

Could A Tech Giant Build A Better Health Exchange? Maybe Not - daigoba66
http://www.npr.org/blogs/alltechconsidered/2013/12/02/248225524/could-a-tech-giant-build-a-better-health-exchange-maybe-not

======
nostrademons
I think the root cause of both this and the healthcare.gov failure is Gall's
Law:

[http://en.wikipedia.org/wiki/Gall's_law](http://en.wikipedia.org/wiki/Gall's_law)

The problem with dealing with the government is that they have a long list of
requirements that they absolutely _must_ have. As a result, the programmers
will work to satisfy all of those requirements, and will let the unwritten
requirements (like, oh, "must not fall over when more than a dozen
simultaneous users connect") lapse. Frequently with software you _have to_
trade off requirements against each other; when you go to implement it you
realize that what the customer actually wanted is self-contradictory. The
essence of good product management is being able to make these trade-offs
smartly.

One thing that all the big companies realize is that to build a large working
system, you have to start with a small working system, and then evolve it so
it keeps working at all points. Google doesn't dictate exactly how the product
is going to turn out at the end - it sets a general direction and product
statement, and lots of individual product managers or tech leads then work on
figuring out the details.

~~~
danenania
This makes a lot of sense. As a consultant, I consider the most valuable and
important service I offer to be analyzing, simplifying, and focusing a
project's goals and requirements. If this part of the process goes well, it's
usually smooth sailing on the design and implementation. If it gets impeded by
obstinance, scope creep, or indecision, the project is probably doomed from
the start.

Being handed a pile of requirements that are sloppy and contradictory and then
being told they are non-negotiable is kind of like being asked to build a
submarine out of swiss cheese. No amount of money or expertise can make that
work.

------
chaz
This was never a technology problem -- it was a business problem. Extremely
complicated industry dealing with legacy infrastructure, data, and processes
with sprawling, out of control requirements.

As context, take a look at Alabama's RFP for their health exchange. [1] It's
286 pages long. A version of it was issued just a month earlier. And this is
just the RFP -- I assume the product spec was longer, much more detailed, with
changes issued right into summer 2013 or later.

[1] [http://www.aldoi.gov/PDF/Consumers/FINAL-Alabama-HIX-
RFP-v47...](http://www.aldoi.gov/PDF/Consumers/FINAL-Alabama-HIX-
RFP-v47_acceptedchange.pdf)

~~~
malandrew
I simply don't know why we don't handle this like we do tech startups. Start a
small $15 million dollar fund with $1 million for each startup and a project
whose scope is a very small starting point for the long term project. Give all
15 startups 6 months to a 1 year to develop the first version. Whittle it down
to like 3-4 startups and grow the scope for the second round of funding. Give
each like $3-4 million. Whittle it down to two or so startups.

Anything is better than this big design up front with a million must have
requirements.

I also don't understand why every state has their own portal. There should be
maybe at most half a dozen different teams/designs/systems. We could expand on
the startup funding idea by having each state act like a venture capitalist.
They hear pitches and invest in the teams and designs that are most promising
each round.

All code from all participating startups should be some open source license,
preferably a Public License, but a BSD-style would work too. This allows the
creation of an ecosystem where all are allowed to borrow from one another.

~~~
rmc
> _a project whose scope is a very small starting point_

I can see the headlines and complaints now. People will complain that you're
forgetting about $EDGE_CASE, like pensioners who worked abroa/new unmarried
mothers/mothers who divorced recently/young children with
$RARE_DISABILITY/etc./etc.

No matter what you do, so photographic sympathy story will have been
"delibrately left behind". No politican wants to sign off on that.

You can't win.

------
olefoo
As an Oregonian, this whole episode irritates me to no end; the fact that I'm
shoving an application into this meatgrinder is just insult piled onto injury.

State and local governments should learn from this and other episodes ( our
failed DMV upgrade from a few years back for instance ); that an RFP and a
procurement process that eats 5% of the budget before anything actually
happens is bound to betray the public trust.

While I'd like to think that there was an easy solution; say appointing an
'implementation czar' and requiring open source solutions be the default. I
don't fool myself as to the likelihood of that working any better.

Governments are human nature magnified and focused and as such they have all
the human frailties; not to mention that everyone involved is pushing and
pulling in a different direction.

That said; I do believe that all government IT projects should be open
sourcing everything they do or have done for them ( not the data, the
functionality ) so that it is open to public review and provides the
possibility for public improvement.

At the very least if that $43 Million had been spent on something that left a
github repository behind; Oregonians would have something to show for that
money...

~~~
cgs
Speaking of Oregon, I went to find the online application today and was
disappointed (but not surprised) to find out it can only be submitted using
IE. Tens of millions of dollars spent and I can't even use a modern browser.

~~~
olefoo
Yeah, that was pretty special. It's because it's a fillable PDF...

------
andrewflnr
I think the lesson to take from this whole fiasco is not that anything the
government does is bound to fail, but that the redundancy offered by multiple
_competing_ entities trying to do the same thing is valuable. Everyone here
knows software projects have a high failure rate, especially those with
complicated specifications. Trusting something as important as a national
health care system to the success of one project seems insane to me.

~~~
dreamdu5t
I don't buy it. This contractor got paid. I don't see how a business would pay
a contractor for not delivering, and if they did deliver and the product was
crap, they would directly suffer as a result.

The _only_ reason the government has to change healthcare.gov is because it's
an issue that republicans have put on TV to use against democrats. That's it.
If it sucked, but wasn't in the news cycle (like everything else), then the
government wouldn't do a damn thing about it.

~~~
Tloewald
So, do you have any experiemce of consulting work (I mean the big firms like
McKinsey and Accenture)? Most consulting work comprises being paid handsomely
for failing to deliver. Sometimes they get paid to destroy companies. (I think
McKinsey has run some countries into the ground.)

------
ChuckMcM
I swear I am astonished that they didn't just tell Zynga to build it, call it
'Healthville' or something, I am sure my Facebook feed would fill up with
"Jimmy Can't Sign up for Colon insurance unless he can get 8 friends under 40
to sign up with him, click here to sign up for Jimmy!"

~~~
fletchowns
I know you're just joking, but it's kind of spine tingling to think about what
Zynga might do with personal health data.

------
nhebb
Two issues came up during congressional testimony that I haven't seen
discussed are (1) the constantly evolving requirements and (2) the lack of
security. I don't know whether the Oregon site has security issues, but the
evolving requirements would likely affect both the federal and state sites.
According to the testimony I heard, the 2400 page law resulted in tens of
thousands of pages of regulations, which were still being codified up until
September of this year and impacted site requirements. If this is true then
it's little wonder the project failed.

BTW, as an Oregonian myself, I find it irritating that the site doesn't work
but we are still being subjected to the truly awful Cover Oregon ads (see
[http://www.youtube.com/watch?v=Xv2UUcXCo9g](http://www.youtube.com/watch?v=Xv2UUcXCo9g)).

~~~
olefoo
I don't know I thought the one ad with the musician from Bandon, was kind of
catchy; but it did seem like a poor use of public funds.

The musician is Laura Gibson
[http://www.youtube.com/watch?v=Xv2UUcXCo9g](http://www.youtube.com/watch?v=Xv2UUcXCo9g)
and the song is very hopeful.

But, buying all that airtime and all those billboards...
[http://www.wweek.com/portland/article-21410-live_long_and_pr...](http://www.wweek.com/portland/article-21410-live_long_and_prosper.html)

Definitely showed the risk of a marketing campaign too far in front of the
product. Not to mention that a marketing campaign for something with so much
pent up demand is kind of goofy.

------
Glyptodon
I'm not real thrilled with their use of Oracle as an example... If you've used
Oracle you've probably done it wrong is kind of a mantra for me, anyway.

~~~
sliverstorm
That seems like a rather conceited thing to say.

~~~
malandrew
Not really. Have you ever worked on projects outsourced to Oracle, IBM or
similar large company?

The project managers are total PMP dopes that know fuck all about software
engineering. People get promoted to those positions because they are
political. Not because they know what they are doing. Back in my big corp life
from 5-6 years ago, I witnessed several multi-million dollar train wrecks.
They were the epitome of sunk costs fallacies.

Oracle and IBM both have great developers working on products that are core
technology that both those companies sell, but their software engineering
consulting and project management is atrocious. There is a reason why
companies like Thoughtworks exist. TW and similar firms come in to clean up
the messes started by the Oracles and IBMs of the world.

------
etrevino
I'm not sure how this is significantly different from the Federal government's
approach. Both hired Big Data. There was little to no accountability during
the process. In the end, neither product was delivered because the
consequences of nondelivery weren't, well, consequential.

------
saosebastiao
40 million? Thats just for one core of the database! Oops, we forgot to tell
you about that? Gee, I'm really sorry. Have I told you about our Spatial
Extensions?

~~~
jsmeaton
The Oracle licensing model drives me crazy.

------
eranation
These things drive me crazy, 40 million $? I'm sure half of the people here in
HN if not more, would do it twice as good, twice as fast, for a fraction of
the price.

On the other hand, I've worked with tough clients that want a solution "for
everything" and force the vendor into a rigid waterfall / BDUF but in the same
time keep changing the requirements as they go.

But come on, for 41 million dollars you can develop it as static pages, that
get submitted to mechanical turk and will have change to operate this for
years... I don't get the math.

I'm in the wrong business, I should start applying for government contracts.

~~~
cheez
When I was in school, I used to troll around government offices looking for
easy contracts my friends and I could actually deliver on. What we discovered
is that the amount the government pays is not for the work, but for the pain
you endure in dealing with the government.

~~~
comicjk
Ironically, most of this pain was designed to prevent government waste.

~~~
boie0025
How true, and ironic indeed.

------
pcurve
Anyone here working for Fortune 500 company's IT department knows that hiring
companies like IBM global service, accenture, capgemini to do large IT
projects is like rolling dice on craps table. Large private corporation's
procurement process isn't any better. Anybody here ever had to deal with PEGA
systems? :shudders:

~~~
rtx
I left my job because of them.

------
saalweachter
I wonder how the math works out.

If you assume that each dev has a salary of $100k, they're probably costing
the company $200k for benefits, office space, etc. so $40 mill pays for at
most 200 years of dev time.

Add in managers and a profit margin and $40 mill probably buys you a team of
fifty devs for two years.

That doesn't sound too absurd. They may have failed, but $40 million seems
like the right ballpark for a healthcare exchange.

~~~
__chrismc
Don't forget to account for licensing (after all, this _is_ Oracle),
hardware/hosting, software 'maintenance' fees, etc... I'd have thought a
significant part of the $40m figure to be in these types of cost alone.

------
dethstar
I dont really understand why you guys dont get mad at your taxes beung thrown
like that. Last time something like this was to happen in mexico this
happened: [http://techcrunch.com/2013/04/14/bringing-down-the-
mexican-m...](http://techcrunch.com/2013/04/14/bringing-down-the-mexican-
mafia-how-mexican-hackers-stopped-a-93-million-fraud/)

------
tibbon
I'm honestly not sure why a better health exchange couldn't be built by
practically _any_ team. I've kept hearing on NPR that one of the big problems
is that they 'needed to make it talk to X number of other government/insurance
service'. Have these people never heard of REST or JSON? The problems that the
health exchange is facing _seem_ to be largely solved problems and not ourside
the realm of reasonable scalability. I'm good, but not amazing at development,
and I think I could make Postgres do that is needed for this within a week or
two.

~~~
patio11
Man I hate it when HN makes me feel like a grizzled veteran of the technology
industry, since I'm barely 30, but I suppose having ever worked with a legacy
system qualifies me to comment here:

Some challenges with "Just use REST/JSON and then Bob's your uncle:"

1) You will probably not have the source code of the system you are
integrating with, which is likely a mainframe system written in COBOL.

2) The engineers who built that system are retired or dead.

3) The company which they worked for is no longer operating / was sold 15
years ago to IBM and then reverse merged into a different unit 7 years ago /
lost all of its records in a fire / etc.

4) Your sole documentation is the dogeared paper copy describing file formats
for their sole input method, CSV files, which was current as of its
publication date, before you were born.

5) Your sole documentation incorporates by reference four other documents
which, ahem, yeah.

6) You have a working test suite which accurately models the production system
in all respects. It is the production system. Please do not run the equivalent
of Accounts.all.delete when cleaning up from your test runs. (The system won't
stop you from trying to do that. No, really.)

7) Praise God, there is actually a bridge between the mainframe system and the
Internet, so at least you don't have to reverse engineer wire protocols. It
was coded in 1996 by IBM's crack team of integration engineers. This will give
you an excellent opportunity to brush up on your Java 3.4.1. It speaks
REST/JSON, as long as as you spell REST/JSON "XML". Good news, though: your
time spent learning the CSV file format won't be wasted, since the XML is just
a straight mapping to it. Except for the four bugs in the mapping, which are
dutifully recorded in a database in Hyderabad whose existence will be exposed
to you 8 months into the project.

Welcome to legacy integration! We hope you enjoy your stay.

~~~
incision
Anecdotally, what's described here would actually be unrealistically
optimistic given the context of Government where I have entirely too much
experience.

First, you can forget about having documentation of any kind or anything as
recent as XML.

Also...

8) Nearly everyone you need to interface with on the customer side is
apathetic at best. More likely, they are plain adversarial for fear that the
work you're doing will eliminate their jobs. A single person can plop
themselves in your critical path and refuse to cooperate - millions of dollars
or public safety be dammed - there is nothing you can do other than work
around them.

9) You will need to coordinate with half a dozen other subs under the contract
prime. Some of those subs will be unassailable due to pre-existing
relationships. Others will depend on talent with a 10 hour time difference.
One will suddenly be in charge of "testing" your code in order to generate
more billable hours. You will be in a constant battle to avoid being used and
abused by the prime to make up for the deficiencies of other subs.

------
ibsathish
Give it to a dying start-up. They'll certainly pull it off with cutting edge
technology & tools with great eye for UX, which usually giants fail to do.

This will give them a runway till take-off.

------
mumbi
why would anyone give 40 million to Oracle for a web development contract?

~~~
jrmcauliffe
I would assume because the sales team has told them they already have a 'best
of breed' solution in 'your vertical market'. Oracle then bills the client for
them to write ('customise') said solution, then adds it their product
portfolio.

------
moron4hire
I read this and I hear every experience I've ever had on government contracts:
a bunch of entrenched liberal arts majors who-know-what-these-computer-things-
are-about on the governments' side thinking they can throw money and jargon on
literal paper at a bunch of fresh-out-of-college interns hired by the company
owned by the government's project manager's college roommate, getting pissed
when the programmers don't understand their acronyms and 20 year old paper
business process with steps labeled "call Jim in accounting".

