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The Plight of the Navigator

October 1st, 2013 - 8:43 pm

The navigators mentioned don’t find their way around the surface of the Earth. They find their way through the bowels of Obamacare. The role of these “navigators” was described by Politico:

More than 100 groups will split $67 million to help people “navigate” the new Obamacare health insurance exchanges — more money than the administration initially said would be available but short of what advocates say will be needed to help people sign up, especially in states where the governors are hostile.

The grants announced Thursday will go to 105 organizations, including community groups, health care providers, business groups and a handful of Planned Parenthood affiliates. The program, which got an extra $13 million from the health law prevention fund, is for those states that refused to set up their own health insurance exchanges, and the federal government is stepping in.

The “navigators” will have to fill in the outreach gaps in Obamacare-resistant states that are doing little to raise awareness of the law. With just 46 days until Obamacare health insurance exchanges open for enrollment, the timeline is also extremely tight for the groups receiving the grant awards to hire navigators and have them undergo mandatory federal training.

This stampede of mediocrity has created a hasty toxic pudding, a jerry-built monstrosity of such complexity that possibly no living human being understands it, and whose general effect is to create a jungle in which tigers, tarantulas, and giant reptiles can lurk at will. For her own part, Kathleen Sebelius dismissed any such charges of incompetence. She believes the technical problems in the program’s rollout are due principally to the overwhelming enthusiasm which has caused droves of insurance seekers to crash the health care exchanges. The glitches were, in her words, “a great problem to have.” They are proof of the overwhelming demand for Obamacare.

Obamacare care has often been referred to as “insurance,” as if it reflected some relationship between premium, payout, and risk. But it should be abundantly clear from this peek under the hood that the “insurance” purchased on its exchanges is a product of the “rule engine,” which is fed literally thousands of tax regulations, subsidies, fines, transfer payments, and fees as fast as the programmers can code them. These somehow spit out a number. That number is what you pay.

What it means, what it may include? Who knows? As the Oregon people put it: “it was constantly emerging requirements.”


There is now some preliminary data on how well the system has been working. The Daily Mail reports:

Less than 1 per cent of Web visitors are signing up for Obamacare on some state health exchange websites

California’s program registered an estimated 0.58 per cent of website visitors in its first day

A Connecticut congressman boasted that his state took 167 applications for Obamacare services on day one, a rate of 0.59 per cent

Obama administration won’t say how many Americans signed up on the central website that covered insurance exchanges for 36 states

Kentucky’s 5.3 per cent application rate seems to be the nation’s highest

Other states wouldn’t provide statistics, or tracked only the creation of new online accounts, not numbers of completed applications

It’s anecdotal data but if there were good news the press would be trumpeting it already.  This has been a disastrous rollout.

While there have been some dark hints that New York’s system jammed up because of suspiciously high traffic — denial of service attacks? — the most probable cause for these “glitches” is straightforward. We are watching a complex system, insufficiently tested, perhaps poorly executed and hastily rolled out, basically fail. This happens because neither Murphy nor the Gremlins ever take a day off.

Murphy belongs to no political party. He and his partner the Grem are willing to gum up anything half-assed on an equal opportunity basis.

There is nothing shameful in watching your rocket crash to the ground just so long as you realize the payload isn’t launched. What is shameful is pretending to receive signals from orbit when Telstar is smoking on the launch pad.

A reasonable manager would delay the rollout until more testing can be done and the problems are understood because the chances are the more the debugger looks the more he finds. Fixing something this big isn’t as easy as the movies make it look.

But then a reasonable manager would have tested the system before turning it loose. Many of you will doubtless know that even the “unexpectedly high traffic excuse” cited by the press is hardly credible. There are services which simulate test traffic and hit test sites with however many zillion hits you desire that you may configure capacity accordingly.

This miserable rollout cannot be plausibly explained by IT incompetence. A disaster of this magnitude can only be the result of politics; by the imposition unrealistic deadlines; by a refusal by managers to understand that if a system isn’t ready then it ain’t ready. That circumstance is sometimes difficult to explain to “political” people; to leaders who live their mental lives sweeping across the panorama of history.

Nobody ever beat arithmetic.

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Deja Vu all over again.

In 1993-1994, I was a hired as a consultant to a deliberately unidentified major blue-state Medicare/Medicaid rewrite. They spent about 9 months of a 1 year schedule designing and redesigning the data model. There were about 80 data modelers, about six or eight programmers, one DBA, and the rest (rounding out the team to about 100) subject matter experts. They designed the office with the programmer-analysts in open desks pushed together in the middle, and the managers and SME's in outer desks around the programmers. The data modelers were out in conference rooms interviewing in teams.

This was supposed to be an "iterative" process, i.e. design... redesign.... redesign until the model was perfect, then had the specifications to the programmers to "generate" the code using a CASE tool from their brilliant, perfect design, and then a week or two at the end for testing. The programmers were rebuffed whenever we pressed for details and inputs to the design. We were told to sit in the middle of the office, and study the vendor's CASE materials - for months. We were allowed to eventually sit in on some of the JAD (joint application design) sessions as long as we agreed to keep silent.

Richard, and any other experienced programmer out there, is probably chuckling. The project was doomed to failure from the start. By the 10th month, they had fired the data modelers, handed the results to the programmers, and asked us to make something out of the mess. We THEN began the iterative process of actually interviewing SME's and end users, presenting prototype software, defining the business rules, data flows, and data transformations necessary to bring the ERD (entity relationship diagram, i.e. a mapping of information of a system and relationships, the result of data modeling) to life.

It was at that point that we started making real progress. This was not my first government project; unfortunately, it was one of many and quite typical. The first thing I learned when writing and implementing business rules for government is that many situations will occur where they are illogical. I mean "illogical" in a classic sense, not as a pejorative statement, in that there would be rules that say "If A+ B, then C", and later, If "A-B, then C", and then, "If A+B+C, then C, and so forth. Because LEGISLATORS and their staffs are not wizards of logic, and because laws are passed in conflict with many preexisting laws, it can be impossible to make sense of when the law actually mandates, in terms of business rules. Programmers cannot program an action, unless the business rules are clear AND Boolean.

In any case, I left the project after the first year, but kept tabs with some on the team that remained. I believe that they implemented key portions of the system after 2 or 3 years, but it was probably 25% of the original target.

So, I knew (as any decent developer would) that implementing Obamacare rules into an IT system would be challenging, if not impossible. I've heard from some folks looking for help, and I believe at least some of the states are using a Service Orientated Architecture (SOA) for the rules engine, connecting via a SOA interface to the Federal rules engine. I just spent 2 years tuning a system for a major medical insurer, which worked out well, but one of the key choke points were insurance rules verification to external (and internal) entities. That system was a massive, four-plus year project and which was relatively successful. However, it's but a tick compared to the Elephant called Obamacare.

One more thing: The Medicare/Medicaid rules were relatively consistent, if not uniform, across the fifty US states. I used to work for a guy named Ross Perot very early in my career, and I learned at that time that he grew Electronic Data Systems (EDS) into the giant it later became by getting the first Medicare/Medicaid contract with the first state, and then "reselling" the same software to the other 49 states, slightly modified as a new instance of the software, reaping 49x the rewards. Certainly EDS put a lot of work into each implementation and incurred huge risks as they were "fix price, fixed date" deliverables. However, it speaks to the uniformity of the rules that this was indeed possible back then. The fact that they cannot do this now, speaks volumes about the ACA implementation across the fifty disorganized states of America. It looks like there's little if any synergy between states.

And of course, the specifications have been changing throughout the development of the Federal rules engines, as well as the individual states participating. The result will be "jello", not stability.

Good luck with that, Mr. President.
1 year ago
1 year ago Link To Comment
Great Minds Think Alike.
On the last thread I posted:
"The Democrats want Obamacare to fail because they want a single payer British NHS system. They want a government shutdown because they want to replay the assault on Gingrich of 1996. The contents of the Bill or the quality of the web engine were always unimportant.

One thing meant to survive are the taxes, which will be eternal. The other important part of the plan is the jobs for the Navigators. Acorn is back big time. This is more money for them by the most expensive and complex route possible."

Anyone registered with the VA is exempt from Obamacare, that is they are already compliant. If America just instituted universal military conscription and registered every citizen and permanent Resident with the VA then who would be left? Perhaps the law would have to be renamed the "Care for the Courts Martialed Act."

Can someone exhume the ridicule the Democrats heaped on Reagan's Strategic Defense Initiative aka Star Wars. They said it was unworkable and to complex while needing millions of lines of code.
1 year ago
1 year ago Link To Comment
Is this a government version of "Grand Theft Auto?"

If they had contracted the whole thing out to Amazon or Turbo Tax, they might have had a chance at success. However, "success" is relative to whatever is the actual goal. This fiasco will work out fine for the government.

Here's how: The Exchange will be essentially a beta version that generates crap quotations and bookings for insurance that will collapse after verification and adjustments. The end product for the would-be client will end up as inappropriate coverage with coverage lapses, and miles from what was quoted. In a year or two of frustrated customers and confusion, all pretense of "insurance" will be lost after a flurry of corrections, stopgap measures, and waivers for "humanitarian" reasons, for "the children," and the "poor and needy." Then it will be welcome to the American version of the National Health Service. Brought to you by the friendly folks who provide you your daily ration of barnyard-fresh fertilizer.
1 year ago
1 year ago Link To Comment
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All Comments   (84)
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The glitches were, in her words, “a great problem to have.” They are proof of the overwhelming demand for Obamacare.
What a boneheaded comment by Sebelius. That's like saying being laid off gives me more time to catch up on my reading. My doctor already quit seeing patients 6 months ago - he saw this nightmare coming and wanted no part of it. He opted for "Healthcare administration" at a local hospital as opposed to be bullied into taking whatever fees this mess imposes.
1 year ago
1 year ago Link To Comment
I doubt Sebelius actually believes that, but this is government. She has to lie.
1 year ago
1 year ago Link To Comment
Our Canadian newspapers keep saying that there are 4.1 million people employed by the U.S. Federal Government and that 80% of them are expected to show up at work during the "shutdown". So 20% of the Federal civil serpents not showing up at work is a "shutdown"?

Let's hope that the 800,000 (20%) aren't getting paid so that the wealth sucked out of the economy by civil serpents is temporarily reduced.

Just 20% less of Nanny and President Princess Numb Nuts is shouting that the sky is falling?
1 year ago
1 year ago Link To Comment
On another thought, some of you might have heard that Tom Clancy has passed away. RIP. I have an interesting anecdote about his "Red Storm Rising" book vis-a-vis my military service at that time, but I'll hold off. Wretchard may be coming forth with a thread on Clancy, since as a similarly successful author, well, I'm just sure he'll have some sort of observations.

An interesting writer, by most accounts a pretty good man, died too young at 66 yrs, but that time will come eventually for all of us.
1 year ago
1 year ago Link To Comment
I hope you do post that anecdote. And I hope that Wretchard does do a threat on him, both for my own selfish reasons. I knew him for 31 years, and yes he was a pretty good man indeed.

Subotai Bahadur
1 year ago
1 year ago Link To Comment
Yes, please post it.
1 year ago
1 year ago Link To Comment
C**p. "threat" should = "thread". Been a long day.

Subotai Bahadur
1 year ago
1 year ago Link To Comment

drbatman and ,
Thank you for your replies. DB I would like to hear a professional opinion of just how loose BHOs screws are and whether any are likely to come off and start rolling around in public.

Possibly being the least qualified person in the room, and seeing that this is the Internet, I want to follow up on one of my points. Let us compare Obamacare to the SDI.

SDI was attacked by the Democrats for being an insolubly complex problem that would need millions of lines of code. Obamacare is touted with religious fervor as the answer that is out there.

SDI called for solving a basic two body problem in physics. A potential threat had to be spotted, analyzed and determined to be a threat, IMHO the hard part since false positives would be unacceptable, and then the location trajectory and speed of the threat had to be calculated fast enough that an intercept, missile pebbles or laser, could occur. The core problem of the intercept though was a simple two body problem in Physics. While the initial threat assessment is difficult and the engineering problems to attain the demanded level of reliability were formidable the basic concept was comprehensible.

The success rate had to nearly 100% for it to work, also a hard part. That was a much higher standard than traditional BMD which was only expected to degrade the reliability of a threat so as to induce uncertainty. SDI or Star Wars was intended to render the threat obsolete.

Obamacare relies on hundreds or thousands of constantly changing variables to deal with a potentially infinite number of conditions. The good news is that perfection is not demanded. If some people save something, even at ruinous cost to society, and others get jobs as bureaucrats, even if the economic costs destroy hundreds of thousands of other jobs, then it will be declared a success. In the long run we are all dead anyway.
1 year ago
1 year ago Link To Comment
My apologies. It ate your name. We have found another flaw in the software.
1 year ago
1 year ago Link To Comment
The main thing the Govt Shutdown will achieve is make very sure that EVERYONE not seriously afflicted with dementia will KNOW FOR CERTAIN that the Republicans DO NOT LIKE Obamacare.

When it crashes, no one will be able to say that "What difference does it make now? Both parties are the same!"

The biggest worry is that Obamcare will not fail. It will just needed to be "tweaked" and be given just a little more time to work, just a little more effort to get the software working, just few more special favors and exemptions for deserving groups - and just a little more money.

After all, for a $ trillion program, another $ billion won't hurt if that is all it takes to fix it. And just another $ billion, and another and another.

And a few extra taxes on medical equipment. By the way, are not cars medical equipment, since you drive in them to the doctor? And don't hospitals use TV sets and computers and printers and staplers and refrigerators and microwave ovens and AR-15 rifles? All are medical equipment that should be taxed!

A mere 4 years before the first Space Shuttle flew, NASA said confidently that each Shuttle launch would cost $14M. The actual cost was 114 times that. Even the government's abject failures die hard, take a long time to do it, and are celebrated and mourned when they go.
1 year ago
1 year ago Link To Comment
buddy, Very interesting comment. It sure fits Buraq's methods.

I guess it comes down to whether enough of us have reached psychological level of the New Soviet Man.

I sure hope not.
1 year ago
1 year ago Link To Comment
Unsk, this is the Beria Doctrine. The stage where the Party reveals that it is indeed causing the people's misery after all, and if the people want relief, there is therefore no one to come to but the Party.
1 year ago
1 year ago Link To Comment

Intriguing comment about your daughter and her pals. Why are they upset over the shutdown? Do most of those under 30 feel that way?
1 year ago
1 year ago Link To Comment
--near as i can tell, in a sample of about 15 or 20 kids she stays in close with, the split is about as it is in the general population, and --not that i judge their politics deliberately, but impressions form autonomically --the big bell curve recapitulates --on the interest in and understanding of politics and policy.

The interested are fully aware of the mess in DC, the less interested are i think trying to compensate for their lack of study, by lapsing into what until recently was a safely 'good citizen' attitude which attaches them to officeholders by the fact of being officeholders, and against insurgents, which continuum has al-shebab on one end and tea party on the other --IOW just as they are being told by the overwhelming preponderance of the usual suspects.

The less interest or understanding they have, the more demonstration they make if or when an issue discussion arises. I'd say three quarters of word counts and nine tenths of sound volume come from the left slope of the cognition curve.

The principle-aware and ethos-developing conservatives don't say much --they don't proselytize. Alas. And tho i flatter myself that i would sniff it out, truth is my presence may be skewing the sample behavior by creating the Eddie Haskell Effect. "Hi, Mr. Larsen, boy is that Obama ever annoying, huh?"

All in all, they're way too passive for the situation. I'm usually torn between giving a blood sweat & tears speech, and just letting them enjoy the Sitzkrieg while they can.
1 year ago
1 year ago Link To Comment
PS, i forgot to mention, the pro-admin kids lard it on the others in the social media --instagram especially --while the anti-admins don't.
1 year ago
1 year ago Link To Comment
Damn I- thingy-

Sentence should read as follows:

the administration ordered the cancellation of the Air Force/Navy football. the navy athletic director was ordered to cancel the game by his superiors to show the right "optics".
1 year ago
1 year ago Link To Comment
Me thinks our Dear Leader's shutdown strategy is starting to go to sh*t.

The optics sure are starting to show just who is the "anarchist/extremist".
these stories are starting to paint a very slimy picture of Buraq Hussein:

- the Dems have shutdown the N.I.H., and in the process shut down potentially life saving trial treatments for children enrolled. guess this shutdown is not for the children after all.

- the Dems have gone to extraordinary efforts to barricade the Veterans WWII monument in DC that was always accessible and wide open to the public.

- the Dems have shut down Williamsburg, and sent home the staff even though the park was financially self supporting..

- the administration ordered the Air Force/Navy college football. the commander in charge was ordered to do it for the "optics".

these slimy antics by Dear Leader are starting to pile up, and I can't help think that the public is going to notice soon.

meanwhile, the pubs may have found a strategist - Senator Mike Lee. He is proposing that the Pubs fund popular essential services in individual bills so the Dems will either be forced to fund or take the heat for shutting down popular services. (Lee was also behind the Cruz filibuster.)

if this strategy starts to take hold, the Tea Partiers will look like the sensible ones and the Dems will be the ones who will look like the anarchists and obstructionists.
1 year ago
1 year ago Link To Comment
They have to shut the parks and monuments down now and get ready, where else are the 800,000 federal employees going to set up their tents after they are evicted for not paying rent? It just shows how great a heart Obambus has, he does it all out of kindness.
1 year ago
1 year ago Link To Comment

Later in his remarks, Perry highlighted some of the positive effects that have manifested because of the reforms passed 10 years ago:

“Since Proposition 12 passed 10 years ago, Texas has added more than 30,000 doctors, with significant gains in communities that had been traditionally medically under-served.

“Over 3,000 new medical licenses have been issued each year for the past seven years, and more than 3,500 over the last two fiscal years.

“We also set a record for applications, with more than 4,600 applications filed in Fiscal Year 2013.

I’m continually surprised some people still want to argue the case that tort reform hasn’t worked; they’re swimming upstream against a flood of hard data.

“Many of the same lawsuit reforms we passed also freed entrepreneurs and employers across our state to worry less about lawsuit abuse and invest fewer resources in defending them.”
1 year ago
1 year ago Link To Comment
That wasn't gratuitous --my youngest telling me last night of her cohort waxing wroth over the Tea Party's shut down of the government, we all need to remember the quick & dirty rebut, that what was wrong with the best healthcare ststem in world history was that it cost too much, and it cost too much because a few easy reforms were impossible to get past the Democrat Party. Tort reform, no go due to nearly 100% Democrat plaintiff's bar, insurance portability no go due to local monopoly-loving Democrat lobby lock, and the HSA model that would overturn every efficiency disincentive (most egregiously the three party transaction) also a Democrat no-go due to danger of the Enlightenment crashing into the Inquisition.

First, they infect you with the sore throat and runny nose, then they cure the infection by chopping off your head.

Don't believe it? Look at the results of a few light modifications to the three uglies, the blooming of pretty flowers on state levels here and there, and always only after bitter struggles with the Democrat party, and there's the proof of the pudding.

So when the Democrats defend ACA the only way they can, that is by screaming that the system before was terrible and Obamacare is simply an attempt to do so, the proper answer is to toll like a liberty bell, 'wrong ...wrrrong ...wrrronnnnng ....
1 year ago
1 year ago Link To Comment
"...was terrible and needed fixing and Obamacare is ...."
1 year ago
1 year ago Link To Comment
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