A Billion User Load Test on Healthcare.gov
blog.navapbc.com
blog.navapbc.com
Their escalation process is useless, 30 days to resolve (if I'm that lucky). Will try not to get injured in the meantime.
Glitches and data sync issues are unreal, this is not an isolated incident. Every year it's been something. 2014 I was on Covered California and had to take them to administrative court to resolve data and tax form issues (canceled then due to a move and it completely wiped out my 2014 enrollment). Then in 2015 on HealthCare.gov they had me enrolled in the same plan twice and the insurer wanted double the premiums until they could resolve it.
Having said that there is still a ton of red tape and issues surrounding not just government contracting in general but also around the fact that different states and insurance providers have different systems that all work differently but somehow need to work together under this single application.
So I wouldn't expect much even though the Nava folks, in my short time dealing with them and comparing them to other contractors, seem fairly solid.
(/me doesn't work for nava, does work on healthcare.gov)
Startup founders should be a lot more concerned about this than they seem to be. Health insurance almost screwed me at Matasano in 2005; it would have, had Erin not taken a full time job elsewhere until Matasano had group coverage.
From a macro lens there is definitely a huge disincentive to start a company in this country.
Not "expensive to insure". Uninsurable, at any cost.
https://marketplace.cms.gov/technical-assistance-resources/e...
Personally I preferred the previous way of signing up for coverage ... call up a private insurer and sign up? The cost was less too as I wasn't paying for insurance for lazy sally or Joe Schmoe! So for me Obamacare/social medicine forced those who do and work to pay and cover for those who don't. See ya Obamacare(love obama though).
Also the $300 plan I paid each month for sucked.. they fought me tooth and nail to cover things my doc prescribed.. I.e. Various scans(cat scan, etc).
With everyone left to their own devices, the elderly/unhealthy are strongly incentivized to have insurance, and the young and healthy might reasonably conclude that their best bet is to not pay for insurance, that results in higher average premiums.
For many (most?) cases you can still buy individual market directly with the insurer via phone/website. My understanding is you have to go through exchanges for certain subsidy situations.
> The cost was less too
> Also the $300 plan I paid each month for sucked
First off, the old way was for an employer to handle it for you. If you had your own solo insurance before, I'm impressed. I had a hard time finding health coverage as a freelancer years ago.
But more to your point, the cost was less, and sucked, because insurers could offer barebones, high-deductible plans that didn't really cover much except for catastrophic needs. Hence why you encountered high payments every time you actually needed healthcare.
In addition, premiums cost more now because:
- The highest risk and most expensive people were excluded from coverage entirely, either because they couldn't afford it or insurers refused to cover them, which they are no longer allowed to do. As a result, insurers are paying out more to cover medical treatment.
- Providers and drug companies continue to raise prices, while insurance premiums are regulated and locked annually.
- Government subsidies that were initially promised to insurers to help them cover gaps as they figured out the first few years of the ACA market were eliminated prematurely (cf. Marco Rubio).
As a result, annual increases have jumped dramatically as they adjust to increased care, increasing costs, and drops in subsidies.
So premiums are up because (a) you have better coverage (due to regulated minimum levels of coverage), (b) there are more sick people being covered (either because they couldn't afford coverage before or were excluded), and (c) net costs have risen.
> forced those who do and work to pay and cover for those who don't
I think that's an overly simplistic way of interpreting the situation.
Insurers don't HAVE to sell direct to consumer (off exchange), but they're incentivized to do so because that population is on average healthier than that coming in through the exchange. Plus it's easier to manage customer records directly than rely on the data that comes from the state or federal exchanges.
The downside is that if you have anything interesting on your medical history --- including many things in your past that aren't chronic conditions, but could be predictive of future health care costs in some circumstances --- you will be turned down without recourse. That's the problem with the pre-Obamacare individual health care market: it didn't work.
My $300 Obamacare plan was horrid! Love Obama but see ya Obamacare!
Medicare for all, $120/month/person - problem solved.
This is a simple issue of how healthcare Became more expensive, less accessible (primary care docs hard to find and not readily available to see you.. so we flood the ERs), harder to use(insurance companies throw up the gauntlet and don't want to pay for things prescribed) and a real pain in the butt to sign up for.
All the above happened because of Obamacare and its eye towards helping every man, woman and child access to affordable healthcare. But that mantra goes against capitalism and thus creates a system where care is worse because insurance companies who once covered most things aren't so they have enough money/profit to pay for those men, women and children who are poor and can't pay. That demographic is the winner and all others are the losers in this game. It's a losing game either way and soon for the poor so and again see ya Obamacare ... socialistic ideas working within a capitalistic system is going to fail.
If it was completely socialistic it might work, but heck no the govt already taxes me enough I don't want them taxing me at 60 to 70 percent!
Hopefully it is replaced with a better system! Time will tell.
*typed on crappy iPhone 7 whose auto correctness/AI needs work!!!
https://www.nasa.gov/ http://www.darpa.mil/
And is Healthcare.gov developed by the government or just bough to an external company? It just an observation, I don't know if Healthcare.gov is a good or bad technology.
The first head of the USDS was involved in coordinating the fixing of Healthcare.gov, though.
Budget $1 Billion
1. Large government contractors: keep $400 million, outsource all work to->
2. Other government contractors: keep $200 million, outsource all work to->
3. Third party companies: keep $100 million, outsource all work to-->
4. ....
5 .....
..
10. Bangladesh code farm does all coding for $10 million.
When it comes to health care systems there is no evidence whatsoever that less government means more efficiency, if anything the US is a huge example to the contrary.
Now, you can see crazy waste on both sides EX: Drug Advertising. But, it's hard to look at this objectively.
Really it is only a right-wing profit-driven talking point to say government is inefficient, mostly to protect against their profits that government takes away.
Government is exceedingly efficient.
Literally 10x-20x costlier.
Government just doesn't have to waste money on things like profit or marketing that private companies need to do.
You can look at the military and at obamacare/heathcare.gov for examples.
Also, the military and healthcare is more efficient in government, but you probably already knew that already.
With a single payer system, at least it would be fair to lay all blame on the single payer. It'd still be beuqacratic and political, but at least there'd be direct responsibility.
Removing the regulations, at least the customer would be able to choose a provider themselves and people could sue over pricing disagreements. There would be issues with pre-existing conditions and low income that would still need to be addressed, though.
Either option is better than where we are today, which is, well I'm not sure. There's not really a term to define the mess we've created. It's not socialist, it's not capitalist, it's just a mess of special interests, political concessions, and reactionary legislation. I guess the one thing we can definitely call it is bureaucratic.
One of my past employers was Salesforce.com. Seems pretty simple at first glance (and the early implementations were very simple), but then you learn more. Ignoring all of the platform-related stuff, just doing a multi-tenant database at scale turns out to be plenty hard.
The fact remains, they're a couple orders of magnitude away from extreme load.
The number of requests per seconds doesn't matter, what matters is the complexity of the logic behind the request.
If they used 70 4-core m3.xlarge that means that they can attend 114 transactions/second per 4-core server. And that looks slow without more data about what are the requirements for the login process.
But if you look at the peak of 150 requests per second, then probably it will cost more money to improve the performance than to actually just add servers.
At work we have over 1 billion users. But as it scales horizontally the relevant number is how many memory/disk database instances do you have. The same applies to the application layer for the number of transactions. In fact the development servers are slower than the live ones even that they have just tens of thousands of users. For our amount of users/transactions tuning for performance saves lots of money. So it makes sense to improve the code on that measure.
The numbers that were asked for were 12k/auth per second during peak time for the Italians.
The British wasn't clear but it hinted at 0.1% of user authenticating per second, which is about the same range. (The numbers of users itself was not defined, it depends on who would join the program).
SLA: 1500 ms for the account verification. 150 ms for most operations. (Some more time when requesting optional attributes like name/address/phone)
If this interests you, I've published a few numbers I got from preliminary testing (to determine whether we could answer the RFP or not): https://thehftguy.com/2015/10/23/10-millions-users-accounts-...
If you have many active users, you're testing for the write load of user tokens and sessions.
If you have many accounts, you're testing for the read load of the account database.
Technically speaking, user id and sessions should be two different database systems, because they have different requirements and they're conflicting.
For the first one, the problem is to have lots of write and enough performances. Plus having the storage if you keep tokens forever (typical for auditing).
For the second one, the problem is to be able to store all the accounts, plus read performances (which can always be hacked by adding layers of caching).
Funfact: if each account is only email + password (64 + 64 char), 1 billion accounts consume 128 GB, just for storing the ASCII characters. A lot more in practise with metadata, empty space and other fields.
They say that they only had 1 maria DB on a single EBS P-IOPS volume. That's kinda weird that a 1 billion users database could fit in that -and zero errors, really?-. Maybe they just had a single integer field (1,2,3,4) to define the user and the password :D
IAM: Identity and Access Management
Forgerock: https://www.forgerock.com/
2016 Dec 14? Did I miss something?
What about the bugs that arise from many connections from many machines? Those must exist too.
News Flash: Engineers think technology while, in the real world, the problem has nothing whatsoever to do with it.
It's like tuning your Ferrarri for more power while your reality is you commute on the 405. In other words, irrelevant.
But, hey, congrats, glad to see what I am paying for.
http://kff.org/report-section/uncompensated-care-for-the-uni...
There are other discussions of cost shifting that will make more aggressive claims; I've chosen to link Kaiser Family Foundation because I think they are pretty credible.
But the $21.1 billion out of $84.9 billion is a pretty big chunk of the unmet costs.
The ACA/Obamacare doesn't have a healthcare.gov traffic problem, it has a "it's a piece of shit" problem.
Of course, this is not the purview of engineers working on healthcare.gov. The point there is that we all get excited about building monuments to technology while completely forgetting the problem that had to be solved in the first place.
Someone will invariably say something like "20 million people have insurance now that they didn't have before!" or some other fabricated number. Let me address that now.
First. The President of the United States of America promised ME and my family that we could keep our plan, our doctor and, on top of that, we would save $2,500 a year. No need for a link, it's all over YouTube. He made that promise dozens of times.
I don't care of one or a hundred million people got insurance. The POTUS made a promise to families. If someone in business made such a promise and then reality was exactly opposite, in an unbelievably grotesque way, the smallest lawsuit for breach of contract and fraud would have them curl-up into a fetal position and cry.
Oh, yeah, and the rich part is that they stick the IRS on us. You know, the Gestapo-like, most-feared, we-can-ruin-your-fucking-life agency in the US now has hooks into your healthcare. And this is OK, how?
The POTUS lied to all of us. Period. The fact that there are people with insurance now is irrelevant. My family is playing the equivalent of a home mortgage for health insurance. How could anyone even remotely tolerate this from our elected officials.
Now, to address the "insured".
Most of these people have been shoved into Medicaid. The magic pill that solves it all, right?
I am not going to go into a long explanation. ACH/Obamacare represents the largest theft of personal property in the history of this nation. Why? Here, go learn something:
https://www.medicaid.gov/medicaid/eligibility/estate-recover...
Short version: These "insured" have signed over their personal assets to the government. All care they receive --by law-- requires reimbursement and the government is REQUIRED by law to recover costs.
Wonderful, isn't it? So many people now have insurance! So many people who have no clue the government just sunk their hooks into their estate. What a country!
I don't particularly like Trump but I hope he shreds Obamacare to little pieces, it is nothing less than the largest criminal act ever perpetrated on the American people.
Obamacare forced our insurer to cancel our plan.
First lie: "If you like your plan you can keep it".
The new plan was $1,450 per month and a $9,000 annual deductible.
Second lie: "A family will save $2,500 per year".
Even at that, we lost many of the doctors.
Third lie: "If you like your doctor, you can keep your doctor".
There's more in the details (co-pays, etc.). The above would be enough to throw any business person in jail for fraud. Yet we somehow tolerate and rationalize our elected officials behaving this way.
I don't particularly like Trump but if anyone is wondering why he got elected, well, start by understanding the true depths of Obamacare and go from there.