Category Archives: Health

Business, Health, Media Criticism, Political Commentary, Popular Culture, Space, Technology and Society

Healthcare.Gov

16 Comments

…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.

Business, Economics, Health, Media Criticism, Political Commentary, Social Commentary

The ObamaCare Debacle

5 Comments

Will it kill Big Blue?

Edsall is simultaneously overestimating the policy sophistication of the white middle class and underestimating its morality. While it is true that, as Edsall points out, Obamacare is an aggressively redistributionist program that intends to shift hundreds of billions of dollars away from the middle class to the poor, I don’t think many voters have done the math on this. They are not reacting to the $455 billion in Medicare cuts that help to feed the Obamacare beast because not many people really understand how the new system is supposed to work. And at the same time, unlikely as it may sound to the finely tuned consciences of the New York Times editorial page, there are scores of millions of middle class white Americans who don’t hate minorities and would actually like to see things go better for them.

Sorry, lefties, the race card is maxed out.

Health, Media Criticism, Political Commentary, Social Commentary

Schadenfreude

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Has its limits:

I suspect that one of the reasons Obama’s approval rating is in free fall is because of his obvious surprise and petulance in his public encounters over the disaster of Obamacare. He has made some grudging half apologies, but it is clear that the only thing he is sorry about is that he cannot — not yet, anyway — simply decree what happens with health care in this country. He believes himself above the law and is impatient about finding a means of achieving that discretion. For our own good, of course. Many observers on the Right have long known this about Obama. Suddenly, though, it is out there for all to see. The American people don’t like tyrants, even smooth-talking, Harvard-educated ones. The great trek away from Obama and what he stands for — above all, government unlimited — has begun. The journey will not be pretty, but I think it is all but certain to continue.

Let’s hope.

Business, Economics, Education, Health, Media Criticism, Political Commentary, Social Commentary

Obama’s Learning Curve

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I wouldn’t call it “slow.” It actually basically vertical:

The education President Obama received at Columbia University and Harvard Law School — and delivered to others as a lecturer at the University of Chicago Law School — encourages the fantasy of a political world subject to almost limitless manipulation by clever and well-orchestrated images. This explains why the harsh exigencies and intractable forces of politics keep stunning the president, each new time as if it were the very first.

How might higher education be reformed to produce political leaders more familiar with how the world really works, more alive to the realities of social and political life and better able to discuss them honestly with the American people?

He’s lived his entire life in a bubble of unreality. A lot of us realized this in 2008, but a few million too few.

Business, Economics, Health, Media Criticism, Political Commentary

The ObamaCare Death Spiral

102 Comments

Some observations from Richard Epstein:

The Obamacare fiasco now flunks Justice Holmes’ extreme rational basis test in the 1905 decision of Lochner v. New York: “I think that the word liberty in the Fourteenth Amendment is perverted when it is held to prevent the natural outcome of a dominant opinion, unless it can be said that a rational and fair man necessarily would admit that the statute proposed would infringe fundamental principles as they have been understood by the traditions of our people and our law.”

In the light of day, Obamacare is that bad, even if the minimum wage law is not. Even the most ardent defender of government power must concede that it is sickening when a president tells people without healthcare insurance that they must navigate his government websites or go without. If “the right to healthcare” is fundamental, Obamacare violates it. Delay here is no option. If left in place, every single structural problem that besets Obamacare today will continue to wreck innocent lives a year from now. Striking it down is an act of mercy for the American people.

Bottom line: other than that it is logistically impossible and unconstitutional, the president’s “fix” is just fine.

[Update a while later]

Three lessons from ObamaCare.

I’m sure there are more than three, but I agree with them.