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Obamacare and Middle-Wheel-Wheelbarrows

timothy posted about 9 months ago | from the well-here's-where-your-problem-is dept.

Bug 199

davecb writes "The Obamacare sign-up site was a classic example of managers saying 'not invented here' and doing everything wrong, as described in Poul-Henning Kamp's Center Wheel for Success, at ACM Queue." It's not just a knock on the health-care finance site, though: "We are quick to dismiss these types of failures as politicians asking for the wrong systems and incompetent and/or greedy companies being happy to oblige. While that may be part of the explanation, it is hardly sufficient. ... [New technologies] allow us to make much bigger projects, but the actual success/failure rate seems to be pretty much the same."

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I sense the problem... (0)

Anonymous Coward | about 9 months ago | (#45757855)

developers developers developers!

Re:I sense the problem... (1)

Anonymous Coward | about 9 months ago | (#45758347)

Did you read the linked article? Take this requirement for instance...
(A) shall be designed to engage patients, caregivers, and authorized representatives in informed decision making with health care providers;

Um, yeah... FYI in requirements-land 'shall' means that is absolutely must deliver, well... something, it gets pretty vague as to what is to be delivered
In Agile, that would not be a user story, it would be a novel that would have to be torn down into multiple user stories

What would help in these cases would be direct interaction between the people building he requirements and the IT people (analysts, developers, architects, etc...) in order to avoid ambiguous and meaningless requirements from becoming absolutes that must be delivered for a system to be accepted

Any computer system that was attempting to deliver to these requirements was doomed from day one

Developers are but the least part of the problem (4, Insightful)

Taco Cowboy (5327) | about 9 months ago | (#45758723)

True, the code for that ill-fated website was really out-of-this-world in term of lousiness, but in the whole scheme of things the developers play but a very minor role in that disaster.

The ones who should shoulder the most blame are the people who awarded the entire project (without proper bidding process) to a totally incompetent company due to political reason ( read: cronyism )

The ones who should shoulder the second largest portion of the blame are those who, despite receiving untold millions in funding, they hired totally incompetent people to be in charge of that project.

Shock! (3, Insightful)

the eric conspiracy (20178) | about 9 months ago | (#45757877)

Actual rational commentary unencumbered by raving political partisanship.

How is this legal?

Re:Shock! (3, Interesting)

immaterial (1520413) | about 9 months ago | (#45758101)

The article doesn't actually seem to say much of anything (insights into stupid European wheelbarrow design notwithstanding). And there's this:

I looked at one of the actual laws that make up Obamacare ... After a few pages I ran into this definition of patient decision aid:

(1) PATIENT DECISION AID—The term patient decision aid' means an educational tool that helps patients, caregivers, or authorized representatives understand and communicate their beliefs and preferences related to their treatment options, and to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences. ...

Unless Congress thinks of teachers as "educational tools," I think we can take it as written here that they expect this to be some kind of computer program. ... These paragraphs legislate that Obamacare will fund research in heavy-duty state-of-the-art artificial intelligence—I somehow doubt that is what Congress intended it to say. I posit that Congress worried about having enough doctors and nurses for this new health care, so they wanted to use computers to cut down the talking and explaining. In other words, they want to save manpower—by replacing the front man on the handbarrow with a wheel.

It looks to me like his interpretation of the law is extremely ridiculous. As I read it, it applies just as well to a simple brochure, ie. "Your Treatment Options for Prostate Cancer..." that is required to be understandable to the patient or caregiver (in their native language and not overly technical) so they can make an educated choice about their own treatment.

The author of the article is the one attaching the unnecessarily complicated wheel to this particular example.

Re:Shock! (3, Informative)

Jane Q. Public (1010737) | about 9 months ago | (#45758163)

"It looks to me like his interpretation of the law is extremely ridiculous."

You're pulling only part of what he wrote, out of context. He also quoted several other sections that referenced (1), and described some of the other things it must do... greatly expanding on that one paragraph.

Having said that, I agree that he doesn't say much of anything that hasn't already been said. His analogy with the Chinese wheelbarrow is certainly interesting (and rather funny, really). But I think all of his points were made before in The Mythical Man-Month and other writings.

Re:Shock! (1)

immaterial (1520413) | about 9 months ago | (#45758341)

You're pulling only part of what he wrote, out of context. He also quoted several other sections that referenced (1), and described some of the other things it must do... greatly expanding on that one paragraph.

I used the summary portion and skipped the details for brevity, but here they are. Feel free to point out the parts that require an advanced artificial intelligence system instead of a properly targeted brochure or pamphlet:

"(2) REQUIREMENTS FOR PATIENT DECISION AIDS—Patient decision aids developed and produced pursuant to a grant or contract under paragraph (1)—
"(A) shall be designed to engage patients, caregivers, and authorized representatives in informed decision making with health care providers;
"(B) shall present up-to-date clinical evidence about the risks and benefits of treatment options in a form and manner that is age-appropriate and can be adapted for patients, caregivers, and authorized representatives from a variety of cultural and educational backgrounds to reflect the varying needs of consumers and diverse levels of health literacy;

"(C) shall, where appropriate, explain why there is a lack of evidence to support one treatment option over another; and
"(D) shall address health care decisions across the age span, including those affecting vulnerable populations including children."

Re:Shock! (0)

Anonymous Coward | about 9 months ago | (#45758357)

I think that his point (and one that I make repeatedly in my work) is that the decision makers, that define what these systems shall deliver, need to be coached by IT professionals in defining their requirements before they get set in a contract (or law) as an absolute deliverable

Re:Shock! (1)

whoever57 (658626) | about 9 months ago | (#45758183)

The article doesn't actually seem to say much of anything (insights into stupid European wheelbarrow design notwithstanding).

I'm not sure that the "insights" into European wheelbarrow design are actually insights. Like most designs, wheelbarrow designs are a mix of compromises and I can think of a number of advantages that the European design has.

Contracting and subcontracting (3, Insightful)

Joe_Dragon (2206452) | about 9 months ago | (#45757883)

To many middle man get in the way of the people doing doing the tech work and it's like that part is being worked on by team X and you need to wait for them to do there part and no you can't talk directly to them.

Re:Contracting and subcontracting (3, Insightful)

pepty (1976012) | about 9 months ago | (#45758201)

Just out of curiosity: How many super-jumbo IT projects, whether the clients are public or private, are up and running within two months of the original deadline? If Oracle had taken the job wouldn't we be expecting the site to be up and running sometime in early 2015?

Re:Contracting and subcontracting (1, Insightful)

Runaway1956 (1322357) | about 9 months ago | (#45758333)

You're simply pointing out the administration's ineptitude. They insisted that the system be put into place, they insisted that it meet a firm time schedule, insisted on putting incompetent "managers" in charge of everything, and further insisted on hiring incompetent "technical" advisors and "engineers".

There was no compromise in any portion of the planning or implementation. On the day of the Grand Opening, it became appallingly obvious that the Emperor had no clothes.

If anyone in a position of authority had the brains one might find stowed up an orangatan's anus, they just might have averted some of the embarrassment that we saw when the site opened to the public.

I'm perfectly happy to poke fun at Oracle, too. But, Oracle would at least have come up with some face saving explanations, and they could probably have cobbled together some backup scheme to make it appear they were doing something useful. Sometimes, appearances are more important than reality. In the case of the Obamacare site, not only did they fail utterly, but they failed to appear to understand how utterly they failed.

Re:Contracting and subcontracting (3, Informative)

peragrin (659227) | about 9 months ago | (#45759171)

Here is the trick. something like 80% of large projects fail on the first try.

From business linux deployments, to website creations, to new weapon systems for the military(M-16 anyone)

The federal government does nothing but large projects so it gets lots of failure, but the every large company in the USA has at least one large boondogle project fail annually. Or at least fail the first couple of times.

BING, FBI database, iphone 4 (you're holding it wrong) all suffered from design failures of the real world.

Forget cronyism, bureaucrats are the real issue with every large project. Real leaders can reign them in and control them. unfortunately real leaders can't get elected very often.

Re:Contracting and subcontracting (1)

Imrik (148191) | about 9 months ago | (#45759141)

And how many of those projects get launched on schedule despite not being ready?

Re:Contracting and subcontracting (0)

Anonymous Coward | about 9 months ago | (#45759197)

Bigger the project bigger the chance it fails as the problems are bigger. If you take agile project frameworks big starts with more t han one team and volume requiring to work longer than 3 months. But any other method of project administration is going to have a problem with this many requirements. Especially that requirements are put in place by many lobby groups acting trough a proxy of their bribed politicians which means that requirements are difficult to change, often unreasonable and conflicting with other requirements. As this was not bad enough any change coming from below due to these conflicting requirements must not only be coordinated with the rest of huge team which is difficult for big projects but also get approved by political body that is controlled by ill tempered assholes that not only are separated from reality by their idiocy but also cannot talk with each other due to politcial bickering. The way to fix this is to cut the Gordian knot with sword. Societies need that sometimes.

Re:Contracting and subcontracting (0)

Anonymous Coward | about 9 months ago | (#45758851)

yea cause it would be so much easier for one department to do all that is required

No dude... (3, Interesting)

BringsApples (3418089) | about 9 months ago | (#45757895)

...The website "roll-out" was an utter failure, plain and simple. There are so many websites out there that do far more complex operation, and they seem to have very little problem. I wasn't involved in the "roll-out" of the government's healthcare website, so I know jack-diddly about the problems that they faced. But from what I know about websites, especially ones like that one, is that it's a simple matter of input from the user, and then a matter of storage of that input, and maybe some calculations along the way - all very basic stuff for today's world. I went to the website and the damn thing had major problems that made me think that it was trying to do a lot of on-the-fly operations behind the scene that wasn't syncing up correctly, maybe I'm wrong, but that was my feeling.

However, that being said, I cannot see why the website "failure" had such an impact on the "unrolling" of the actual healthcare change. They had a toll-free number to call and operators that would do everything over the phone, very nice people I might add. Why the site didn't simply display the toll-free number is a good question. Hell, maybe they could have simply had an online-chat window pop up. Again, I wasn't a part of the staff that was tasked with this website, so there are things that I don't know.

Re:No dude... (2, Insightful)

Anonymous Coward | about 9 months ago | (#45758051)

No, your metric of success is just different from theirs. Government bureaucracy exists to obfuscate where your money goes and to provide channels for wealth to transfer. To control these channels, you hire people with specialized knowledge of the inner workings of the complex and byzantine procedures. Then you get money, lots of it.

You think along naive lines of getting things to work correctly, efficiently, to help people and at a fair price. These values, nice as they are, simply can't compete against the combined forces of "free-market" (which is anything but free) ideology and the collusion between government and the private sector.

Re:No dude... (1)

tibman (623933) | about 9 months ago | (#45758603)

I think you're way off. The private sector did all the colluding by itself. US medical bills are just crazy. Sky high prescription prices because "the market" can pay it. Lol, they'll pay it or be in agony.

Re:No dude... (3, Insightful)

BradMajors (995624) | about 9 months ago | (#45758065)

The worst part is the government website is totally unnecessary.

There already exists perfectly good working websites for buying insurance (such as einsurance). All that was required was to add the government subsidy feature.
   

Re:No dude... (0)

Anonymous Coward | about 9 months ago | (#45758181)

Insurers pay einsurance to promote their products. I think the purpose of a government exchange was to have an even playing field, where you didn't need to be concerned that an insurer was paying the broker on the side to screw you.

Healthcare.gov was just too ambitious. Kentucky put out the best website, according to critics, and it's dead simple. Not a coincidence.

Healthcare.gov 1.0 should've been simple. Then it should've been updated according to feedback and lessons learned.

As to why complex sites like Facebook or Twitter appear to get done on the cheap by a few engineers, it's because for every one of those there are a thousand similar websites that sucked. It's the law of large numbers. If you have enough monkeys pounding crap out and putting it up on the web, eventually you'll find some gems. But was it due to those engineers' skills, the fact that they watched and learned from all the failures before them (failures in doing precisely what they were trying to do), or just cosmic chance? It's more of the latter two than people realize. Neither Facebook nor Twitter were even remotely unique or ground breaking. They were just the versions finally good enough to catch on, succeeding dozens of other attempts by other poor bastards who started too soon.

Re:No dude... (-1, Flamebait)

Runaway1956 (1322357) | about 9 months ago | (#45758365)

Ahhhhh - the government subsidy. I've strained my limited resources of grey material to figure that out. Allow me to ponder this out loud here, please.

Let's say that I'm a young adult. I can't afford to buy a Big Mac budget meal two days in a row, so I eat a lot of Ramen noodles, carefully budgeting my very limited income so that I can buy an occasional Big Mac. Obviously, I can't afford insurance, either. Or a car. Or a girl friend. Or much of anything.

The government mandates that I MUST HAVE insurance. Amazing. But, wait. In it's infinite wisdom, government already knows that I can't buy insurance, no matter what they threaten me with. They offer me a SUBSIDY!! Oh, wonderful. With that subsidy, I can get insurance, so I don't have to wait for the IRS or DHS to come lock me up.

But, wait. That word, "subsidy". Is it permanent? Will government pay X amount toward my insurance for the rest of my life? Is it written into law that I will ALWAYS have this subsidy, with which to pay my insurance?

Wake up Amerikka - that subsidy is a temporary, fleeting thing. And, once you are registered, once you're in the system, you can never again be without insurance.

Oh well - maybe they won't have Big Macs at the relocation and reeducation camps, but the food will probably be superior to a steady diet of Ramen noodles. I hope, anyway.

Re:No dude... (2, Insightful)

Jeremi (14640) | about 9 months ago | (#45758385)

Wake up Amerikka - that subsidy is a temporary, fleeting thing. And, once you are registered, once you're in the system, you can never again be without insurance.

Well, yes. That's the point -- universal healthcare through universal insurance. Not really all that different from what we've done with auto insurance for years, and that works well enough.

Admittedly it's not as efficient or reliable as a single-payer system, but it's nevertheless preferable to our previous "just wait until you're at death's door, then go to the emergency room and run up an amazing tab on somebody else's dime" healthcare model.

Oh well - maybe they won't have Big Macs at the relocation and reeducation camps

Dystopian fantasies, cute. Not a good approach if you want to be taken seriously, though.

Re:No dude... (3, Insightful)

SuperKendall (25149) | about 9 months ago | (#45758417)

Well, yes. That's the point -- universal healthcare through universal insurance.

Will you be so calm and matter of fact about it when there is a law that every citizen must own a gun?

Because making a law that requires citizens to purchase something from private companies means that the government can make you buy ANYTHING (or pay a fee).

P.S. If " universal healthcare through universal insurance." was really the point, why were unions and many other organizations who contributed to Democrats given a waver for the requirement?

Re:No dude... (1)

Anonymous Coward | about 9 months ago | (#45759365)

Well, yes. That's the point -- universal healthcare through universal insurance.

Will you be so calm and matter of fact about it when there is a law that every citizen must own a gun?

Hmm. Mandating that people have a way to pay for healthcare that clinics are legally required to provide, vs mandating that people have tools to facilitate murder. Not sure I see any parallels. But I don't live in a paranoid fantasy world where the only thing keeping my neighbors from murdering me for my x-box is my Gun

P.S. If " universal healthcare through universal insurance." was really the point, why were unions and many other organizations who contributed to Democrats given a waver for the requirement?

Put down the talking points and get the facts [washingtonpost.com] . Some unions did get a 1 year waiver on the annual benefit cap...hardly the "waiver" for universal insurance you imply.

Re: No dude... (0)

Anonymous Coward | about 9 months ago | (#45758537)

A single payer system will NOT be 'more efficient'. Diminishing returns apply, especially to government bureacracies. The reason payment technologies continually improve (paypal, swift, bitcoin, amazon, credit cards, smart cards, square, mobile payments, etc) is because of competition. Do you really think if we have one government politically designed single payment system (which no doubt will be contracted to the largest government contractor) that it will be more efficient?

Re: No dude... (1)

Imrik (148191) | about 9 months ago | (#45759165)

Done correctly it would be far more efficient, unfortunately it would never actually happen. The government is unwilling to do anything to damage current jobs so they can only add inefficiency.

Re:No dude... (4, Insightful)

Sir_Sri (199544) | about 9 months ago | (#45758351)

There are so many websites out there that do far more complex operation, and they seem to have very little problem.

Not really at least not that worked at this scale from day one. The closest you're going to get to needing to support millions of unique users on the first day, and hundreds of thousands simultaneously are things like MMO launches and WoW expansion packs or something like google+. And most of those can scale by replication and sectioning people off so it's highly parallel, or are built on already substantial infrastructure. If you crunch the math, there were only 90 days from launch to end date, and you need to enrol about 25 million people or something in that time (the uninsured who don't live in states with their own exchanges), so the daily load is actually quite high, particularly with a large number of people hitting the site to browse and decide. It's also quite likely that they gambled on more states setting up their own exchanges... and lost.

The backend of games and google+ of those is trivial compared to healthcare.gov, which not only needs to talk to databases from federal agencies, but it needs to connect to dozens of insurance companies with multiple sets of rules and regulations. Sure an MMO needs to do math, but one designer with no technical training can decide what equations to use and if they get it wrong no big deal. When you're dealing with money - and we're talking about healthcare that's going to be worth a couple of hundred billion dollars bought through this site, even a 1% error rate is going to cause no end of problems.

is that it's a simple matter of input from the user, and then a matter of storage of that input, and maybe some calculations along the way - all very basic stuff for today's world.

Input from the user that needs to be checked against multiple databases that aren't yours, that have private information in them. Then talking to multiple insurance companies in multiple jurisdictions with slightly different rules etc.

I'm not saying that excuses about 2 months of failure, but one should not assume this is a simple project, that they somehow did not realize that this would require probably 10x the server capacity they had is a complete failure. But other projects that are huge and stable have spent a lot more than 500 million dollars to get to that point, over a lot of years. These guys were trying to solve a problem no one else has ever had to solve on this scale. That they didn't recognize that is pathetic, but we shouldn't suppose this is an easy project.

Re:No dude... (1)

Imrik (148191) | about 9 months ago | (#45759175)

Except unlike an MMO the people don't need to interact with each other so it is trivial to scale by replication and sectioning people off while being completely parallel.

Re:No dude... (1)

Papaspud (2562773) | about 9 months ago | (#45759359)

I'm pretty sure they had 3 years to get the site going, of course in government terms that isn't enough time.

Why not call it its actual name? (2, Insightful)

bogaboga (793279) | about 9 months ago | (#45757905)

"The Obamacare sign-up site was a classic example of managers saying 'not invented here' and doing everything wrong, as described in Poul-Henning Kamp's Center Wheel for Success, at ACM Queue."

I mean, you folks at Slashdot should have called it the Affordable Care Act website then reminded us that it's also known as Obamacare. But to call it what it isn't in the first sentence of introduction is [very] unfortunate!

Disclaimer: I am neiter Democrat nor Republican.

Re:Why not call it its actual name? (0, Troll)

Anonymous Coward | about 9 months ago | (#45757931)

Sounds like Republicans are getting worried Obamacare might be end up working and want to change the name...I mean imagine of Social Security was called Rooseveltcare? This attempt to debrand Obama from Obamacare tells me the right is scared that Obamacare is going to be well liked in the end!

Re:Why not call it its actual name? (0)

Suiggy (1544213) | about 9 months ago | (#45758107)

You've been drinking too much of the Purple Drank.

Re:Why not call it its actual name? (0)

Anonymous Coward | about 9 months ago | (#45758167)

if you follow the history of this in MSM, Obama and the democrats complacently went along with the 'Obamacare' nomenclature until Obama's poll ratings took a slump. It is part of the democrat/Obama agenda to get the public to call it 'Affordable Care'. i know this for a fact. a colleague planned a Q/A event about it and arranged for a representative of the O administration to be present. said representative insisted on changing 'Obamacare' to 'Affordable Care' in all promotional material.

Re:Why not call it its actual name? (5, Informative)

haruchai (17472) | about 9 months ago | (#45758225)

Here's what Obama himself said about that - "And once it's working really well, I guarantee you, they'll not call it Obamacare. Here's a prediction for you - a few years from now, when people are using this to get coverage, everybody's feeling pretty good about all the choices & competition that they've got, there are going to be a whole bunch of folks saying "I always thought this provision was excellent, I voted for that thing".
You watch, it will not be called Obamacare," -

http://www.youtube.com/watch?v=7aN2iuIhcx0 [youtube.com]

Re:Why not call it its actual name? (3, Insightful)

sumdumass (711423) | about 9 months ago | (#45758469)

HE also said if you like your insurance you can keep it, if you like your doctor, you can keep him. Something about period too.

It seems to me that Obama is just like any other politicians and lieing out his ass to get whatever he wants done and it wouldn't surprise me if that statement wasn't concocted with the knowledge of trying to get rid of the Obamacare name simply to make it appear to be working better than it is.

I mean seriously, he set up the perfect scam with that line, he says when it works good, they will not call it obamacare and if he gets it called something else, it must be working good then right?

Re:Why not call it its actual name? (1)

haruchai (17472) | about 9 months ago | (#45758785)

I don't think that it's a statement he ever should have made but it's not like he promised Americans eternal life and now is casting them in carbonite.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/29/this-is-why-obamacare-is-cancelling-some-peoples-insurance-plans/ [washingtonpost.com]

Re:Why not call it its actual name? (1)

bondsbw (888959) | about 9 months ago | (#45758471)

Yet Obama himself calls it Obamacare.

Re:Why not call it its actual name? (1)

haruchai (17472) | about 9 months ago | (#45758793)

It's a Republican plan but it's his signature bill.
Better for him to make sure it's implemented well and the flaws get fixed rather than obsess about the name. If it's better known as Obamacare, so be it.
We still talk about Reaganomics.

Re:Why not call it its actual name? (3, Insightful)

jmac_the_man (1612215) | about 9 months ago | (#45759273)

It's a Republican plan but it's his signature bill.

It's not a Republican plan. ABSOLUTELY ZERO Republicans voted for this monstrosity in the House, and ABSOLUTELY ZERO voted for it in the Senate.

The fact that two guys who worked at the Heritage Foundation 20 years ago wrote a white paper saying "Hillarycare won't work without an individual mandate" doesn't make Obamacare a Republican plan. You guys screwed this up on your own.

Re:Why not call it its actual name? (1)

Imrik (148191) | about 9 months ago | (#45759179)

Until it launched, then he (and most/all Democrats) started calling it the Affordable Care Act.

Re:Why not call it its actual name? (0)

Anonymous Coward | about 9 months ago | (#45757947)

Actually, I think it's the Patient Protection and Affordable Care Act.

Disclaimer: I am a Libertarian and pay for my own damn policy.

Re:Why not call it its actual name? (0)

Anonymous Coward | about 9 months ago | (#45757971)

Ten bucks says if you bought your policy through an exchange you'd save money and get a better policy...I too buy my own healthcare and what do you know the exchange policy is 50 bucks less and covers way more shit...

Re:Why not call it its actual name? (-1, Troll)

ApplePy (2703131) | about 9 months ago | (#45758321)

If more people are getting signed up for Medicaid, and lots of people are getting subsidies... where's the money for that going to come from?

Tax increases that we haven't seen yet. I'll wager your taxes are going to go up next year by more than you think you're saving.

Problem is, you numbskulls that drank the Obamacare Kool-Aid can't see past the end of your own noses, and don't know the history of how your government has operated in precisely the same fashion since sometime around the War Between the States.

It's the same shit. Politicians promise shit, but it won't cost shit. It always ends up costing, you dumbfuck. ALWAYS.

There are no exceptions. There never have been any exceptions. Getting something from the government comes out of your pocket, one way or another. How fucking stupid are you people?

Beam me up, Scotty. There's no intelligent life here.

Re:Why not call it its actual name? (0)

Anonymous Coward | about 9 months ago | (#45758455)

Dude, spare me the bullshit... federal taxes are the lowest they've been in a century...

Re: Why not call it its actual name? (1)

nico60513 (735846) | about 9 months ago | (#45758477)

The savings is supposed to come from less people freeloading on the system (by not having insurance and getting free ER care when they get sick). Whether that savings actually is realized or not, who knows. As an independent, I'm constantly surprised by Republicans And Libertarians suggesting that the current system (pre Affordable Care Act) which encourages the young and working poor to freeload on the system. Where did the "personal responsibility" crowd disappear to?

Re: Why not call it its actual name? (1)

ApplePy (2703131) | about 9 months ago | (#45758605)

*Those* people (the young and working poor) are going right on Medicaid, or getting heavy subsidies.

So, umm... still freeloading on the system. /me bangs head on desk...

Re:Why not call it its actual name? (1)

Runaway1956 (1322357) | about 9 months ago | (#45758387)

It's fifty bucks less, out of YOUR pocket, AFTER the subsidy is applied. I suppose that if I were to bend over, place my head between my knees, and forcefully insert my cranium into my rectum, eventually the lack of oxygen could make me forget that this "affordable" health care actually costs about double what my less affordable healthcare used to cost.

Re:Why not call it its actual name? (0)

Anonymous Coward | about 9 months ago | (#45757953)

It used to be referred to as Obamacare quite often in the MSM, especially when the Republicans were trying to defund it. Then it rolled out... The usage of the term Obamacare dropped off the face of the Earth after that. Strange coincidence.

Re:Why not call it its actual name? (2)

sumdumass (711423) | about 9 months ago | (#45758495)

Not a strange coincidence at all. People who want to be taken seriously in their complaints will call it the ACA or affordable care act, sometimes with the PP or patient protection in front of it. If they call it Obamacare, they are treated like a partisan loon and ignored.

The Media, they changed up the terms several times now, I suppose this time it is more because Obama started saying they will call it something else when it starts working so if it gets called something else, it must be working right? You see, if you like your doctor or insurance plans, you can keep it- period. You will have to pay a lot more for them if they are still available but you can keep them so that wasn't a lie. And yes, that was what one of the Obamacare apologists said, it isn't a lie because you can keep them if you are willing to pay more.

Re:Why not call it its actual name? (3, Interesting)

Okian Warrior (537106) | about 9 months ago | (#45757961)

I mean, you folks at Slashdot should have called it the Affordable Care Act website then reminded us that it's also known as Obamacare. But to call it what it isn't in the first sentence of introduction is [very] unfortunate!

Is this a misdirect?

I'm only asking because I'm on the lookout for techniques to derail a discussion. A "misdirect" is calling attention to something irrelevant but intended to provoke an emotional response. It's used to push more-relevant posts down the page - hopefully below the fold.

Already got a +3 rating, it takes up a full two column-inches. I'm curious to see how many respond, and whether they get modded up.

(No one publishes guidelines for this sort of thing, so I have to ask.)

Re:Why not call it its actual name? (1)

Jherek Carnelian (831679) | about 9 months ago | (#45758057)

I don't see what the point of misdirect the discussion on this topic would be, unless a rationale examination of IT project failure is something some group would prefer to be avoided. Accenture maybe?

Besides, both parties have embraced the name Obamacare - the republicans started it thinking it was pejorative and then the democrats must have run a few test groups on the name and decided to try and "take it back" before the last election. At this point, I don't think the name is controversial at all. It certainly rolls off the tongue much better than any of the official names.

Re:Why not call it its actual name? (4, Insightful)

girlintraining (1395911) | about 9 months ago | (#45758149)

I'm only asking because I'm on the lookout for techniques to derail a discussion. A "misdirect" is calling attention to something irrelevant but intended to provoke an emotional response. It's used to push more-relevant posts down the page - hopefully below the fold.

You must be new here. The majority of the intelligent and thoughtful discourse evaporated when Slashdot was bought out by Dice. If you want to see what the future looks like, punch in beta.slashdot.org. Then vomit in your mouth. It's been replaced with paid schills and hobbyists. There are a few of us left from the old guard, but we're only here because, frankly, there's nowhere else to go. Every promising new forum website seems to be shortly after swallowed whole by "Web 2.0" and it promptly goes to shit in an effort to look trendy and hip, at the expense of actual content and relevant discourse.

The post you're replying to was not accidental. It was quite deliberate. Like all things Web 2.0, very little of what is passed off as original or user-contributed content actually is. About a third of the posts here on Slashdot are now by 3rd parties who may or may not be affiliated with Dice, who in turn are just subcontractors for larger business ventures; Shell companies within shell companies.

It's part of a new "dark net" of small companies in quiet office complexes filled with nothing but a few cubes and employees who show up and are handed a 3 ring binder with pre-cooked posts and responses to "criticism" of whatever position they're being paid to represent under a pseudonym.

Welcome to the real Web 2.0.

Re:Why not call it its actual name? (1)

Anonymous Coward | about 9 months ago | (#45758367)

Welcome to the real Web 2.0.

Based on the way I read Slashdot, the beta definitely sucks. Two or three posts per screen; 5 shades of grey; several positioning glitches while trying to read; hunt and guess what and where on the interactions; and of course, everything everywhere given equal weight visually, creating that WTF, where am I at feeling. That's just the appearance--totally web2.0.

I'll miss being able to have each post be on one line with a total of a hundred or so posts on one screen. Reading anything in a decent amount of time in the beta is out of the question. It would take hours instead of minutes to accomplish. I'm sure, in time, the comments will be compressed into a smaller center as the 4 margins continually increase to 70% or more of the screen with distracting bloat.

The summary already has a click to read more page only to be the summaries again, this time with a link to each saying "Read the Comments". CTR FTW, Yeaay! Bandwidth be damned, even if your in the majority that ony has highspeedinternet! (Yeah. It's officially one word now.) It'll be easy to go cold turkey on my Slashdot addiction when the change is finalized.

Re:Why not call it its actual name? (0)

Anonymous Coward | about 9 months ago | (#45758371)

then let's call it... techno-turf?

Re:Why not call it its actual name? (1)

Wallace487 (969090) | about 9 months ago | (#45758853)

This. The site has gotten worse and worse, and it seems like I was left with the B Ark. The new. Beta site is horrible, and I keep getting redirected to it. It is coming whether I like it or not, and it might be the change that pushes the rest of the good contributors over to whatever site they all went to.

Re:Why not call it its actual name? (0)

Anonymous Coward | about 9 months ago | (#45759107)

To be fair, I've seen these sort of comments since 2007(when I started reading slashdot), although I have been wondering what happend with the clearly marked sponsored stories we would get from partners of the parent company... And yes I also have seen the posts that appear to be nothing more then a commercial for a obscure product..

Re:Why not call it its actual name? (1)

Spy Handler (822350) | about 9 months ago | (#45758327)

Obamacare is easy to say and remember. Why not use it?

Star Wars is easy to say and remember, so it stuck. Hardly anyone ever calls it Strategic Defense Initiative anymore.

Re:Why not call it its actual name? (2)

jmac_the_man (1612215) | about 9 months ago | (#45759291)

Also, Reagan EMBRACED the term "Star Wars" (which was originally a slur) and the term was popular among the public.

Just like when the Obama administration embraced the phrase Obamacare.

Of course, the Obama administration and its allies in the media have been going back and forth between embracing the term Obamacare and calling anyone who uses it a racist.

Re:Why not call it its actual name? (3, Insightful)

the eric conspiracy (20178) | about 9 months ago | (#45757987)

Obamacare was originally the government heathcare plan designed to be an alternative to the public offerings in the PPACA. This was so broadly perceived as government interference in the private sector that enough Democrats declined to support it to make passing the bill impossible.

Later the PPACA was called Obamacare as a way to disparage it and to try to attach blame for the unpopular aspects of it to the President as a political ploy.

However even Mr. Obama now calls it Obamacare, so I guess if you call it by its official name you will are likely to just confuse people.

Re:Why not call it its actual name? (2, Funny)

JoeMerchant (803320) | about 9 months ago | (#45757997)

But, virtually all I know about the topic I learned on Fox news, if you called it the Affordable Care Act website I would have no clue what you are talking about.

My neighbor is much more knowledgeable on the topic, he listens to Rush Limbaugh all the time.

 

Re:Why not call it its actual name? (0)

Anonymous Coward | about 9 months ago | (#45758063)

My neighbor is much more knowledgeable on the topic, he listens to Rush Limbaugh all the time.

Not sure if joking, trolling, or idiot.

Re:Why not call it its actual name? (1)

AK Marc (707885) | about 9 months ago | (#45758743)

You are an idiot. Does that help?

Re:Why not call it its actual name? (1)

Anonymous Coward | about 9 months ago | (#45758355)

You've been modded funny, but this is the real answer. Branding allows you to manage the conversation - a person who hears the name "Obamacare" over and over searches online for more information and finds a lot of right-wing blogs ranting about it. If they knew the name "Affordable Care Act" the quality articles that they were given would be very different. It's a self reinforcing system.

You can see the same thing if you compare searches for "Climate Change" and "Anthropogenic Global Warming."

Re:Why not call it its actual name? (2)

game kid (805301) | about 9 months ago | (#45758401)

Or, in short, SEO.

Re:Why not call it its actual name? (3, Insightful)

sumdumass (711423) | about 9 months ago | (#45758517)

There have been informal surveys that ask if you prefer Obamacare or the Patient protection and affordable care act and they pick either one based on emotions rather than facts.

I spoke with a girl just the other day who said she didn't know much about it when I asked if you got her government mandated insurance yet. She was outraged when I told her she was facing a penalty if she didn't have insurance by the end of the year.

The bottom line is that people just don't pay enough attention. Sometimes, they hear something that sounds good and like it, sometimes they hear a person is associated with it and like it. Sometimes, you are better off trying to guess what color any random woman's underwear might be then expect people to know about this stuff.

Re:Why not call it its actual name? (2, Interesting)

LordLimecat (1103839) | about 9 months ago | (#45758415)

Ive heard it called Obamacare on NPR too, but no-- continue your rant.

Re:Why not call it its actual name? (1)

Anonymous Coward | about 9 months ago | (#45758043)

Who cares, that is the name which is popularly used and was until recently embraced by both parties. Now only Democrats want to change it because of the bad publicity and damage it's done to the President and members of the Democratic party who voted for it.

"Medicare" was Title XVIII of the Social Security Act. But people call it Medicare. Even the US government. So what.

Re:Why not call it its actual name? (1)

Anonymous Coward | about 9 months ago | (#45758087)

Who gives a shit? What did you think about the article?

Re:Why not call it its actual name? (1)

Anonymous Coward | about 9 months ago | (#45758209)

I mean, you folks at Slashdot should have called it the Affordable Care Act website then reminded us that it's also known as Obamacare. But to call it what it isn't in the first sentence of introduction is [very] unfortunate!

Disclaimer: I am neiter Democrat nor Republican.

Presidentialcare, Greatleadercare or Bigbrothercare are alternatives that come to mind; people wanting this, even if it's a perfect creation, are being clueless about the somewhat demeaning nature of the terminology. It's reminiscent of an old world monarchist chieftain placating his subjects with a gift -- the benevolent great Leader showering the people with his love.

Re:Why not call it its actual name? (3, Insightful)

Runaway1956 (1322357) | about 9 months ago | (#45758377)

Bullshit. Even Obama was proud to call it Obamacare - until it failed. Democrats owned the damned thing all along, and Obama is the major shareholder. Screw the politically correct claptrap. There isn't a person in the United States (minus immature juveniles and senile old bastards) who doesn't know what is being referred to when Obamacare is mentioned.

Re:Why not call it its actual name? (0)

Anonymous Coward | about 9 months ago | (#45758947)

should have called it the Affordable Care Act

The official name is newspeak itself. It should correctly be called Mandatory Healthcare Insurance. Obama started calling it something that sounds warm and fuzzy, he gets the derogatory Obamacare in response. Pot, meet kettle.

slashdot... (0)

Anonymous Coward | about 9 months ago | (#45757907)

/.

news to someone, stuff you don't care about.

Article is +1 (4, Informative)

noh8rz10 (2716597) | about 9 months ago | (#45757915)

Most articles linked to on slash dot aren't very interesting or are pushing something, but this article was interesting and a good use of my time . +1

Re:Article is +1 (0)

Anonymous Coward | about 9 months ago | (#45758021)

i'm rating your comment -1, because in reality the title should be Obamanocare and Middle-Wheel-Wheelbarrows

Re:Article is +1 (1)

pikine (771084) | about 9 months ago | (#45758191)

Poul-Henning Kamp is probably best known for his phkmalloc used in FreeBSD, and Varnish http cache. He's one of the few who understood [acm.org] that virtual memory under stress essentially behaves like a block device, so he writes software to exploit that.

A standard business problem (3, Insightful)

Todd Knarr (15451) | about 9 months ago | (#45757979)

A problem with business, that is, not a problem of business. All too often I see business requirements for software that specify how things must be done, rather than specifying what is to be done. The problem is that the business requirements are being written by businessmen who have no training or experience in writing software, so they no more know how things should be done when writing software than (according to those self-same businessmen) the software developers know how things should be done when running a business. The solution is always the same: let the business people lay out what they want done, and let the software developers figure out how to do it.

Re:A standard business problem (1)

umghhh (965931) | about 9 months ago | (#45759231)

you touched to one of the main problems me thinks. I saw results of few big SW projects in domain of social security too and the problem is even bigger there as the overreaching businessmen can be convinced especially if you have good arguments after all s/he wants project to deliver things that s/he needs. In social security area in any country this gets tricky because of extreme complexity of the rules and interfaces. The later can be mitigated by prescribing certain interfaces & their rules in law - it binds companies to use common interface which is then worked on together. In US one has additional problem that the entity ordering the shit i.e. Congress is a case of a split brain far detached from reality and actually not wanting the project to succeed. Good luck in discussing change to conflicting requirements with these people.

The ol' good incompetence and negligence is not helping either.

More of a government contracting issue (4, Informative)

tpstigers (1075021) | about 9 months ago | (#45758025)

This isn't the only place we've seen this. The Pentagon and FEMA have been up to their necks in it for years. The process of getting government contracts is so bizarre and complicated that companies have evolved with "getting government contracts" as their only business model. So the companies that actually get the contracts are the companies that are good at getting government contracts (because they focus so much of their resources on the process), NOT companies that are good at delivering what the contracts specify. This is a natural by-product of bureaucracy.

Patient decision aids (3, Informative)

nbauman (624611) | about 9 months ago | (#45758033)

Kemp is being unfair. I understand what this section is about, and he doesn't. A patient decision aid could just be a well-written article or web page. The UK NHS has patient information pages that would satisfy these requirements. There's no requirement for artificial intelligence.

"(1) PATIENT DECISION AID—The term patient decision aid' means an educational tool that helps patients, caregivers, or authorized representatives understand and communicate their beliefs and preferences related to their treatment options, and to decide with their health care provider what treatments are best for them based on their treatment options, scientific evidence, circumstances, beliefs, and preferences."
"(2) REQUIREMENTS FOR PATIENT DECISION AIDS—Patient decision aids developed and produced pursuant to a grant or contract under paragraph (1)—
"(A) shall be designed to engage patients, caregivers, and authorized representatives in informed decision making with health care providers;
"(B) shall present up-to-date clinical evidence about the risks and benefits of treatment options in a form and manner that is age-appropriate and can be adapted for patients, caregivers, and authorized representatives from a variety of cultural and educational backgrounds to reflect the varying needs of consumers and diverse levels of health literacy;
"(C) shall, where appropriate, explain why there is a lack of evidence to support one treatment option over another; and
"(D) shall address health care decisions across the age span, including those affecting vulnerable populations including children."

Re:Patient decision aids (0)

Anonymous Coward | about 9 months ago | (#45759295)

Yeah, he should have googled for 10 seconds and found out about them instead of guessing they're about AI. what a chump.

Naive (2, Insightful)

Anonymous Coward | about 9 months ago | (#45758099)

Charmingly naive, but naive.

The author of that article asks, several times in several ways, why the government always gets it wrong and the lasting solutions always come from the little guys.

The answer has less to do with the size of the organization than the number of organizations all pitching competitive solutions. Yes, a thousand 10-person companies are probably going to do a better job in the long run than a single 10,000-person company or government entity, on problems in the right scale. But you'll never hear about 9997 of those solutions because half of them are dumb and the other half, while not obviously dumb, are inferior in some critical way.

(Then why do we have big companies and governments? Because some projects are simply too large for a ten-person outfit. That, the author got right.)

It's simple... (1)

goathumper (1284632) | about 9 months ago | (#45758119)

It's called capitalism. It's not profitable to solve these complex software problems correctly the first time around because then the software companies would be out of the job of maintaining the deployed solutions.

Re:It's simple... (2, Informative)

Anonymous Coward | about 9 months ago | (#45758169)

So a massive goverment take over of insurance regulation, with tens of thousands of pages of regulations, with constantly changing rules because what they came up with originally isn't working is "capitalism".

I think you need a dictionary.

Re:It's simple... (0)

Anonymous Coward | about 9 months ago | (#45758197)

what a well chosen name

Oh yeah! Take that slashdot obamacare trolls! (1)

Anonymous Coward | about 9 months ago | (#45758165)

"After stumbling out of the gate in early October, the nation’s new health-insurance exchanges are picking up steam. On the eve of the December 23 deadline for securing coverage that starts January 1, more than a million Americans have completed the enrollment process, according to the Commonwealth Fund. Just over half of the new enrollees (621,000) have joined Medicaid programs, and 525,000 have purchased private plans through the marketplaces.

The current tally for marketplace plans is a small fraction of the 7 million the government expects to chalk up by March 31, when the open-enrollment period ends. But as this chart shows, the total has quintupled in the past seven weeks, and has more than doubled in the past four, thanks mainly to brisk uptake in the state-run marketplaces. If these trends continue, the projection for March 31 is still well within reach. "

--MSNBC

What about the wheelbarrow? (3, Interesting)

Yxven (1100075) | about 9 months ago | (#45758173)

As interesting as it is to guess why another waterfall government IT project failed, I'd rather know why we aren't using wheelbarrows with wheels closer to the center. As a guy who has mostly used wheelbarrows for moving concrete, having the wheel support the majority of the load instead of half (or whatever) sounds like a huge advantage.

The Wikipedia article on wheelbarrows suggests "However, the lower carrying surface made the European wheelbarrow clearly more useful for short-haul work." Does that reason really pan out? Can anyone think of any other reasons?

Re:What about the wheelbarrow? (1)

Anonymous Coward | about 9 months ago | (#45758267)

If you're using a wheelbarrow to move concrete, you're moving it from the mixer to the form - a distance probably measured in tens of feet. Yes, it would be easier to lift with a center wheel, but in ten seconds time, you're going to have to tip or shovel it out. That's much, much harder with a center wheel and a high barrow.

(If you have the available width, a barrow with a centre wheel on each side, like a paddle steamer, is low, tippable and easy to lift, but you can't push it along a plank laid on top of the mud.)

Re:What about the wheelbarrow? (2)

Animats (122034) | about 9 months ago | (#45758637)

A wheelbarrow is a specialized tool, for moving loose material a short distance and then pouring it out. For most other applications, a wagon, hand truck, or dolly is more useful. There's also the Gardenway cart, which has two large wheels on an axle slightly forward of the center. It's dumpable, but less work to move. Horse barns usually have a few of those around.

Modern wheelbarrows [tractorsupply.com] have the single wheel much closer to the CG, so you're only lifting a fraction of the weight. You want some weight on the handles, because you're providing roll stability.

Learned about Chinese Wheelbarrows (4, Funny)

PaddyM (45763) | about 9 months ago | (#45758185)

But I think we all know that a car analogy is needed to explain the healthcare.gov mis steps. Namely, the Democrats drove the law through all obstacles, but then after the elections, they ran out of gas. The Democrats wanted to buy more gas, but the Republicans said the engine is broken and should be replaced. The Democrats asked what engine to buy, but the Republicans had no idea except not from Solyndra. While they were arguing about it, Obama said that the midnight train of 2014 was approaching. The Democrats asked the Republicans to help push the car because it at least helps some people get healthy, but the Republicans said it would be faster if they spilled oil on the road and got rid of taxes on oil. Then the wheels came off the healthcare.gov website.

Re:Learned about Chinese Wheelbarrows (1)

Anonymous Coward | about 9 months ago | (#45759061)

Thanks, it is all so clear now.

Several points... (1)

Anonymous Coward | about 9 months ago | (#45758231)

1. As it was, the US healthcare system was a joke to the rest of the world. The democrats looked at the (gawdawful) mess, and tried to fix it. The republicans took what was reasonable, then chopped the best parts of it, and then what was left was passed (pressed with protests galore) into law. Then the Republicans tried to kill it (at least 49 times, I lost count).
2. As implemented, this watered-down, weak-kneed, still a joke of a health system is being implemented very badly. I've seen and used public health care. The one I used is massively better than Obamacare is trying to be. I've seen complex implementations of online real-time systems. I've seen large companies run by MBA's who schmooze politicians and try to implement 'IT Stuff'; Computer website something. Its like mall security trying to be seal team 6. The takeaway would be that business schools would take it as a lesson to let people who know lead. But that will never happen.

Re:Several points... (1)

Anonymous Coward | about 9 months ago | (#45759307)

1. As it was, the US healthcare system was a joke to the rest of the world. The democrats looked at the (gawdawful) mess, and tried to fix it. The republicans took what was reasonable, then chopped the best parts of it, and then what was left was passed (pressed with protests galore) into law. Then the Republicans tried to kill it (at least 49 times, I lost count).

No, sorry that is not how this worked at all. There were a democratically Controlled hose and democratically Controlled Senate at the time. 59 Senators voting in the Democratic Caucus. 41 Republicans. Senator Snow (R) had already committed to voting up to Single Payer System. This puts the onus on this law squarely on the Democratic Party.

c0m (-1)

Anonymous Coward | about 9 months ago | (#45758579)

as f1ttingly

Not "wheelbarrows." (1)

mbstone (457308) | about 9 months ago | (#45758613)

There are already lots of US laws and regulations that mandate how IT is supposed to be procured and implemented by the US Government (see, e.g., the Clinger-Cohen Act [wikipedia.org] .)

Each of these mandates came about because Congress became tired of funding IT projects where the money just vanished and no IT system was stood-up.

The botched implementation of the ACA website raises questions not of "wheelbarrows," but how and why EOP/DHHS managed to bypass or ignore existing mandates.

Amazon anyone? (0)

Anonymous Coward | about 9 months ago | (#45758713)

Regardless of the politics, if Amazon had been selected through a sole-source justification the web site would have been created using a design pattern and it would have worked and scaled from day one. This approach is obvious for those who have worked in government for years. One has to ask why this simple and effective approach was ignored. The competence and agenda of those in charge needs to be questioned from the top down!

Re:Amazon anyone? (1)

Anne Thwacks (531696) | about 9 months ago | (#45758939)

Have you ever used Amazon's web sites? The UI looks great, but too often the "buy now" button is missing, the OS you are using is not tested, and your browser is incompatible (regardless of the fact that you tried three browsers on each of four OS's). It keeps offering you stuff you already bought so dont need, or includes one similar buzz-word, but is completely unrelated. "You had a leg amputation yeterday - why not try a head amputation today?"

As for AWS - after three weeks of Googling, I still could not work out how to work it, and I have been remotely managing servers in colos for over ten years. Private enterprise4 may be the answer, but Amazon is not.

And dont talk to me about Oracle - the thought gives me pains in all the diodes in my left leg.

the amazing unicycle with sidecars and yoke (2)

epine (68316) | about 9 months ago | (#45758989)

I'm sympathetic to PHK, but I could never have written this piece myself without commenting on a single disadvantage of the Chinese wheelbarrow.

You seem to be stuck with one of three problems:
* using a small wheel that won't easily roll over path obstructions
* having the wheel intrude into the barrow, obstructing tending or shifting the load
* having a large wheel under the barrow with a high center of gravity (what could possibly go wrong?)

The large carts at my nearby Costco are set up so that they won't pivot at the front (only at the middle). This is fine if you can find space to make a 90 degree turn on the spot. It's not at all good for creeping around a tight bend. Moreover, you've got both the front and back end swinging at the same time—which is the number of places you can visually attend plus one—so your chances of taking down some rickety display item are fairly decent if try to wing it.

Furthermore, nothing prevents two people from grabbing different handles on the European wheelbarrow. Also, PHK is wrong about the weight distribution. With a heavy load, it's customary to pile as much as possible up against the lip that protrudes over the front wheel in many front-wheel designs. I'd guess an European wheelbarrow front-loaded with wet clay has about a 4:1 lever arm in vertical displacement of the handle compared to vertical displacement of the load.

Wouldn't a Chinese wheelbarrow be something like a small unicycle with saddlebags and a trailer hitch? If you need to clear some brush (where only your wheel fits the path), you've got no way to jack the suspension under the load, either.

And wouldn't it be much harder for short and tall people to share the Chinese design unless equipped with some sort of adjustable handle. Somehow I'm just positive that the Chinese design from 1000 [BC|AD] comes replete with ergonomic dongles for the comfort of whatever schlep needs it next.

But then, with a billion identical people growing rice on ten million identically manicured terraces, I'm sure the Chinese design is a total win.

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