Healthcare.Gov

…and the gulf between planning and reality:

The idea that “failure is not an option” is a fantasy version of how non-engineers should motivate engineers. That sentiment was invented by a screenwriter, riffing on an after-the-fact observation about Apollo 13; no one said it at the time. (If you ever say it, wash your mouth out with soap. If anyone ever says it to you, run.) Even NASA’s vaunted moonshot, so often referred to as the best of government innovation, tested with dozens of unmanned missions first, several of which failed outright.

Failure is always an option. Engineers work as hard as they do because they understand the risk of failure. And for anything it might have meant in its screenplay version, here that sentiment means the opposite; the unnamed executives were saying “Addressing the possibility of failure is not an option.”

This is a point I make in the book. Which will be released (finally!) this week, in time for Christmas.

[Update a couple minutes later]

This is a good point as well:

It’s certainly true that Federal IT is chronically challenged by its own processes. But the biggest problem with Healthcare.gov was not timeline or budget. The biggest problem was that the site did not work, and the administration decided to launch it anyway.

This is not just a hiring problem, or a procurement problem. This is a management problem, and a cultural problem. The preferred method for implementing large technology projects in Washington is to write the plans up front, break them into increasingly detailed specifications, then build what the specifications call for. It’s often called the waterfall method, because on a timeline the project cascades from planning, at the top left of the chart, down to implementation, on the bottom right.

Like all organizational models, waterfall is mainly a theory of collaboration. By putting the most serious planning at the beginning, with subsequent work derived from the plan, the waterfall method amounts to a pledge by all parties not to learn anything while doing the actual work. Instead, waterfall insists that the participants will understand best how things should work before accumulating any real-world experience, and that planners will always know more than workers.

This is a perfect fit for a culture that communicates in the deontic language of legislation. It is also a dreadful way to make new technology. If there is no room for learning by doing, early mistakes will resist correction. If the people with real technical knowledge can’t deliver bad news up the chain, potential failures get embedded rather than uprooted as the work goes on.

This is also a crucial distinction between “new” space and old.

16 thoughts on “Healthcare.Gov”

  1. I just have to add a real world example.

    A company I worked for had software that included work orders, which included services, where each service could be performed by more than one mechanic, paid different rates and working different amounts of time on the same service. The database structure did not reflect these realities.

    Management is not really interested in your little programming problem which in reality is a design problem. It’s there design after all. The programmer has to make it work and can in very fragile code putting numbers in the database that are derived from the information at hand. Knowing that’s wrong because the numbers that derivision come from are independently subject to change.

    In other words, it looks good and seems to work until somebody comes along and does what people do.

    I’d bet a huge some of money this is the story repeated everywhere in the ObamaCare code. Of course, this is not the only problem, just a very common one. You can’t believe how bad some database designers are and how little responsibility they take for some of the problems they cause.

    ObamaCare itself is full of business logic problems that many have pointed out which are ignored and lied about by others. The problem is computers, like rocks, just do their thing. Computers (and rocks) are not the problem.

  2. I ran across an interesting comment on this Politico article about Obama’s “fix” being illegal.

    Someone needs to file a qui tam action against Obama for conspiring to defraud the government by urging insurers to violate the law.

    From the Qui tam wiki.

    The False Claims Act (31 U.S.C. §§ 3729–3733, also called the “Lincoln Law”) is an American federal law which allows people who are not affiliated with the government to file actions against federal contractors claiming fraud against the government. The act of filing such actions is informally called “whistleblowing.” Persons filing under the Act stand to receive a portion (usually about 15-25 percent) of any recovered damages. The Act provides a legal tool to counteract fraudulent billings turned in to the Federal Government. Claims under the law have been filed by persons with insider knowledge of false claims which have typically involved health care, military, or other government spending programs.

    Not enforcing the provisions of the ACA constitutes a violation of federal law, and as those insurance contracts are unenforcible in court, they constitute fraud, as does encouraging any insurer to engage in such a gross and flagrant violation of federal law. So how much is 20% of a couple billion, and who has a lawyer handy who’s willing to take the case on a percentage basis?

    1. Why don’t you do it?

      Instead of urging someone else to do it, if you think there is a qui-tam action there, you hire a lawyer
      and file.

    2. I won’t do it because it would open me up to retribution by the Administration, get me audited by the IRS, put on no-fly lists, put under continual NSA monitoring, and all my private financial information like bank account numbers would be e-mailed to Nigerians.

      1. wow,

        the founding fathers risked their lives, fortunes and sacred honor to fight the British King,
        and you are afraid of an IRS audit.

        1. So you admit Obama is just as far gone into syphillactic dementia as George 3? And that the current Democratic Senate is as corrupt as the late 1700’s Parliament?

      2. So you don’t doubt that the result would be massive Administration harassment and prosecution of anyone who makes it on their “enemies” list.

        1. wether it is or isn’t, you have to be willing to step up.

          In the Ghetto, people step up to identify drug dealers, shooters in robberies,
          car thieves, etc… Sometimes they get harassed, sometimes, they don’t.

          In corporations, people step up to blow the whistle on wrongdoing from
          QA, internal fraud, and they become wildly unpopular to having their careers wrecked
          or assaulted. (See Karen Silkwood).

          Citizen activists get harassed all the time by government and corporations.

          in government, whistleblowers get harassed and retaliated against.

          I’d suggest you either cowboy up, or quiet down.

          If you don’t have the stones of a Karen Silkwood or a Siebel Edmonds or Colleen Rowley,
          well, what can I say.

          1. Of course, the lawyer would also have to be prepared for the consequences. In fact, one of the easiest things for the opposition to do in this case would be to make the suit impossible by (on some pretext) removing said lawyer’s license to practice.

            Unfortunate vehicle accidents or a “coincidental” mugging with fatal consequences wouldn’t be beyond the bounds of possibility, either.

          2. It’s funny you bring up whistle blowers. Have you been following the Obama administration’s treatment of them?

  3. “This is not just a hiring problem, or a procurement problem. This is a management problem, and a cultural problem”

    And an ideological problem. Ideology is a belief system and culture is far too broad to encompass it.

  4. In college I took a course that was all about practical software projects, the last part involved a fairly substantial project with a team of a handful of classmates. Naturally we ended up doing a “big bang integration” with everyone working mostly alone until the last minute. Suffice it to say that was the last time I ever willingly participated in a big bang integration type project, it’s pretty much never a good idea. Today software development best practices have relegated such archaic schemes to the dustbin of history. Daily builds and “smoke tests” have been the accepted minimum level of development practices since the ’90s at least, and it’s been the accepted best practice in web dev. for at least the last 5 years, if not longer.

    Yet here we are, 2013, and one of the most expensive and important websites in history was built using the equivalent of stone knives and bone clubs. To say that this should be an embarrassment of cataclysmic proportions is an understatement.

  5. One thing to bear in mind; the website wasn’t just badly done, it was literally incomplete. For example, the payment option does not work, and according to the guy running the project in testimony to congress, that’s because it hasn’t been written yet. The same goes for several other things, totally at least 40% of the code.

    So, to use a spaceflight analogy, we might say the administration did the equivalent of rushing s Shuttle out the the pad without the usual tests and certs, and then skipped most of the countdown checks before hitting the launch button. This analogy would be wrong, because an accurate analogy would be doing all that, plus not completing stacking of one of the SRBs before hitting the launch button. The result would be immediate, very violent, and leave nothing but smoking rubble. Obama would then describe it as a “glitch” and promise to fix the thing in 30 days.

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