A reader writes:
Not to pooh-pooh the efforts of these guys, but it’s worth mentioning that their “strong suit”, California, has its own exchange and website, and the CA site has had none of the problems of healthcare.gov. It’s long had an easy way to preview plans with subsidy information. So, to the extent that these dudes are making things easier for non-Californians, good for them. But presenting this as a “fix” and using California as an example does CoveredCA.com a disservice.
Another points out:
Go to https://www.healthcare.gov/find-premium-estimates/ and you can do exactly what Health Sherpa does. This feature was functional from the start but no one knows about it. Also the big issue is the back side compatibility with the insurance companies and their systems. That’s where the big problems are. Also, HealthSherpa isn’t getting anywhere near the traffic, but that’s really an early launch issue at this point. Now why did they decide not to display shopping options upfront (which IS a big design flaw)? Two reasons:
1) ID verification: This is necessary for the “conservative” means-testing so that there won’t be fraud by people getting extra discounted insurance
2) Subsidies: In an attempt to avoid sticker shock, they want people to know they aren’t going to pay full price.
You can’t show people the discounts (aka subsidies) they get without the ID verification. So you want people to see that they aren’t getting a raw deal? Well, you have to verify. If anything this is showing the flaw of conservative reform, which in any version was based upon exchanges and subsidies.
The Health Sherpa has received some good press over the past couple weeks, mostly along the lines of “3 geeks built a better Obamacare in almost no time”. This is not a very complete or accurate picture of what’s going on here. Here are a few things to note:
* This site would not be possible without heathcare.gov because it uses data directly off https://data.healthcare.gov – a freely available service provided by the government. CMS (Center for Medicare and Medicaid Services) and their contractors did the hard work of getting, and approving, the rates from the insurance companies, often through processes regulated by the states, and building out infrastructure to store and deliver that data.
* The data provided by data.healthcare.gov is out of date and does not contain accurate plan specifications such as deductibles, coinsurance rates, OOP maxes and copays. All it gives for each plan is an estimated premium for a single adult aged 27, a child of unspecified age, an older adult aged 50, a couple of unspecified age, a single-parent household where the parent and child’s ages are unspecified, and a family of unspecified size and ages. Tobacco is not factored in, as it would be if you actually applied for insurance. So, if you are a smoker aged 49, you’re getting the same estimate from this data as if you’re a nonsmoker aged 21. Premiums and Metal Ratings alone are a bad way to shop for insurance. Depending on the cost of the care you need, a Bronze plan could end up costing you less overall than a Silver plan, depending on the deductibles and coinsurance rates.
* Since the data was released in mid-October, building apps to make use of it was a logical step. Here are a few your readers might enjoy: a search engine using the same data (including subsidy calculations), another search engine using the same data (including subsidy calculations and support for Idaho and New Mexico), and http://www.healthdig.info (disclosure: I am the author of this site).
Another shifts gears with an epic rant:
This post hits home. I have worked as a government contractor for over 20 years and the system is broken and wasteful. It’s no surprise to me that the Obamacare website doesn’t work. The bigger the project is, the more money at stake, the more the overpaid and unqualified managers fight for work scope within and between companies and the more bureaucratic gamesmanship within the agency. I’ve been wanting to write an article or call a whistleblower group or stand on the street and scream. Instead, I keep collecting my paycheck waiting for someone else to break the story on this huge example of waste, fraud, and abuse – the legal contracting activity right in front of your nose.
There’s so much wrong, I hardly know where to start. First, the federal staff – the more the government relies on contractors, the less the government employee knows how to DO the actual work. They only “manage” the work. After a few years of this, few have kept abreast of changing industry standards and practices. The experience they may have once had becomes increasingly irrelevant. They know the jargon and the history of a project(s) but they rely increasingly on contractor managers to develop strategy, budget, and schedules. These contractor managers’ influence over their federal counterparts derives more from their friendship or their powers of persuasion more than actual skill.
Plus, the federal staff have civil service protections, so if they screw up a project, there are few repercussions. I’ve seen federal staff spend $5-10 million dollars on a project that we knew would not further project goals and in most cases alienated the very players, such as state and local governments, that we needed as partners. No amount of polite warnings (you don’t want to say anything too bluntly because friendly relations keep the task assignments and cash flowing) can dissuade a federal manager from their path if their ego is at stake. And yet, I have never seen consequences for incompetent decision-making. They keep getting their salaries and their promotions and can do so for 30 years all without a track record of success or productivity.
Next is the demented contracting system. Often, a government office responsible for a project will have a “Management & Operating” (M&O) contractor and a “support services” contractor. There are legal differences between these two but in practice the feds simply pit the contractors against each other. The M&O contractor will write a project plan. The client doesn’t like the M&O so they hand the document to the support services contractor to review and comment. The competitor rips the document and tells the client they aren’t being well served. The client asks the support services contractor to draft their own project plan and now taxpayers have paid twice for the same work. Before the 1960s (pick your decade, government contracting has been expanding rapidly since WWII), the federal employee would have written the damn project plan. Now they aren’t competent enough to assess the work on their own.
The world of government contracting is very hard to enter, therefore a few companies get much of the work (just look around DC and the suburbs at the HUGE buildings that go on for miles along each commuter artery with the names of contracting companies). These companies become bureaucracies themselves. I’ve had a few excellent managers who would succeed anywhere but most have one skill – they retired from the agency for which they now contract and have excellent relations with the federal staff. They make six figure salaries for holding meetings with the clients and then their staff to relay the message from the meeting with client. They hold another meeting make sure everyone is trained to the latest irrelevant safety measure, and generally interfere with the work. They seldom do any of the work themselves and often don’t know anything about the subject they oversee.
The staff at the contracting companies, who often have the field experience and actually conduct the work, spend equal amounts of time 1) explaining the work to their managers, and 2) explaining and educating their clients why a project needs to roll-out a certain way. The real work to advance a project is squeezed in around these wasteful responsibilities. In addition, the profit for these companies increases with the number of employees they can directly charge to the project. The surfeit of people on these large multi-million dollar contracts makes me sick. Supposedly they can be fired at will, but sleeping at your desk, harassing other employees, having no skills directly related to the work at hand has never gotten someone fired in my experience – because their presence generates profit. Because of the profit motive, there is no incentive to work efficiently.
For example, the client may need to post material on a website to further public communication. The contractor has no incentive to see if a satisfactory website already exists that meets the client needs. Instead, they will spend millions developing a new site with fancy bells and whistles and populating with their own studies without regard to cost-savings or the needs of the users.
Finally, what drives me the most crazy is the argument that private companies replacing government is somehow supposed to be more conservative??? It is nothing but corporate welfare and inefficient use of taxpayer dollars. If you want to shift responsibility for weapons production or waste management or environmental cleanup, then shift the responsibility to private industry and get government out of it. But if anyone thinks hiring companies to do the work the feds used to do is efficient, they haven’t stepped outside their echo chamber long enough to look at reality. These contracting company officials are so savvy at playing the politicians, the regulatory system, the contracting system, and the legal system, that they’ve taken us taxpayers for a ride. Sickeningly, many of my colleagues are Tea Party sympathizers who see no conflict in their positions. I wonder how they would fare if they were thrown to the street and had to survive without a federal tit.