S.F. programmers build alternative to Healthcare.gov

[question everything]

Source: CBS News

On Friday, President Obama had this to say about problems with the Obamcare website during a speech in New Orleans: "I promise you, nobody's been more frustrated. I wanted to go in and fix it myself, but I don't write code."

But plenty of programmers do write code. And three of them have created their own website that addresses some of the most annoying problems with HealthCare.gov. In a San Francisco office shared with other tech start-ups, three 20-year-olds saw HealthCare.gov as a challenge With a few late nights, Ning Liang, George Kalogeropoulos, and Michael Wasser built "thehealthsherpa.com," a two-week old website that solves one of the biggest problems with the government's site.

"They got it completely backwards in terms of what people want up front," said Liang. He further added: "They want prices and benefits, so that they could make the decision. Liang showed us out it worked onscreen. "You come to our website and you put in your zip code - in this case a California zip code. You hit 'find plans,' and you immediately see the exchange plans that are available for that zip code."

They have plenty of experience working at places like Twitter and Microsoft before setting out to build their own Internet companies. But this project is a public service.



Read more: http://www.cbsnews.com/8301-18563_162-57611592/s.f-programmers-build-alternative-to-healthcare.gov/

---

Saw the story on CBS Evening News.... amazing.

[DesMoinesDem]

1. The administration didn't want a site that showed prices without the subsidies.

They could/should have made a simple site like this so people could easily look up prices, but they didn't want people to be able to see prices without seeing the subsidies. That is why you have to set up an account and enter all of your info to look at prices.

[LiberalArkie]

4. I looked it up for my zip code in Arkansas

72126 and put in my Social Security income and it did show it with and without the subsidies.

They did a nice job.

[Renew Deal]

5. Isn't price determined by your info?

Salary and county?

[Scuba]

21. This right-wing meme has been discredited multiple times.

[sendero]

22. That could easily be added..

... the real question here is whether not every bit of information entered here needs to be verified just to get a quote. It doesn't, nobody does it like that for good reason.

Whatever info is needed to calc a subsidy could be entered by the user without the difficult verification step. Then when and only when the user wants to actually enroll for a plan this info could be verified. If the wrong data was entered, guess what your quote is wrong. Most people seeking a quote are not going to actually enroll. It is ridiculous to do all of this verification in real time.

This could even be taken to its logical conclusion where you apply and you get an email in a day or two telling you of the status. There is NO REASON to tie up a web site trying to talk to 10 other databases that may or may not actually be on line and functioning quickly.

As far as I can tell, this site (healthcare.gov) was created by amateurs and hacks. We probably got what we paid for.

[frazzled]

2. They couldn't build an alternative without

having it interface with a bunch of government agencies (like the IRS) and with each of the individual insurers on the exchange.

Did they make it more user friendly on the front end? Probably. But I read two weeks ago that the government had already made the change that allows people to find and browse plans without making an account or enrolling. That's not the problem, and it's not really all that helpful to most people. They can't know if they are eligible for a subsidy, or how much their premium will ultimately cost them without registering and being examined.

Lastly, the reason people aren't enrolling in specific plans in great numbers is that you have to pay the first month's premium in order to be actually "enrolled." Who wants to pay in October or early November for a plan that doesn't begin until January? People will be enrolling at much higher numbers in the weeks before December 15. Some won't enroll until the March 15 end date.

[TheDebbieDee]

6. I'm almost sure that people don't have to pay premiums

Until their coverage starts in January........

[frazzled]

8. I stated it badly: they aren't counted as enrolled until they've paid their premiums

Which affects all the chatter about how many people are enrolled:

He says that, as of Oct. 21, 321 people who created accounts selected a health plan for enrollment. Think of this as dropping an item in your shopping cart on Amazon (which is owned by the same person as The Washington Post, Jeff Bezos). Among those, 164 people have asked for an invoice from the health insurance plan that they selected.

Health insurers aren't notified of these invoices. They only get an enrollment form, from the DC health exchange, when the individual actually pays the first month premium.

"Consumers have until Dec. 15 to finalize their selection by paying their first month’s premium in order to have coverage on Jan. 1, 2014," Sorian writes. "We are very pleased with the strong, enthusiastic response from the residents and small business owners in the District.”

In the end, this boils down to what is the best metric to gauge interest in the health law exchanges. Health law supporters tend to prefer to look at something like consumers who have selected a plan but may not have actually paid for it quite yet. They contend that, given that premiums aren't due until Dec. 15, it's not reasonable to expect people to pay right away.

As Rhode Island's exchange director put it in late October, "The idea that people are going to do layaway purchasing three months out goes against the American way."
Health law opponents, meanwhile, tend to argue that paying a premium is the best metric -- it's the step that guarantees you're actually enrolled in the insurance plan, and will begin to receive benefits from that carrier.


http://www.washingtonpost.com/blogs/wonkblog/wp/2013/11/08/congress-says-five-d-c-residents-enrolled-in-obamacare-theres-more-to-the-story/

[gvstn]

7. This never seems to be mentioned in the media.

People aren't shopping for a few pair of socks. This is a major buying decision that can cost hundreds per month, each and every month. It is actually smart for people to get their options, discuss them with their family members and crunch both the coverage numbers and their personal budget numbers. Only then should they be ready to commit to a new plan.

[PoliticAverse]

27. And research the doctor and hospital networks each plan offers including checking if a potential

primary physician is actually accepting new patients.

[jtuck004]

14. Their goal wasn't to build an alternative. The goal, which they accomplished, was to show publicly

available data that could be browsed by a user seeking information, which very likely would have made this look like more of a success with a few tweaks needed than amateur hour. They also have links to the insurance cos with phone numbers to enroll if one wishes.

I threw in RIchmond, 23235 (I have no idea where that is in Richmond, just grabbed one) and it shows many different plans, a subsidy calculator, the ability to change for # of people in the family, etc. I threw in a WA state zip code, but we have our own exchange and there is no public interface.

It is a very good example of what the health insurance site could have looked like in the first place, had competent professionals been in charge of presenting the flagship effort of this administration, as if it were 2013 and we knew how to do such things. And a lot more people know how than one might think.

Slate has a tongue-in-cheek (sort of) take on how the big boys might have done it -

http://www.slate.com/articles/technology/low_concept/2013/10/how_google_facebook_or_microsoft_might_fix_the_obamacare_website.html

Kinda funny, and the google one is likely very possible.

[a2liberal]

16. You still can't lookup exact quotes on the official site

The thing they added only does very rough age categories (under 50/over 50 iirc) and doesn't have any plan details, just a list of plan names and very rough (because of not knowing age) premiums.

This 3rd party site doesn't seem any better though... it almost looks like just a front-end to the official pre-registration lookup. I was excited for a bit because I thought someone had actually done a full one. (I had thought about doing it myself but it's not trivial...)

[Ava Gadro]

33. I wish they would fix it so that people could check the prices

by zip code and income. I know quite a few people that refuse to go to the site and sign up because they don't want to give their information. They think it's a security risk. They worry about the NSA. They worry about the IRS. They worry about this. They worry about that. If they could just see how much the ACA will save them, I think they'd forget their worries and gladly submit their information. Extra money in their wallet talks!

[question everything]

24. Reality is that we have plenty of brain power in Silicone Valley

so why did the HHS go to a Canadian company that, apparently, had a bad product?

A friend of a friend of a friend has a son who works for UnitedHealth. IT, apparently. He was called to an "undisclosed location" to start working on fixing the government site and is amazed how bad the coding has been.

The reporter also added that in some cases you can get info that you can use to go directly to the insurance company and skip the site enrollment altogether.

[bvar22]

28. The work was outsourced to a Canadian firm that had just been fired....

...for messing up Canada's Health Care Site.

Bad enough to stiff American Workers in desperate need of jobs,
but hire a firm whose claim to fame was Failed Websites???
I could have delivered a non-working website for 1/2 this price.

"The HealthCare.gov fiasco"

But you don't have to be conservative to be angry at the rollout. Yes, liberals believe that government is a powerful tool for improving the lives of people. But we don't believe in wanton waste of taxpayer dollars. Yet HealthCare.gov cost over $500 million (and counting) as the Canadian contractor overseeing the biggest chunk of the project has taken advantage of its open-ended contract to deliver a non-working product for ever-increasing rates:

The company [CGI] – the largest tech company in Canada with subsidiaries around the world – was initially awarded a $93.7m contract, but now the potential total value for CGI's work has reportedly tripled, reaching nearly $292m.

I won't absolve Republicans entirely for this mess, as it is their outsourcing fetish and hostility to government workers that have created a contractor culture that is fleecing the American taxpayers. But Republicans aren't in charge of Health and Human Services. Democrats are. And there were plenty of signs that CGI was generally incompetent, such as this:

Last year, the Canadian province of Ontario fired CGI and canceled a $46 million contract, accusing the company of failing to build an online medical registry on time.

http://www.dailykos.com/story/2013/10/21/1249365/-The-HealthCare-gov-fiasco

For most of MY working life, companies with a record of huge failures were avoided.
Those responsible for failure were fired.
Life was simple.






You will know them by their [font size=3]WORKS.[/font]

[StrayKat]

3. Summary of Benefits

The plans need links to the summaries of benefits so we can see what is actually being compared. The plan that costs $20/month more may actually be the better deal, but with out reading the summary there is no way of knowing.

[Myrina]

10. +1

n/t

[Leith]

9. Well, Not Really Fixed Because There's More Than Just a Website

There's another big consideration that most people aren't aware of: the database is not on a network. The user interface is. The "workings" of the whole thing is on a mainframe computer - and that kind of thing isn't taught much any more in universities. You have to learn it on the job.

The programmers may have made a nice informational website, but it is nowhere near fixing the whole program. Programming on a mainframe is worlds different than programming on a PC, Mac, or the internet. For starters, the operating system doesn't do half of what is expected (like automatically expanding database size). Since mainframes are most commonly used for huuuuge applications (state and federal government and corporations with giant databases like the phone company), most programmers don't have any experience with them.

Yeah, I used to be a mainframe programmer. It could be horrendous, but the plus side for the ACA is that the computer operators have almost 50 years of practice with security. I have never heard of a single instance of a hacker or spy getting past RACF security. Ever.

Disclaimer: I do not work on the ACA nor am I any way involved with the program construction. I'm assuming that something this big would have to be mainframe based. Also assuming that things have not changed in the past decade.

[htuttle]

12. Things have actually changed quite a bit in the last decade

Distributed computing is all the rage now. Instead of one enormous database, you might have 20 or 30 of them, with the data sharded across them. Instead of one huge application, there might be 10 smaller ones, all connected to a message bus, etc.

Old-line industries and government probably still do things much as they did 10 years ago, due to the huge investments they already have, but someone starting a greenfield project from scratch would be able to do things quite a bit differently. Of course, that new system is going to have to interface with the old ones at the insurance companies at some point. Those are the places where I'm guessing the worst bottlenecks happen.

[passiveporcupine]

11. K&R

Extremely cool. Thanks for posting.

[ErikJ]

13. Need AGE, number of family members and smoker status too

to get appropriate health plans

[ailsagirl]

15. kick

[a2liberal]

17. This site doesn't really seem any better than the official pre-reg one

I was excited about the article because I thought maybe they did a full thing with age-specific quotes and plan details. But it really looks like just a dumb frontend to the official one with marketing to make it sound like they did something better. Compare to https://www.healthcare.gov/find-premium-estimates/ ... the only difference is some dynamic buttons to change your choices, zip code lookup instead of state+county, and getting to skip the million screens reminding you that you may be eligible for a subsidy.

[Rstrstx]

20. Actually I like it better

If you look at the bottom left of your screen you'll see a place where you can enter your income and it will determine your subsidy. On the healthcare.gov site you have to go to the Kaiser website to estimate your subsidy then go back (after you've divided by 12) to calculate your actual cost.

This site looks simpler, it also leads you directly to sites like Blue Cross or (for the Austin area at least) Sendero. Sendero claims they will do the application work for you, whatever that means (don't know if it includes getting you the subsidy). So yes, I think it's a better site. I really like the idea that some companies which offer policies are starting to take it upon themselves to do a lot of the work that you'd otherwise have to do on the nearly-unhackable healthcare.gov website.

[a2liberal]

30. Ok

I'll concede slightly better, but still not what I was hoping it was (full-fledged age-based rate lookup, comparison tools [deductibles, co-pays, etc])

[Rstrstx]

31. What do you mean by comparison tools?

Do you mean the specifics about coinsurance, deductibles, etc? If that's the case you might want to give this website a try:

http://www.valuepenguin.com/ppaca/exchanges

[a2liberal]

32. Yes, something along those lines

There seems to be a lot of data missing for some plans, and it would be nice to be able to see side-by-side comparisons, but that's the best I've seen so far. Thanks!

[Jim Lane]

18. Didn't the Kaiser Family Foundation have a similar service early on?

I remember looking at the KFF site and being able to see the specific policies available, the details (co-pay, etc.), the gross price, and the subsidy based on whatever income I stated.

I noted the URL on a document on my hard drive but that computer is in the shop at the moment. When I go to kff.org now, I can find the subsidy calculator but not the information about the policies available.

The site mentioned in this thread doesn't have the detail about each policy that I remember finding at KFF. Even within a given category (bronze-silver-etc.), policies varied in terms of the co-pay, co-insurance, deductible, and cap.

Has anyone used the KFF site? Is that information still there and just eluding my search-fu?

[Kablooie]

19. The California website works similarly.

I just tried the sherpa site and it's quick and efficient.
Pretty cool!

[bigworld]

23. This is beautiful. Fast, efficient, simple, logical.

... look at Maryland's convoluted site if you want to see an exercise in frustration (and a waste of $67 million).

[seabeckind]

25. Shows why systems work is so dam hard.

Each of these sites fail to meet the true requirements. In the case of Healthcare.gov, the functional side threw every possible scenario at the systems people. And then since the systems people were primarily contractors with no damping factor in the form of a knowledgeable gov't systems person, the contractor promised it all. Just sign right here and we'll work that in.

In the case of the subject programmers, they took the bare minimum of the requirements and implemented that. Of course it's easy and fast, it cuts corners to prove that a quick cheap system is possible. Itsd requirement wasn't to actually implement a working system, it was to prove that a halfassed job is possible.

Different goals.

The big fallacy in putting any credence in this system is that some numbskull rightwinger will point at it and try to use it as one more example of why gov't fails.

Implementing systems is very hard. It follows the 90-10 rule. The first 90% of the requirements takes 10% of the effort, the next 10% takes 90% of the effort. And the more people thrown at the system increases the development overhead exponentially. It ain't like doing a highway.

The most difficult part of the systems work is determining the most effective point to stop in the 90-100 range. To do that you have to know the 100% requirement part but decide that we'll stop at 97% and kick the rest out to a warm body cause that last little 3% is going to cripple the whole development.

But as I said above -- no contractor will ever say that. There's much more profit in that last 3%.

[BenzoDia]

26. This is pretty handy

[B2G]

29. It's one thing to view rates

They don't even link to the plans and the estimated subsidies are questionable.

It's an entirely other matter to code everything required to do all of the verifications and actual enrollment. The number of interfaces alone is huge.

If it was that easy, it would have been fixed by now.