Sunday, October 27, 2013

Always Enough Time to Do It Over

If you have been reading my posts over these last few years, you are most likely aware that my chosen career field is Software Quality Assurance and Testing so needless to say, I have found the contretemps about the Affordable Care Act web site to be quite interesting. A friend from my small hometown in Kentucky last Wednesday (October 23) posted a link to a New York Times opinion piece by Dr Ezekiel Emanuel about the problems:

First, the Obama administration acted too slowly. It waited too long to release specific regulations and guidance on how the exchange would work. It also waited too long to begin building the physical Web site. These delays were largely because the administration wanted to avoid election-year controversy. This may have been a smart political move in the short term, but it left the administration scrambling to get the IT infrastructure together in time, robbing it of an opportunity to adequately consult with independent experts, test the site and fix any problems before it opened to the public.

Second, the ostensible quarterback of the federal health care exchanges, with responsibility for integrating all the various components, is the Centers for Medicare and Medicaid Services. While the agency has expertise in issuing reimbursement rules and overseeing large-scale claims-processing operations, it has little expertise in creating a complex e-commerce Web site. More important, there was no single senior person in the agency tasked with running the exchange rollout.

Finally, this was not the first health insurance exchange ever created. Massachusetts has had years of experience with its exchange, and there are private exchanges, like eHealth, where individuals can shop for insurance. In addition, many states, like California, Connecticut and Kentucky, had already spent around two years building their exchanges, gaining experience and proving it was possible to create a good customer shopping experience. It does not appear that the Centers for Medicare and Medicaid Services or its contractors spent much time reviewing these models and adopting best practices.
My friend had posted a comment with the link about how he was curious about the technical design, project plan, QA processes and other software development metrics and planning used. I added my 2¢ worth in the following comment:
I will go out on a limb here and with no evidence (other than experience in large complex applications) state that the QA process was probably cut short due to other "unexpected problems"
Now just imagine my (lack of) surprise when I saw news reports on Thursday about there being extremely limited testing of the site. From McClatchy:
WASHINGTON — Private contractors working on the troubled federal health insurance marketplace told a congressional committee Thursday that they needed several months, but only had two weeks, before the launch date to fully test what could be the most complex government IT system in U.S. history.
I have worked on large, complex client-server applications for child welfare databases for various states. I have tested various applications or overseen testing as an IV&V contractor in multiple states. I was not at all surprised to hear that testing had been given short shrift because testing is pretty much always given short shrift. Invariably, the project schedule and "go-live" dates are seemingly graven in stone so when problems crop up, time has to be taken from other areas in order to meet the required date. So time is taken from testing most frequently. Hyperbole requires me to say at this point that "I can't imagine the pressure the testers were under to meet the schedule" but in fact, I can very well imagine the pressure they were under. It is a cliche but many software development professionals can attest, there is never enough time to do things right the first time but there is always enough time to do things over.

In the interest of full disclosure, I will now state that the overall contractor for the effort, CGI Federal, is part of what was a former employer of mine, American Management Systems although I was part of the State and Local Government Group rather than the Federal (non-DoD) Group.

While I am among the uninsured, I have not gone to the web site for a couple of reasons. First, I am a veteran so will be checking in a couple of weeks to see what coverage I am eligible for through the Veterans Administration. I have not checked with the VA yet because I did not want to be bothering them while they were dealing with the recent shutdown. Secondly, I am residing in Kentucky which has its own newly launched insurance exchange (as noted by Dr Emanuel above) so if I am not covered through the VA, then I will enroll through KYnect along with a few thousand other fellow Kentuckians.

For what it's worth, CNBC had this article on Tuesday (October 22) with some quotes from a former president of Oracle:
The federal Obamacare insurance marketplace's many tech problems were inevitable given the brief time contractors had to build it—but they can be fixed fairly soon at a fraction of the troubled website's cost, the ex-president of software giant Oracle told
Indeed, most anyone who has spent significant time working in the tech field has experienced similar situations. There is no application that has ever been built that has worked first time every time. No matter how much time is spent on design, development, and testing, there are problems that will not show up until an application goes live. It is also true that most of the problems are fixable and not a justification for doing away with the entire Affordable Care Act.

Also for the record, I was and am still a proponent of a "single-payer system" and of getting the for-profit insurance companies out of the picture completely.

And because I can:


  1. Enjoyed the read. I have been in the insurance industry for thirty years and I fear that if your idea to get rid of for-profit insurance companies were to be adopted we would be left with less talent and subsequent inferior claims adjudication, provider contracting and ultimately, higher costs. The same deterioration would happen, I think, in any industry required to forego profit. Perhaps doctors should be required to work without profit. It is scary to think about how bad the rollout of the ACA would be if the computer geeks were forced to work without profit. On second thought, could it be worse?

    1. Well Canada, Great Britain, France, Denmark and all the other industrialized nations seem to do reasonably well with their health care without having for-profit insurance companies. The US spends nearly double what the next closest in ranking for spending in the world yet the outcome rankings places the US far down the list. For profit insurance companies rake roughly 20% - 30% off the top and make the "death panel" decisions so decried by many folks (by deciding what coverage someone will receive and denying treatments)

      Here are a few links:
      Most efficient via Bloomberg


      New England Journal of Medicine