Later On

A blog written for those whose interests more or less match mine.

Archive for October 15th, 2013

Why Obamacare’s health exchange is having so many problems

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In a word: incompetence and ignorance. The project was clearly overseen by people who had too much confidence in their knowledge—and I’m talking about Kathleen Sebeliius. This was an absolutely top-priority job, and she did not assign the right people. Ezra Klein interviews Robert Laszewski in the Washington Post:

Robert Laszewski is president of Health Policy and Strategy Associates, a policy and marketplace consulting firm that has him working closely with many in the heath industry as they try to navigate the Affordable Care Act, as well as the author of the excellent Health Care Policy and Marketplace Review blog. As such, he has a unique view on how the rollout looks from the industry side. We spoke on Monday. A lightly edited transcript of our conversation follows.

Ezra Klein: You wrote about how the problems on the back-end of the insurance portals, in the way they communicate with the systems of actual insurers, might be as bad or worse than the front-end traffic problems. What are you worried about, exactly?

Bob Laszewski: What I’m worried about is that when people go to their doctor in January they may walk in, and the doctor and hospital won’t find them in the insurer’s computer system or their bank account won’t be appropriately debited or they’ll be signed up for the wrong plan. I’m worried about all these things. Now, we have a few weeks to get this straightened out. But only a few weeks.

EK: Tell me what you’re hearing from the insurance industry that has you concerned.

BL: The insurance industry is literally receiving a handful of new enrollments from the 36 Obama administration-run exchanges. It’s really 20 or 30 or 40 each day through last week. And a good share of those enrollments are problematic. One insurance company told me, “we got an enrollment from John Doe. Then five minutes later we got a message from CMS disenrolling him. Then we got another message re-enrolling him.” On and on, up to 10 times. So insurers aren’t really sure if the enrollments they’ve got are enrollments they should have.

And remember, the insurers have automated all this. They don’t have a clerk sending out a welcome letter and an enrollment card. So if you just let the computer run, it could theoretically issue a welcome letter, a cancellation letter, a welcome letter, a cancellation letter, etc. Now, they’re not doing this right now because it’s all screwed up. They can manage a few dozen per day by hand. But when you’re talking about thousands or tens of thousands or hundreds of thousands, it becomes completely unmanageable.

EK: What do you think went wrong in the design of the federal insurance marketplace. The Obama administration put a lot of focus on this. They knew how important it was. But what they built has, thus far, performed disastrously.

BL: I think they trusted their subcontractors. There’s an astronaut joke that an astronaut is a guy sitting on top of a rocket assembled by the lowest bidders. Obamacare is a bit like the astronaut on top of the rocket. As I understand it, some of these were no-bid contracts, like CGI.

So I think some of the problem is the Obama administration never brought in heavyweight IT people to oversee this. Are there no Democrats in Silicon Valley? Kathleen Sebelius was the governor of Kansas. Mary Tavenner is a nurse and health policy person. Their senior people had no information technology background. And they’re listening to the consultants! There’s an old joke in the insurance industry that you don’t get very far if you bet your career on promises the IT department is making. And these people didn’t just bet their career on it. They bet Obama’s signature project on it!

Something to compare with is they really brought in the A-team from the campaign to promote Obamacare. They have a heck of a team to go out and communicate it when it’s up and running. It’s the best people. But there were no heavyweights brought in to manage the IT.

This project is one of the single biggest IT projects in American history. When Amazon.com and Facebook started they came up as a small company and came up slowly. This had to become prime time on day one. And this business about building it for 50,000 people? You have 50 million people uninsured and 19 million in the individual market and a few hundred million who aren’t eligible for Obamacare but have been hearing about it for years! Did they not think a few of those would go take a look? I think it gets back to oversight. It was a lack of oversight on the part of the Obama administration. They needed to bring in the same kind of heavyweights in IT that the Obama administration brought in to sell this from the campaign.

EK: You said a few minutes ago that they really only have a few weeks to fix this before they run into serious problems for the law. Is anything you’re hearing from the insurance side convincing you that the system is improving that quickly?  . . .

Continue reading.

Written by Leisureguy

15 October 2013 at 10:45 am

The sunk-cost fallacy in action

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Sometimes it strikes me that our Representatives are not well educated. Read this article and weep.

Written by Leisureguy

15 October 2013 at 10:36 am

Posted in Congress, GOP, Government

Fascinating interview with Nobel prize winner

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Neal Irwin interviews Robert Shiller for the Washington Post. The interview is well worth reading. To take one example, Shiller notes:

When everyone else agrees that something is true, I don’t just jump in and assume the same.

I’ve always felt that people like to exaggerate their certainty about theories that their ego is involved with. I think something is suspect there when someone has such overwhelming certainty.

It’s also a philosophy of science. As a child I wanted to be a scientist. Maybe I’m trying to do that as as social scientist. I had a view that emerged as a child really that science is about respect for the facts, about really studying nature and trying to take into account all the facts. No legends or myths or self-serving stories. I wanted to know the real facts. I thought that’s what a scientist does. You devise an experiment if there’s any confusion.

When I was getting started I thought a lot of economics wasn’t in that mode. It was more storytelling. We have this model. We test it, but we’re really not testing it. We just love these models. We’ll lionize and publicize the facts that are consistent with the model, and anything that’s inconsistent with it, we’ll put in some ad hoc fix.

That has often bothered me about the economics profession.

Written by Leisureguy

15 October 2013 at 10:19 am

Posted in Science

Totally misunderstanding of software development

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From this article in the Washington Post:

Aetna CEO Mark Bertolini appeared on CNBC’s “Squawk Box” on Monday to deliver a brutal review of the Affordable Care Act’s launch.

“When you implement a project of this size, the first thing is unit testing, then application testing, and then integrated testing, and then scaleability testing and user testing,” Bertolini said. “That plan is usually a lot longer than some of the application development itself. That’s happening on the fly.”

I hope this guy is not involved in product development. The idea that usability testing is done only after development is complete is …  words fail me. It’s completely wrongheaded and leads to disasters at various levels, up to and including having to redesign the system internals from scratch. I think he must never have worked in software development, and I hope he has the good sense to leave software development to other, more knowledgeable people.

Usability testing as the final step of development. Wow.

Written by Leisureguy

15 October 2013 at 10:13 am

Posted in Business, Software

Military going all out to protect its rape culture

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An interesting column by Dorothy Samuels in the NY Times describes the military leadership’s efforts to maintain the military’s culture of rape:

The latest reason to worry about the military’s handling of sexual assault complaints comes from Jo Ann Rooney, President Obama’s nominee for under-Secretary of the Navy.

Asked what the consequence would be of letting an independent, professionally trained military prosecutor outside the chain of command decide which sexual assault cases to try — the sensible reform pressed by Senator Kirsten Gillibrand, Democrat of New York — this is what Ms. Rooney had to say in written testimony submitted prior to her confirmation hearing last week:

“A judge advocate outside the chain of command will be looking at a case through a different lens than a military commander. I believe the impact would be decisions based on evidence rather than the interest in preserving good order and discipline. I believe this will result in fewer prosecutions and therefore defeat the very problem that I understand it seeks to address.”

Ms. Rooney’s unpersuasive claim that Ms. Gillibrand’s proposal would somehow undermine discipline or end commanders’ accountability has been heard before, from Secretary of Defense Chuck Hagel, among others.  But the implication that there is something wrong with basing prosecution decisions on the available evidence is both new and alarming.

“Under what world would you recommend the decision about whether a serious crime, meaning a conviction that could mean more than a year or more, should not be based on evidence?” Ms. Gillibrand inquired of the nominee.

Ms. Rooney, a lawyer who now serves as the principle deputy undersecretary for personnel and readiness, had no good response.

“What is counter to good order and discipline is victims’ inability to access justice because legal decisions are based on commander bias rather than evidence,” aptly remarked Ann Bhagwati, executive director of Service Women’s Action Network, which supports the Gillibrand bill, following the hearing. “Diminishing the importance of evidence in criminal cases is, frankly, un-American.”

Note the bolded statement: Decisions based on evidence are inimical to military order and discipline. That is a jaw-dropping assertion and strongly suggests that there is something seriously wrong with military order and discipline if it is unable to accommodate the findings of evidence.

Frankly, I’m disgusted. I passionately hope that this woman will not be confirmed. She strikes me as unfit to serve in any capacity in which she will be required to make decisions, given her contempt for evidence.

Written by Leisureguy

15 October 2013 at 10:02 am

Posted in Military

An interesting point: GOP changed rules in the House

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They repealed the Gephardt rule, that I knew. The Gephardt rule (from Wikipedia):

In 1979, noting the potential problems of hitting a default, Dick Gephardt imposed the “Gephardt Rule,” a parliamentary rule that deemed the debt ceiling raised when a budget was passed. This resolved the contradiction in voting for appropriations but not voting to fund them. The rule stood until it was repealed by Congress in 1995.[10]

It’s important to note that raising the debt ceiling is needed to pay for legislation that Congress passed. Passing legislation and then refusing to pay for it makes no sense to me—why pass it?—but obviously it does make sense to the GOP. (For more on the Gephardt rule, Joshua Green has an excellent brief article from 2011 (the last fiscal crisis cliffhanger) in the Atlantic.)

But there’s another rule change that I didn’t know about: the GOP changed the House’s regular procedure with a new rule that allows ONLY the Speaker of the House or his designees to move legislation to the floor: that totally locks out the minority party. And yet the GOP seems quite sensitive to the rights of the minority in the Senate (where they are a minority). Can it be that the GOP simply adopts any rule that gives it an advantage, with no interest in logic, consistency, or ethics? Sure looks that way at first glance.

At any rate,  Juan Cole at Informed Comment points out:

Representative Chris Van Hollen (D-Md) went viral in a YouTube video he released of his parliamentary inquiries on a change in House rules that forbade individual members to initiate a motion to open the Federal government. Only the Speaker of the House can now do so, in a highly undemocratic step.

Here is the Van Hollen inquiry:

UPDATE: And not just the GOP voted for this change: seven Democrats did as well (and have subsequently lied about their vote).

Written by Leisureguy

15 October 2013 at 9:53 am

Posted in Congress, GOP

NSA and your address book and contact lists

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NSA has your contact lists and address books. All of them. Because they can and because they kept secret what they were doing.

Here’s the story in the Washington Post, along with the actual Powerpoint slide presentation. As pointed out, the NSA trove of messages must contain a lot of spam.

Juan Cole has a good post on this at Informed Comment.

Written by Leisureguy

15 October 2013 at 9:43 am

Brush experiment, with BBS result

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SOTD 15 Oct 2013

Quite a nice shave today. In a discussion on Wicked_Edge, someone mentioned that it takes longer for soft brushes to make lather. This was a surprise to me—I get immediate good lather from my softest brushes and hardest soaps, thanks in part to having relatively soft water. I inquired as to the nature of the difficulty he encountered, and in the exchange I learned that he preferred large knots, so his soft brushes were substantially larger than those I generally favor (in the 20-22mm range).

It makes sense that a larger brush would take a longer time to load than a smaller brush, but of course it also makes sense that a heavier object will fall faster than a lighter object (duh! It’s heavier, dude.), and yet when you actually try it, the bowling ball falls at the same speed (and acceleration) as the golf ball. So “making sense” is not a reliable guide to understanding natural phenomenon: you have to actually observe the phenomenon. More trouble, but there it is.

I was going to say that making sense is a necessary but not sufficient condition, but then I realized that, as we see from quantum theory, making sense is not even necessary: the double-slit experiment shows that to be true.

In any event, I decided to check the loading times for two brushes of unequal size: the Wee Scot and Rod Neep’s Dreadnaught, which has a 26mm knot and, Neep says, will hold 1 cubic inch of water.

Results: the Dreadnaught took 25% longer to load than the Wee Scot. The difference in absolute terms is not large (8 seconds for the Wee Scot, 10 seconds for the Dreadnaught), and I don’t think that difference is really behind his experience that loading a soft brush takes him longer than a stiffer brush, so something else must be in play—perhaps the water? the soap? the loading technique? In fact, I believe that loading a boar brush takes me longer than loading a badger brush—partly, I suppose, because boar brushes tend to have larger knots, but also because the action seems different. Tomorrow I’ll try a boar and a badger brush and compare loading times.

At any rate, I got a terrific lather—Martin de Candre does that—and ended up with a BBS result, thanks is large part to the Merkur bakelite slant and the Personna Lab Blue blade it carries. I have found that, although a regular straight-bar razor can produce a BBS result, I get BBS shaves more consistently and more easily when using a slant.

Written by Leisureguy

15 October 2013 at 9:36 am

Posted in Shaving

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