Doing Better: Making Improvements to HealthCare.gov | Hacker News Reader

Doing Better: Making Improvements to HealthCare.gov

hhs.gov

20 points001sky27 comments

"...bringing in some of the best and brightest from both inside and outside government."

Did any of you get a call? I imagine many of the best and brightest are on HN.

They're bring in Top Men. Who? Top. Men.

I can think of several engineers I would consider "best and brightest" for something like this. To my knowledge, not one of them posts on HN. Get over yourself.

They're currently somewhat busy. Don't take a non-response as proof of anything.

I think they are all busy prepping their applications for the YC application deadline tomorrow.

So who are these "best and brightest" they are bringing in? Surely they are HN readers or an HN reader knows them. Would love to hear about an in depth postmortem. Joking aside, if you are Obama & Co. and your entire administration is hinged on the success of this program, how do you not get the "best and brightest" from the outset to make what you can control about this - the technology component - work? Not to say there is that much complicated technology here. We've known how to make sign-up sheets for a long time. Also, surge protection is also somewhat of a solved problem - just use AWS or one of their competitors. Didn't the Democrats crush the Republicans in their pre-electioneering with a much better system built on AWS? Why didn't they get those guys to do this stuff? Oh well.

> This tremendous interest – with over 19 million unique visits to date to HealthCare.gov– confirms that the American people are looking for quality, affordable health coverage, and want to find it online.

Sadly the system can only work if healthy people sign up. This disaster of a website has made it so that only the most desperate of people will eventually sign up, thus ensuring the inevitable collapse of the whole system.

> confirms that the American people are looking for quality, affordable health coverage, and want to find it online.

They are, except they're not finding it.

I'm not sure how much longer they are going to be able to spin this once people start inputing their info, and getting back rate shocks instead of what they expected.

http://www.forbes.com/sites/theapothecary/2013/09/25/double-...

If you are making more than 15-25k/year (after which there is little or no subsidies), you're going to pay about 2-4x the rate you would of paid before Obamacare was enacted.

Male, healthy, young? What cost you $40-$100 before, is now $300/month (and mandated by law). And that's just the lowest level/plan. If you want something good, you're now paying $600-1000/month.

Older, wiser, richer? What cost you $8k/year is now $15k/year.

I checked my rates today, and was very surprised by it all. But I guess it kind of makes sense, the system will only work if the young and the healthy are required to pay. My problem is that pay is not really what anyone would call "affordable". It's going to be intresting how this all plays out.

Edit: to the downvoters... Go ahead, input your info into the system or just use your zipcode + age at ehealthinsurance. I'm not making these numbers up. I don't mind the idea of universal coverage, but I do mind being lied to.

This is FUD. Anecdotally, I managed to browse coverage on the healthcare.gov site a few days ago, and the cheapest plan offered is about what I currently pay for individual health insurance, but a much, much, better plan than what I have. (In fact I got a letter saying my plan was so bad that Obamacare made it illegal, and yet the cost compared to a much better Obamacare plan was about the same.)

Obamacare might not have gotten everything right (single payer is the only good solution IMHO), and I too have doubts as to whether it will be a net plus in the long run, but your post is just FUD and not helping anyone.

Raising rates 100% across the board for healthy males below 40 in all but 3 states is not FUD. It's a documented fact based on statistical analysis (and even liberal-biased channels are beginning to report on it).

You probably live in one of those 3 US states, or you perhaps fall into some sweet spot or other category such as being chronically ill, having pre-existing conditions, having abnormally expensive or bad existing insurance, low income, etc - categories that benefit from Obamacare.

But the young, healthy, and the middle class mostly do not.

http://kff.org/interactive/subsidy-calculator

Let me give you an example -

A person that never needed health insurance before, lives in NC, 30-40 years old, made 35k. You're going to fork out $3,000k/year for whatever that Silver level is.

But if you get the pre-Obamacare plan.... Only $100/month.

Thats a 3X increase.

Here are some more examples -

http://townhall.com/tipsheet/kevinglass/2013/10/17/the-horro...

That may only hold true if you're looking at the cheapest available options. I skimmed over the options available through my state's exchange (Covered California) and ehealthinsurance.com; for a 25-year-old making $40k/year, Covered CA's options range from $252 to $305, and ehealthinsurance's range from $100 to $384. The $305 option looks pretty attractive compared to most of the more expensive ehealthinsurance plans (although that $384 plan is, admittedly, hard to top).

I'm not sure this is good 'analysis'. The entire premise is for a certain subset of the population to subsidize universal coverage. The US Supreme Court backed the legislation under this rationale. It is by design a 'synthetic' tax increase.

The problem for everyone is that this is not saving anyone money on a net basis. The original purpose/goal of universal healthcare was to achieve the extension of coverage with a net synergy to the US Fed. budget (which picks up the tab for the uninsured). And this will be a failure if the risk-pool is not of proper metric.

There is a story in the NYT today that details this.

The system’s sustainability depends on getting enough healthy people to sign up, he pointed out, and if they don’t then insurers “will have to raise everyone’s premiums,” which “could create what actuaries call a ‘death spiral’: Rising premiums prompt people to drop out, causing premiums to increase even more.”

https://news.ycombinator.com/item?id=6581817

> Go ahead, input your info into the system or just use your zipcode + age at ehealthinsurance

I did, it's cheaper. Personal insurance would for me would go from about $680/mo to $214.55 starting in 2014. My current employer plan would go from about $520/mo down to $214.55. (hint, most companies already subsidize your insurance premium, what you pay out of pocket is usually <50%).

My wife's drops from ~$750/mo (employer provided) to $222.92.

But neither of us has to buy it through the exchanges because our employers already provide it. Mine covers 100% and my wife's covers about 70% of her premium.

My mother on the other hand will go down from either completely ineligible (pre-existing conditions) or $2200/mo to <$406.95/mo.

Isn't the point of the OP that they are actively working on fixing the site? I don't see how being active in repairing broken parts of the site is any indication on "inevitable collapse". There is no indication that these will be long term problems.

The post is referencing a different problem. This is the scenario described:

1) since the exchanges can't discriminate on pre-existing conditions, many people with expensive pre-existing conditions in need of treatment will sign up.

2) because a high percentage of the new customers to the new plans need expensive treatments, insurance companies are forced to raise the rates on the new plans to cover costs

3) after seeing the higher insurance rates, healthy people quit the plan since their expected healthcare costs are lower

4) repeat steps 2 and 3 until very few people can both afford to be in the plan and have very pressing healthcare needs.

It's an insurance death spiral [1]. NPR's Planet Money talked about it last month [2].

[1] http://en.wikipedia.org/wiki/Death_spiral_(insurance)

[2] http://www.npr.org/blogs/money/2013/09/30/227468495/one-key-...

Have you ever been involved in large complex applications? They're not pretty and does not simply involve "repairing broken parts".

I'd love to see a more in-depth explanation of what's gone wrong.

Since the target is probably the general public, I wouldn't expect a technical write-up on problems faced and potential solutions (though it would have been nice) - but this write-up is devoid of any actual information whatsoever.

I fear this is what we can expect in the future was well. At least give us the names of the folks you're bringing in to make this thing work! This is the reason those of us in the US were doubtful of this project in the first place - not a single one of my peers expected this site to stay up (we've all got experience with media company advertisement efforts, so we know what it means to go from zero to millions).

As an aside - spewing this "with over 19 million unique visits to date to HealthCare.gov– confirms that the American people are looking for quality, affordable health coverage, and want to find it online" is ridiculous - it confirms only that Americans are now legally obligated to look for health coverage... There's more, but instead of pissing myself off further I'm just going to hit 'reply' and shrug away to my corner of indifference for the day.

same. pretty vague.

I often wonder why something like this is not required to be open source from day 1. I think you still contract an agency to build it, but had the specification and code been open all along then this kind of thing would be less likely.

Of course, that would make sense and since we are talking about government contracting...

The fact that this little blog post stutters and jerks as I scroll down the page (using Chrome) on a fairly new RMBP means they've got a lot of work to do.

I don't understand how these things become so complicated and expensive and still not work right.

I just want to have access to the code again. I can only speak for myself but I'd love to contribute patches.

The code that was public was just a Jekyll static site, which wouldn't have any performance problems to worry about.

I wonder if any of the members of this "surge" have read the Mythical Man Month.

Even if states are incentivized to create their own exchanges, they are not doing it.

Politics > money.

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