagnosis of medical comorbidities may be a marker of access to health care and may be associated with treatment, which may explain the gap in mortality rates between insured and uninsured trauma patients. [3] e.g. https://www.sciencedirect.com/science/article/pii/S0002961010000115?np=y https://www.sciencedirect.com/science/article/pii/S000296101... -- A total of 1,203,243 patients were analyzed, with a mortality rate of 3.7%. The death rate was significantly higher in penetrating trauma patients versus blunt trauma patients (7.9% vs 3.0%; P < .001), and higher in the uninsured (5.3% vs 3.2%; P < .001). On multivariate analysis, uninsured patients had an increased odds of death than insured patients, in both penetrating and blunt trauma patients.
- trhway 13y ago
  >mortality rate is significantly higher for uninsured than for insured. correlation doesn't mean causation. >to help make our government work better i somehow doubt that throwing a team of "rockstars" to clean up the mess is making the government to work better. If anything, it enables the typical government behavior we saw in the case of healthcare.gov.
  - aero142 13y ago
    Many people believe that the Oregon Health Study is the best chance we have of teasing causation out of the data. It is still in progress but it is being watched closely. http://oregonhealthstudy.org/ http://oregonhealthstudy.org/
kyro 13y ago
You're talking about EMTALA, which is an act that prohibits turning away uninsured patients away who are in need of emergent care. Once the patient is stabilized and either discharged or admitted, they are subject to payments. The patient with metastatic cancer who needs chemoradiation on an outpatient basis must pay for his/her care.
- dragonwriter 13y ago
  > You're talking about EMTALA, which is an act that prohibits turning away uninsured patients away who are in need of emergent care. Once the patient is stabilized and either discharged or admitted, they are subject to payments. More importantly, as it only requires emergency stabilization and not further care to be provided without regard to ability to pay, once they are stabilized they can be discharged instead of being admitted.
runamok 13y ago
They don't let them die right there because of the Emergency Medical Treatment and Active Labor Act (EMTALA). But they patch them up and send them home as soon as they're stable. That absolutely leads to significantly worse outcomes which others have referenced. http://en.wikipedia.org/wiki/EMTALA http://en.wikipedia.org/wiki/EMTALA
dragonwriter 13y ago
> Hospitals don't let uninsured people die They don't do as much to stop them from dying. (Other than public hospitals -- of which there are a limited number with limited capacity -- they are only obligated to stabilize them in the ER and then, if they have further medically-necessary care but are stable, they can discharge them and/or transfer them to a public hospital if one is available, whereas those that have resources, insurance or otherwise, to pay would be admitted.) > insuring people doesn't magically save their lives. Strictly true -- it doesn't do so magically. It does so, instead, but the relatively mundane mechanism of providing them the ability to pay for care other than emergency stabilization, which reduces the probability of them having such care denied or delayed.
PhasmaFelis 13y ago
> Hospitals don't let uninsured people die Irrelevant, even if true. Uninsured people often don't go to the hospital until it's too late, because they know the expense will ruin them and they're hoping it will get better on its own.

joehillen 13y ago

Why isn't it open source like it was before?

brandonb 13y ago
The portion that was open-sourced was actually only the static portion of the site (the 'Learn' side). That was taken down before I got here, so I'm not sure on the complete backstory, but I think it confused a lot of people since they assumed it was the source for the whole site.

jquery 13y ago

What if you'd like to help out but aren't an anointed™ one?

toomuchtodo 13y ago
+1 Haven't worked at Google, Facebook, whatever, but would love to help.
brandonb 13y ago
You certainly don't have to be anointed™ or have worked at any particular companies. I'd say the two most urgent roles we're looking for now are: * Site reliability engineers * Software engineers, including backend and frontend If you do something else, like design, product management, or data science, feel free to send me an email anyway — I'm certainly happy to check around and see what's needed!
trhway 13y ago
just like with any other government contract - being anointed is the deciding factor.
djKianoosh 13y ago
what do y'all mean by anointed? I've been a gov contractor for many years. It doesn't take all that much to get into this space. Basically, if you're a citizen and don't lie on applications and resumes and in interviews then there's really not any significant barrier to entry.
- mbrameld 13y ago
  I think by anointed the parent means a Google or Facebook alum, or other big name from the Valley.
- rhizome 13y ago
  He asked for "amazing."

deleted 13y ago

[deleted]

aamar 13y ago

> "1 in 1000 uninsured people die each year. It's not an exaggeration to say that due to the work we're doing here, 5,000-10,000 people will live to see the end of 2014." This probably a significant exaggeration. It is based on a 2009 study[1] which examined correlation, not causation. It did not control for many factors that may be relevant (e.g. smoking). The study expressed this in much more careful words: "Lack of health insurance is associated with as many as 44,789 deaths..." (This number was then divided into 45M uninsured in 2009 to get 1 in 1000). Politifact did not rate this claim due to lack of information[2], but they previously rated "Half-true" a number half as big[3]. The latter essay cites work that did control for relevant indicators and found: "the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance." I'm not sure where to place blame: - On the authors of the correlation study, who should never have studied this question without looking at extensive control variables or without more specifically studying causation? - On Alan Grayson and similar folks, who are smart enough to understand the difference but are happy to assert causation? - On Abbott, who implies causation, pointedly rejecting caveats ("it's not an exaggeration") in order to motivate developers? I don't want to blame brandonb, particularly. I very much support his recruiting effort. In fact, I would say that the government probably has a disproportionate number of people who can resist unwarranted self-justifications. But I don't think a statistic like this should be left unchallenged on HN. --- [1] http://www.pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf http://www.pnhp.org/excessdeaths/health-insurance-and-mortal... [2] http://www.politifact.com/truth-o-meter/article/2013/sep/06/alan-grayson-claims-45000-people-die-year-because-/ http://www.politifact.com/truth-o-meter/article/2013/sep/06/... [3] http://www.politifact.com/truth-o-meter/statements/2009/aug/20/bill-pascrell/pascrell-says-22000-americans-die-yearly-because-t/ http://www.politifact.com/truth-o-meter/statements/2009/aug/...

slurry 13y ago
Why would you blame the study authors for doing a correlation study? I know "CORRELATION IS NOT CAUSATION!!!" is the go-to takedown on the internet, but correlation studies actually can have significant value - otherwise peer-reviewed journals wouldn't publish them. I'm also skeptical of Politifact's competence to adjudicate public health scholarship.

djKianoosh 13y ago

I'm curious how you're breaking down the work and if you only take full time devs or are bringing in hourly contractors for different pieces. Do you think you'd have better luck finding good devs if you broke it down like that?

brandonb 13y ago
So far, it's been on a rotation -- folks go on leave from their jobs for 1-3 months, move out to DC/Baltimore area, and work as hard as possible while they're here. :) It's such a high-intensity project that I think the we'll want to keep it to full-time for the time being. Otherwise, it's hard to even keep up, let alone make progress. (As a technical point, though, even though everybody is working on this for well over 40 hrs/week, we're technically hourly subcontractors. That's just how the government works.)
- coldcode 13y ago
  What technology knowledge are required?
  - brandonb 13y ago
    No particular knowledge is required, but all of our new code uses technologies like Backbone, Node, Capistrano, and MySQL. We also make API calls into the existing system, which is written in Java, so it helps to be able to grasp a complex Java codebase with way too many layers and enterprise systems. :) But mostly, we're just looking for great software engineers who want to make a difference, not any particular set of acronyms.
    - blendo 13y ago
      Is it the existing system the "bad" kind of Java (J2EE 1.4/EJB 1/xml hell/Abstract Factory madness) or the nicer and more modern RESTy/Dependency Injected/JEE6 (or Spring) variant? And I recall that one of the trickier requirements is correctly sending and acking enrollment info (EDI?) to and from the many (dozens?) of insurance companies involved. Is that piece looking ok?

keithwarren 13y ago

Aside from the rhetoric, the political opinions and people firing at you now over the 5-10K thing, I do have an actual question of substance. My assumption when things melted down so drastically, was that the key problem was integration with the various vendors. Yes we all could look at the Html itself and make assumptions about poor practices but given that you are on the inside - what was the biggest issue?

brandonb 13y ago
The biggest general problem is that people thought of shipping the site the same way they thought of shipping an aircraft carrier -- you write the code, hand it over, and you're done. It wasn't treated as a running service. So, for example, when the site went down, there wasn't a group of people responsible for bringing it back up. That's what Mikey and the other Site Reliability Engineers fixed. They set up a war room with an engineer from each and every subcontractor, and the war room had three rules: 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." Rule 3: "We need to stay focused on the most urgent issues, like things that will hurt us in the next 24-48 hours." Once you have that process working, it's the same as optimizing software: you find the current bottleneck, fix it, find the next, etc. The Time article mentions two -- the lack of DB caching and the bad ID generator. There were dozens of things like that. And still are!
- keithwarren 13y ago
  What is the biggest issue right now architecturally?
  - brandonb 13y ago
    Complexity. We have 10x more code, 10x more components, and 10x more layers than we need. If the initial architecture had been dirt-simple, I don't think the site would have had so much trouble scaling or staying up. But, of course, removing complexity without breaking things takes longer than adding it in the first place. The other big problem is operations — many steps are done manually which should be done with tools like chef or puppet. When you have a lot of manual steps in your deploy process, it makes the whole system harder to scale, test, modify, and keep running. "Devops" has become a buzzword but it's definitely needed here.

spikels 13y ago

Besides the obvious issue that correlation does not imply causation what does the statement "1 in 1,000 uninsured people die each year" even mean given that the overall annual mortality rate in the US is 799.5 per 100,000[1]. Is this in addition to the background rate? If true that would be quite astounding. Or is it just rounding? [1] http://www.cdc.gov/nchs/fastats/deaths.htm http://www.cdc.gov/nchs/fastats/deaths.htm

samstave 13y ago

The least of my worries is government enforced purchasing of over-priced, broken healthcare. How about sending to prison those that paid nearly 1BILLION for this site as well as the bankers and defense industry gluttons who stole trillions from us in the last ten years? If I want to make my government modern - I'd put in place a system of accountability.

efa 13y ago

> people who wanted health insurance could finally get it Maybe I don't understand Obamacare well enough but I don't understand this statement (which I hear all the time on the commercials). Who couldn't get insurance before this website? I know the health care law did add guarantees around pre-existing conditions. So other than that, who couldn't call an insurance company directly (or use esurance or other portal) and sign up for insurance? This website is just a marketplace hooking you up with normal private insurance companies correct?

mikeyouse 13y ago
Who couldn't get insurance before this website? Poor people. You can only get the Federal subsidies through the insurance exchanges which was supposed to primarily be online, but had small phone support staff too. The phone support staff was completely overwhelmed due to the website problems, which left thousands with no method to get insurance.
- efa 13y ago
  Couldn't they have had Medicaid before this?
mlangdon 13y ago
You're not allowed to "other than that" preexisting conditions. I'm one and the ACA means I got to quit my shitty telesales job and take a no-insurance-provided-at-a-small-company first software development job. There are millions like me who can take risks for the first time, whether that's working for a small company or starting one. And I don't have to worry about the next 40K hospital bill burying me.
- efa 13y ago
  I understand (in fact I have a daughter with preexisting conditions). But I'm referring more to the web site. There is not magic about the website. The law itself brought in some changes that will help some. You don't even have to use the website to take advantage of new law.

kalvin 13y ago

(I'm working with Brandon) To clarify, you don't need to be able to commit long term-- if you can take leave from what you're otherwise doing for a few months, that's enough. If you want to work on something with real impact and help change the culture of government technology, email Brandon above! We're actively looking for a few good people.

joshAg 13y ago
man, i wish i had come across this offer a few months ago.
vinhboy 13y ago
So, out of genuine curiosity, why are you doing it? To help the country? It's exciting? For the money? Or some other reason completely? What about your co-workers. What's everyone motivation to help fix this site?
- lorenyu 13y ago
  I believe that healthcare is one of the most important issues the country faces, on the same level as education, or climate change. And this was an opportunity for me to help out with that. This is also one of rare times where we have a non-zero chance of pushing the government towards solving technological problems in better ways than hundred million dollar contracts with broken specifications for projects that are doomed for failure. Kalvin is a friend of mine, and when he called me up I saw it also as a chance to work with a good friend and a great group of people, so it is exciting as well. It has been a great experience working with Brandon and everyone else on the team.
  - keyhole_downs 13y ago
    Where do you draw the line on enabling a broken system that awards contracts to ill prepared monolithic RFP generating machines, and start saying, "We need real reform for technology in government and not just half-hearted bloviating about transparency"?

rmrfrmrf 13y ago

"And, as the motley team of software engineers looked on in admiration, a single tear drop departed from Mikey's eye. As the drop hit the marble floor, it suddenly exploded into a majestic bald eagle, who screetched dutifully and flew out of the White House."

rdl 13y ago

Thanks for doing this. I still think completely replacing it from October to ~December, and extending the deadlines, might have been a reasonable choice, and re-architecting to move all PII related stuff away from the "shopping" stage and only into the final request stage, but I guess it's better now. The "replace everything, end all the contracts, etc." option might not have been politically viable, and showing people the pre-subsidy prices with subsidy adjustments later in the process probably would have been a bad political move, too. (I'm not in a federal marketplace state, though, and I ended up having my insurance canceled under ObamaCare and got a 364 day short term $750k policy instead. Still no idea what I'm doing in 2015.)

vassvdm 13y ago

Thanks for the insights. Apparently Accenture has been contracted to help out (or take over) the HealthCare.gov website: http://online.wsj.com/news/articles/SB10001424052702303819704579316944287311118 http://online.wsj.com/news/articles/SB1000142405270230381970... I'm wondering - how is this perceived within the current team? Are you relieved that you will be getting reinforcements, worried that another big contractor could contribute to the complexity, or even disturbed that they could get the credit for fixing the site after all the hard work you put in? I used to work at Accenture, so I'm curious as to how this will turn out.

brandonb 13y ago

Update -- wow, a lot of you out there want to help with healthcare.gov, or the government more generally! That's awesome. I'm trying to reply to each person, but it may take a couple of days. :) If, for whatever reason, you haven't heard back from me by Monday, please email again! (The discussion on the 1 in 1000 fact has also been interesting, and I've personally learned a few new facts about the original study and what is controlled for. I'd rather have rigorous analysis of impact for everything, including and especially "good causes," than to give us a free pass.)

JustARandomGuy 13y ago
Hi Brandon, I emailed you on Thursday, haven't received a reply back. Is the Monday expect-a-reply-back time frame still good, or are you just buried under all of the replies? :-) I don't want to spam you with inquiries if you're busy, just wanted to check in on this. Thanks.

gadders 13y ago

>"1 in 1000 uninsured people die each year. It's not an exaggeration to say that due to the work we're doing here, 5,000-10,000 people will live to see the end of 2014. You should be proud of what you've done, but we should also all be grateful to have this opportunity." Using that logic, how many have died due to the botched rollout of the website?

ctdonath 13y ago

Does the extrapolated result include the number of people who are losing their insurance because of this program?

AutoCorrect 13y ago

So you're saying that with the 6 million cancelled policies, the government has killed approximately 6000 people with this new mandate?