Everything is Awesome

Anyone want to take a whack at what is going on in Massachussetts?

Massachusetts health care officials struggling to repair the state’s hobbled website are looking at the possibility of leasing or buying technology from states with functioning insurance sites.

[…] The Connector is supposed to determine who is eligible for subsidies this year, and get everyone into a new insurance plan by the end of June. But the digital tool that looks for a match between all these people and the state’s 260 eligibility programs is still not working.

[Gov. Deval Patrick’s special assistant Sarah] Iselin says she may ask the federal government for another extension.

In the meantime, those 120,00 residents who have subsidized health insurance may have to switch plans by the end of March. Some insurers who extended their Commonwealth Care plans say they may not be able to extend them again because they are losing too much money or because contracts with hospitals and physicians have expired.

MA hired CGI Group to ogranize its transition into a system more compatible with the federal ACA program. Apparently CGI, the contractor that botched the Healthcare.gov rollout on the national level, did an even worse job in Massachussetts, and now a lot of people might or might not have health coverage at the end of March. It seems like the couple of weeks remaining ought to be enough time to finish getting everyone’s records in order, but seriously, WTF MA? Even Rhode Island and Maryland eventually got their house in order. This just seems baffling to me.

97 replies
  1. 1
    Cassidy says:

    Feast or motherfuckin’ famine. Hell yeah.

    OT, the best part of a good, hard session of lifting weights is the absence of guilt afterward as I enjoy two Whopper hamburgers. Mmmm Mmmmm Mmmm.

  2. 2
    jonas says:

    How the hell is this CGI outfit even still in business at this point? They appear to be the most incompetent tech services company ever.

  3. 3
    Campionrules says:

    Oregon’s website managed to enroll exactly zero people. Zero. It cost 200 million dollars and managed to perform perfectly bad.

  4. 4
    Belafon says:

    Like the federal government, I suspect MA has a rule requiring the state to look at a number of bidders before picking the lowest priced one. And, like when the federal government asked, there were only a few companies prepared for what is required to submit a bid. And CGI passed both (ready for a bid, and was the cheapest). Welcome to the flip side of trying to prevent corruption at all costs.

  5. 5
    BGinCHI says:

    CGI is the process in movies where stuff that’s not real looks real.

    The states should have seen this coming.

  6. 6
    drkrick says:

    I very much doubt that the criteria were as simple as ready to bid and cheapest. I know much smaller contracts are evaluated on a lot more than that. Call me a conspiracy theorist if you want, but I’m finding it hard to believe CGI is really this bad all of a sudden. Have they been trying to make this stuff work or the opposite?

  7. 7
    Gin & Tonic says:

    @jonas: We had a project that involved CGI, not by choice, and over the span of a year pretty much pulled out all the stops so we could off-board them as soon as practicable. We saw entrenched incompetence at nearly every level.

  8. 8
    aimai says:

    I live in MA and I have no idea why they did this. Except to say that perhaps they assumed, stupidly, that if the US government were going with CGI then it would be trivial to construct a single state’s website at the same time. I can’t even fathom why this is apparently so hard to do. For fuck’s sake we already had exchanges up and running here. Was it really necessary to redesign this from the ground up?

  9. 9
    Belafon says:

    @drkrick: I sent this link to a coworker back when the conspiracy theory was that CGI was chosen because one of the coworkers knew Michelle Obama.

  10. 10
    raven says:

    @Cassidy: And I come home from my workout to BOCA Burger and two whole grain frickin crackers!

  11. 11
  12. 12
    Biscuits says:


    That’s what I want to know.

  13. 13
    alhutch says:

    Oregon hired Oracle to do their state exchange website “Cover Oregon” and got exactly nothing for their money.

    Doesn’t matter how good the brand name is or isn’t, if the “boots on the ground” suck, so will the result.

  14. 14
    kindness says:

    I remember when Massachusetts rivaled Silicon Valley in computers. I first learned BASIC, Fortran & Cobol on a Digital Equipment mainframe. Yea that was back in the 80’s.

  15. 15
    SatanicPanic says:

    Quick someone call Mitt Romney!

  16. 16
    Fuzzy says:

    Maybe the state should turn this project over to one of the great local scientific universities as a grad study project. Put some bright eager minds to the task. Just don’t buy CGI stock or ever give them another contract.

  17. 17
    Cassidy says:

    @raven: Better you than me. No way man.

  18. 18
    Belafon says:

    @kindness: I attended Worcester Polytechnic in the late 80s. The school had DEC as a partner, so we had some nice workstations.

  19. 19
    Phoebe says:

    It’s a mystery. I’ve been using the Massachusetts Connector to buy unsubsidized insurance for years now, and up until October of this year it was a perfectly functional website, backed up by competent, dedicated people who were reachable by phone whenever there was any difficulty. Post-changeover, the site has become not merely unusable in the ways you might expect, but unusable in ways that make no sense at all in this day and age. And while the people who have been hired to answer phones and try to help people work around the catastrophic failure of the website are clearly well-meaning and hard-working, they don’t have anything like the expertise of the previous staff. They can’t answer a lot of fairly basic questions, and they can’t get information from the computer system any more than we can.

    To illustrate the degree of the dysfunction: In order to enroll in a new insurance plan through the new website, it is necessary to have an account on the new website. (You can examine what’s available and decide what to buy without an account, on the sporadic occasions when the site is up, but you can’t enroll in anything.) It is, however, impossible to create an account. I’ve tried to do it over a period stretching from this past November through February; on one occasion a staff person tried to do it for me. It fails over and over, at various points in what should be a simple process. It’s obviously not a security issue that somehow makes the coding difficult: the world is filled with websites that have secure account creation, and it’s never that difficult a process to register and set up accounts on those websites. It would be understandable, if maddening, for there to be problems with enrollment and subsidy calculation for a new and complex program. It is not understandable for there to be no way to create a mandatory account.

    The only reason I’m not panicking about my own coverage is that people in my situation have now been offered a way of avoiding the site entirely. In what must have been a move of desperation, they’ve looked at the current plans of everyone buying unsubsidized coverage via the old Connector, identified the plans our current insurers are offering that are most like our old plans, and informed us that all we need to do to enroll automatically in these best-match plans is to pay the new premium by the enrollment date. Since the plan they identified for me is in fact the one I’ve spent four months trying to enroll in, this will work out for me. But I hate to think what it would be like if I had wanted to make a major change — and even as a fix, this is obviously a lifeboat-on-the-Titanic kind of arrangement. I’m glad to have my own place on one of the lifeboats, but there’s not a lot of excuse for the ship having hit the damn iceberg. It’s good that there’s time for the state to keep churning out new lifeboats, is all.

  20. 20
    aimai says:

    @Phoebe: Disgraceful. I hate to say it because I’m not a “head’s should roll” kind of person but if Deval Patrick weren’t already not running again he really should have resigned over this. This isn’t rocket science. There’s no excuse for it.

  21. 21
    Cervantes says:

    Anyone want to take a whack at what is going on in Massachussetts?


    Problems with the web-site were first reported in July. In January the state hired MITRE (a non-profit MIT spin-off) to figure out what to do. MITRE’s report, issued in February, is available here (today only). Mostly the report blames CGI for its lousy project management and lousy “communications structures.” It also argues that various state entities failed to create a “unified vision,” which did not help matters. There are recommendations I do not have time to explain (read the report).

  22. 22
    Mnemosyne says:

    Meanwhile, California has enrolled almost a million people despite a weeklong website outage and a few additional problems.

    Also, someone was asking how they could file a complaint against Anthem Blue Cross in California, and I found another website to access the complaint form. You can fill out the online form in both English and Spanish, or print out a version in one of the other mandated translations (we currently have 13 different languages that state documents are available in).

  23. 23
    rikyrah says:

    The Financial Industry Doesn’t Want You to Know About Its Lack of Diversity
    Financial institutions fight a new rule that would have them assess employee diversity.

    Dodd-Frank, the Democrats’ bill to reform Wall Street following the crash, included a provision that creates Offices of Minority and Women Inclusion in each branch of the federal regulatory regime, such as the Department of Treasury and the Securities and Exchange Commission. (The provision doesn’t touch sexual orientation.) These new offices are tasked with boosting diversity within their own ranks and analyzing hiring practices of the businesses in their purview. Late last year, regulators from six of these offices wrote a rule, still in the proposal stage, to enforce the second half of that mandate. It’s a modest measure—a simple request that the banks conduct self-assessments based on a few best-practice guidelines, but it was enough to rile up the banks.

    Complaint letters sent from the main lobbying arms of the financial industry to regulators show a concerted effort to avoid changing their hiring practices and to dissuade regulators from revealing the lack of diversity in the banking sector. “In an otherwise good-faith effort to utilize the joint standards and meet certain standards or metrics relating to ‘diversity,'” the Chamber of Commerce wrote in its letter, “regulated entities may inadvertently run afoul of federal workplace requirements by, for example, engaging in ‘reverse’ discrimination.” Smaller regional banks shared those concerns. The Missouri Bankers Association likened the agencies’ proposal to a “government mandated affirmative action program.”


  24. 24
    raven says:

    @Cassidy: No red meat in over 20 years!

  25. 25
    catclub says:

    @Gin & Tonic: “We saw entrenched incompetence at nearly every level. ”

    Except their contract bidding team.

  26. 26
    Tommy says:

    As a few folks have said, how is CGI even in business at this point. I do pretty complex web sites for a living. Now I will openly admit these sites are WAY above my pay grade. However I follow the industry closely and the problems these sites are having, well they just don’t happen in 2014 (or 2013), The tools that are out there are staggering and easier to use then ever before.

    I also hate to admit this, but I feel like there are more problems coming. We’ve heard a lot of insurance companies are not actually getting folks enrolled and/or signed up. My gut is a lot of folks don’t know this is happening. And I also fear there will be billing problems we are not aware of yet.

    But I hope not.

  27. 27
    SatanicPanic says:

    @Mnemosyne: There have been some pretty well known people on the radio ads too. Last week I heard Sammy Hagar and Jason Derulo FWIW

  28. 28
    JVader says:

    I’ve spent my entire 25 year career in IT (various aspects from being a PM, Ent. Arch., Sys Eng, cyber security SME) and none of this shit is as easy as people seem to think. Good, Cheap, Fast, pick any 2 but you can’t have all 3. In any government setting it is cheap and fast with good being no where in sight. 4-5 years ago there was a change in how IT was viewed by the general public… suddenly you could search for anything, your grandmother could use Facebook, you could get laid instantly, you could look for a relationship, etc. Many people (including some in IT) assumed it meant it would all just be free and easy.

    Learn it. Know it. Live it (Fast Times at Ridgemont High).

    BTW, while I’m ranting, “the cloud” and “shared services” are bullshit only a Dilbert strip could make sense of.

  29. 29
    Tommy says:

    @JVader: It is much harder then people think. And your point your grandmother can use Facebook or you can drag and drop stuff on Square Space to build a site is, I agree, one of the main reasons why. Everything on a computer, if you have half a mind, seems pretty simple.

    I read a long format article a few days ago that talked with the team of programmers they actually brought in to fix the system on the Federal side. They were told it would only take a week or so of their time. When they saw what they were looking at, it took three months. It was FUBAR beyond all reason.

    The thing that pissed me off the most was all of them were able to see all the problems in hours after getting their hands on the code. IMHO anybody that had a clue what was going on knew they had problems, but honestly seemed they were to afraid to tell anybody. Or put another way, none of this had to go down the way it did.

  30. 30

    Simple Question : Massachusetts had a website and a health care exchange that actually worked, what was the need to rebuild something that was not broken?

  31. 31
    ruemara says:

    @schrodinger’s cat: Somebody had to make a buck on it.

    That’s the one truism of politics I’ve learned over the years.

  32. 32
    catclub says:

    @raven: “Big ass explosion in NYC”

    another use of the transposed em-dash!

    Big-ass explosion
    Big ass-explosion

  33. 33
    ericblair says:


    I very much doubt that the criteria were as simple as ready to bid and cheapest. I know much smaller contracts are evaluated on a lot more than that.

    I don’t deal with state-level bids, but am pretty familiar with federal bidding. A lot of the federal stuff now, in the interest of saving money, is Lowest Cost Technically Acceptable. The Technically Acceptable part can be just pass/fail, where the source selection team evaluates the written technical approach and its risks according to its published criteria and any contractor that passes looks the same at that point. Past performance may not be a large factor depending on the RFP. If you put in a low enough bid, the team may not be able to justify hiring anyone else. And there we go.

    As someone said, if you work really hard at eliminating the possibility of corruption you can quite easily eliminate any ability of the government to use discretion. When people started making noise about the healthcare.gov fix and firing those people and hiring these other people off the street, well, That’s Not How It Works.

  34. 34
    Regnad Kcin says:

    Speaking from painful experience, state and local procurement processes here in the Commonwealth are the worst.

    Except for all the other alternatives (to paraphrase Sir Winston)…

  35. 35
    Higgs Boson's Mate says:

    @Gin & Tonic:

    You have verified my suspicion that Massachusetts and the Federal government would have obtained better results by hiring four script kiddies working out of Mom’s basement.

  36. 36
    raven says:

    @catclub: Did you know what I meant?

  37. 37
    Tommy says:

    @ruemara: Oh how true. I get a ton of referrals with my web development business cause I tell clients the truth, and sometime the truth is I don’t need to start from scratch. We can make tweaks here or there and it will cost them a fraction compared to starting over.

    Everybody is always stunned when I say this, cause it would seem nobody usually does.

    But by not screwing them (and most don’t understand anything I do) a funny thing happens. I joke web development is like taking your car in for repairs. Maybe it needs a five dollar piece or maybe it should cost $1,000. You just have to trust them cause you don’t know. Same with my business in most instances.

    By doing this they push a lot of business my way.

    Plus I can sleep well at night :).

  38. 38
    🎂 Martin says:

    @JVader: What drives me crazy about this is that we’re effectively paying for 30 redundant systems. The one in CA doesn’t materially do anything different from the one in NJ. And yet I know that bureaucratically, it would be near impossible for states to get together to develop a handful of generic systems that each state could adapt.

    @Tommy: I think it’s easy to underestimate how bad state government backend systems can be, as well as how antiquated and bad the insurance company systems often are. I have a close family member that is currently a high-level gun for hire to get ICD-10 implemented for insurers that have completely screwed the pooch. The deadline under ACA was supposed to be last October, but too many insurers weren’t ready. The new deadline is this October, and a lot aren’t ready (based on the job offers he’s still receiving 6 months out, some are just now getting to the problem). Keep in mind that ICD-10 was completed in 1992. China implemented it 12 years ago. Thailand has been using it for nearly that long as well. I won’t even go into other more developed countries like Germany and the UK.

    This is not some new, unknown thing. Any insurer could have looked out at the world and seen that ICD-10 was inevitable and started working on it, and almost none of them did. Even when ACA passed in 2009 and mandated ICD-10, most of them did nothing. This tells you quite a bit about the state of IT within the ‘best healthcare system in the world’. Now ICD-10 has nothing to do with the exchanges, but the insurers need to interact with the exchanges in other ways, and the contractors being hired for the exchanges are often the same ones that we’ve been hiring to get ICD-10 done. It’s a litmus test for how things are working more broadly.

    Healthcare IT in the US is a fucking clown show from top to bottom, mostly because the insurance CIOs are drawn not from innovative IT but from policy or support. The executive team doesn’t want someone with the vision and eagerness to actually unfuck the system, they want someone who won’t change anything because change is bad, change is expensive, change is disruptive. And if the CIO does want to actually make something better, you can count on the rest of the executive team to kill that idea dead.

  39. 39
    Tommy says:

    @🎂 Martin: Well government IT in general is a fucking clown show. I did a lot of work for Federal contractors and I was always stunned by how bad the entire process was. I worked on the IRS Tax Modernization program. See the IRS has 6-8 DIFFERENT databases of your info. So when you call them and can’t get a straight answer, well that is the problem.

    The goal of this almost $30 billion contract was to fix that. They are years and years behind. Behind budget. Everything is as messed up as you can get. And the contract, well it was a ten year contract.

    Ponder that for a second. How much technology can change in ten years. My gut is once they are done with everything, it will once again be outdated on day one.

  40. 40
    Villago Delenda Est says:

    The contractors are in it for the grift. There are no consequences for failure of outcomes. They’ll get rehired to fix their own fuckups.

  41. 41
    Villago Delenda Est says:

    @🎂 Martin:

    You left out “change might diminish executive bonuses” in your litany of things that are bad about change.

  42. 42
    Tommy says:

    @Villago Delenda Est: The core group of folks that fixed the site worked for pretty much free. They came from tech firms, and like with Obama’s campaign, just took time off from work to do this work cause well, they cared.

    Now when you have millions in stock options and you are so good at your job you can leave for months and months and still have a job, well that must be nice :).

    But as much as we hear a lot of these folks are assholes (and many are) there are others that know they have the knowledge and ability (a fat bank account can’t hurt) to do amazing things, you know if you just ask them.

  43. 43
    Another Holocene Human says:


    The thing that pissed me off the most was all of them were able to see all the problems in hours after getting their hands on the code. IMHO anybody that had a clue what was going on knew they had problems, but honestly seemed they were to afraid to tell anybody. Or put another way, none of this had to go down the way it did.

    I disagree. When I was in government and doing coding, like a fool, I found out that the contractors they were dealing with were stone cold liars. So were most of the IT people they hired. Like the fool who wasn’t backing up daily and lost months worth of work. Or the fool who got mad at ME for using Mozilla instead of buggy IE to do my work.

    This is the consequence of IT expanding rapidly, IT people being hired by HR instead of IT people, and liars being rewarded. You reward liars when you demand “10 years of Java experience” when Java has only existed for 6 years. There you go, entire department of people with a problem telling the truth.

    You know how they were saying that academic credentials didn’t matter and were actually a problem? Well, for quick and dirty coding, sure. But once we’re talking about serious applications, you start needing people with SERIOUS mathematics, physics, EE, and computer science backgrounds who can develop architecture that saves your hardware, keeps your stuff robust… oh, and today you need security experts out the wazoo as well. And then you need experienced project managers, like that guy on Office Space WHO TALKS TO THE ENGINEERS!! but nobody in the early 2000s seemed to value that.

    I still work in government… we had TWO IT depts who did NOTHING. Hell, I met some of these guys socially… they made more than me, knew less than me, and bragged about doing no work all day. Well, they got new management in there who combined the depts and required that a trouble ticket be filed for literally everything. It’s amazing how much stuff and how fast is being accomplished. (It’s also nice to know in advance when the system will be down.) Apparently they also monitor phone calls into the dept now because I don’t get an enormous attitude when I call someone.

    All of this shit is 100% predictable.

    As for Mass, if their website worked before, I guess the ACA system is just more complicated? Either the agencies didn’t have a sense of urgency meaning that there were the same kind of institutional problems that the federal system faced but without the POTUS Barack Obama making it his #1 priority mid-fall, or for some reason, and this happens ALL THE DAMN TIME in Massachusetts, they dumped the successful contractor they had before and went with CGI and then nobody could admit they’d made a giant mistake until the trolleys were jumping the tracks website didn’t work. (Cf.)

    Oh, and Tim F., fuck you for your motherfucking earworm.

  44. 44
    Kerry Reid says:

    @schrodinger’s cat: I have the same question regarding the Chicago Transit Authority’s Chicago Plus transit card system and the (mandatory) switch to Ventra. I’ve been resisting, but my days are numbered as a non-Ventra user.

  45. 45
    Tommy says:

    @Another Holocene Human: I oversimplified a little. What they were able to see in seconds was that a database query would taking more than five seconds when they wanted them to take well under a second. Took them much longer to id why this was and fix it.

    Also, and clearly you know more about tech then I do, they didn’t even really have one operations center where they could see everything, in real time that was happening. They joked (and they didn’t think it was funny) that the first weeks they were spending more time driving around the DC area just talking to all the contractors.

    I need to save everything I read in Evernote or Pocket so these articles are easier to find …. cause I think you would find it an interesting read. But I can’t seem to backtrack and find the darn thing.

  46. 46
    Another Holocene Human says:

    @Tommy: Biiig difference being highly successful IT contractors, where contractors means people who work on contract, and government IT contractors, meaning firms who bid for government contracts. But you know this. Just thought I would clarify for anyone who was wondering what you and Villago appear to be arguing about. Not even the same class.

    Anyone who works on contract has to be good or the jobs dry up. There was that one guy who hired people in India to work for him, that was a nice little grift. The gov’t contractors for the most part do seem to be in it for the grift. Construction less so, especially if they don’t solely do gov’t jobs. (If they do, look out!) But IT? Hell, yeah. (Also, anything to do with airplanes/vehicles/buses/trains… hell, often the bidding entities are multinational government subsidized concerns. Look at all the “fun” WMATA has had with Ansaldo Bredaferroviare, the “fun” Amtrak had with Bombardier, which got that contract in a clear political fix-up job, the “fun” Boston and SF had with Boeing-Vertol in 1978-1981 and their 3000 part airplane fuselage Light Rail Vehicles. And let’s not even discuss anything with the word “military” attached to it.

  47. 47
    opiejeanne says:

    Tim, you saw the Legos Movie too. That song is an ear worm.

  48. 48
    Elie says:


    ..and that was Oracle — not CGI

  49. 49
  50. 50
    🎂 Martin says:

    @Villago Delenda Est: I actually don’t get the sense that’s a problem (I know a few C-level healthcare execs, FWIW.) I think this is much the same as government and other industries (music, movie distro, etc) where the 50-60 year olds that know the industry inside and out grew up in an era of paper and pencil, and know fuckall about the tech side of it and are legitimately terrified of this thing that they just don’t get. Respect is given to the guys that paid their dues rather than the young guys that can turn the business on its ear by aggressively employing smart tech. They don’t clue in until the place is practically burning down around them because some guy like Elon Musk or Apple shows up and kicks their ass. They can protect themselves against the visionaries within the company by firing them, but they can’t protect against a visionary competitor.

    I hear about these internal fights and the best way to summarize it is that 1985 is pissed off that it’s now 2014. Execs upset that the CIO moved the call center from POTS to VOIP, or that the sales tools can be developed for iPhone far more easily than for Blackberry, so the CFO needs to give up his physical keyboard. Shit like that. There are days you think we’d be better off if we just blew it up and started over.

  51. 51
    Higgs Boson's Mate says:

    @🎂 Martin: @Tommy:

    Well, hell, people. IT is a type of infrastructure and you know how America deals with infrastructure.

  52. 52
    Belafon says:

    @🎂 Martin: My wife does the billing for the clinic she works at. She just went to training on ICD-10, and they are telling her that clinics doing commercial billing need to have a 2-4 month money cushion to allow billing companies to handle the new codes. If they do medicaid/medicare, they need to have a 6 month cushion.

  53. 53
    Another Holocene Human says:

    @Tommy: Driving around DC to see all the contractors sounds about right to me! How many big deal projects in the 1990s got destroyed by contractors? Remember that Mars probe that blew up because one of the contractors passed data in the wrong format? This is SOP for federal projects.

    If you’re going to use 50 contractors, fine, but you need better in-house project management. It’s possible NASA did have lessons learned but, oh well, guess we laid most of them off and they’re in the private sector now instead of say, merging NASA and NOAA….

    Decades of contempt for labor means that, sure, the gov’t has access to some really, really smart people but they hire them and discard them and sooner or later if they’re smart enough they jump off to a job with more security for them and the ones who stay in gov’t are in more politically protected depts where they have people that learn how to be a pod person and mole into the inside where they can never, ever be fired. Like DOT or some shit like that. DOT is pretty terrible, way too heavy with straight out of college sorts with no industry experience. I’m glad they put a mayor in charge. He probably has more life knowledge than any of his underlings could ever hope for. My mom wanted me to work at USDOT. She cray-cray. Not just no but hellllll naw.

    If creationist asshats and labor haters would leave technology/science/research/USGS etc dollars alone, you know, and fund NOAA research instead of backfunding through USN contractors (I mean, seriously?) because rah rah military, the USG would have a really great nerd brigade, like a top-flight research institution that works directly for the American people. Germany has the Max-Planck-Instituete.

    But no. Gotta punch those nerds and break their glasses and steal their lunch money. Besides, we can outsource all of that to India.

  54. 54
    Tommy says:

    @🎂 Martin: Blow it up and start over. Oh how often I think that. My brother is a Cisco networking guy. I am stunned he spends most of his time with VOIP installs. I mean unless you are Verizon and you actual own the phone lines, how in 2014 isn’t everybody on VOIP? Well a hell of a lot of places, and the push back he gets from management when he is on-site and doing an install is mind blowing.

    You’d think things like cost savings would be enough to win them over. Then the “intelligent” call routing. Much superior VM. But alas, some folks don’t like change.

    Heck my father is pretty good on a computer. He is doing an inventory of all the stuff he owns (and my gosh he has a lot of stuff). He is entering the info by hand in Excel. I am like dad, just upgrade your cell to a smart phone, use a free bar code reader, and the entire process could be automated.

    He refuses. Sometimes hard to get people to change ….

  55. 55
    Elie says:

    @🎂 Martin:

    great comment.

    The issues here are not just government IT — but ALL healthcare IT– for many of the reasons that you cite.

    There are other challenges in the offing. To make the profound changes required to deliver integrated care, we need electronic health records that can be integrated across proprietary designs and code. Good luck with that! There are 6 zillion EHR products, none are compatible enough with each other to begin considering how to use that information across all providers, much less payers…

    We are going to have some painful but very necessary change and modernization over the next ten years. It will cost a lot of money before it costs less money. There is no going back either….

  56. 56
    Belafon says:

    @opiejeanne: It’s an ear worm and satire all in one song.

  57. 57
    Another Holocene Human says:

    I may be a little bit pissed, not just because of what happened professionally to my father, and because of asshats like Newt Gingrich and Jesse Helms cutting research funding every single year, but because an insanely smart friend of mine got hired by NASA when they still had funding for one of GWB’s bullshit gee whiz projects and of course when that got defunded she got laid off and stuck in fucking Houston. This woman is so creative and smart it makes my brain bleed. She’s trying to break into industrial design now (she’s a mechanical engineer). In the meantime, she’s selling earrings online. *cry*

  58. 58
    Another Holocene Human says:

    @Elie: I wish somebody could point out for once and for all:

    a) this had to happen–I mean, as a patient, aren’t you tired of doctors offices not talking to each other? and sending your xrays through email is not secure, let’s be real

    b) everything was balkanized and gov’t had to step in–and did

    c) this is part of PPACA but actually predates it, so no, Obamacare did not make you shut down your Luddite practice

    d) the docs shutting down over this had their head in the sand or were being cheap and didn’t move to digital records even when everyone around them was, so everyone should know it’s THOSE DOCS, not Obama, that is putting them out of business now … they were the dairies who stuck with horses when all the other dairies bought internal combustion-powered trucks

  59. 59
    Tommy says:

    @Another Holocene Human: And I hate the fact you didn’t want to work at the DoT. After the whole healthcare.gov blow up I saw some interviews with top tech people that worked on Obama’s campaign. They all were like if called, no way we’d help out. On Obama’s campaign we were just allowed to do what we knew. We got ZERO desire to get into the procurement process. Work with contractors we can’t fire. I wonder how many smart folks feel like you do.

  60. 60
    ericblair says:

    @Another Holocene Human:

    If creationist asshats and labor haters would leave technology/science/research/USGS etc dollars alone, you know, and fund NOAA research instead of backfunding through USN contractors (I mean, seriously?) because rah rah military, the USG would have a really great nerd brigade, like a top-flight research institution that works directly for the American people. Germany has the Max-Planck-Instituete.

    In the commercial sector, we used to have Bell Labs. So much for that. In academia, researchers are expected to be funded through their grants and pay the university for overhead, so you’re basically a commissioned salesperson. We’ve taken all the research institutions everywhere, burned the boats for firewood, and expect all research now to be funded by the next stock market bubble.

  61. 61
    Punchy says:

    you could get laid instantly

    Wait….what? Where? How did I not hear about this?

  62. 62
    Another Holocene Human says:

    @🎂 Martin:

    Healthcare IT in the US is a fucking clown show from top to bottom, mostly because the insurance CIOs are drawn not from innovative IT but from policy or support. The executive team doesn’t want someone with the vision and eagerness to actually unfuck the system, they want someone who won’t change anything because change is bad, change is expensive, change is disruptive. And if the CIO does want to actually make something better, you can count on the rest of the executive team to kill that idea dead.

    The problem is that they were making fucktons of money with shitty IT support and now the gov’t passed a law that pisses all over their profit margins and requires them to straighten and they’re trying to make a phone call to get that fixed, omg, it’s on fire with their pants around their ankles.

    Fuck them. Boo de fucking hoo. They sure didn’t apologize when they were taking our hard-earned cash to deny benefits, bury us in billing storms, lose records, never answer the phone, and generally be little shits.

  63. 63
    JoyfulA says:

    @Another Holocene Human: I have personal knowledge of a big state contract via a complaining friend hired by the giant contractor to do end testing. This contract has been ongoing for years and years. This giant contractor replaced a first giant contractor.

    When my friend showed up to work, the project was nowhere near ready for end testing, but there was plenty of work for her to do. Giant contractor had imported a floor of Indian programmers. When they were still way, way behind schedule, giant contractor imported a floor of Chinese programmers. Now all these imported programmers speak American English well enough for my friend to understand, but the Chinese and the Indians can’t understand each other! So she spent her days as an English-English interpreter.

    So now the state has canceled this contract. All that money down the tube. I suppose they’ll be working with a third giant contractor—

  64. 64
    Tommy says:

    @ericblair: Years ago when Lucent was spun off from AT&T I worked at one of their ad agencies. Their new tagline was “We Make The Things That Make Communications Work.” They wanted a brochure developed on Bell Labs. We were set to New Jersey to figure out how we’d do it.

    As we were walked through the place I was floored. I mean they kind of invented everything.

    I recall calling my creative director and saying the brochure would write itself. He asked what I meant and I started down the list of their inventions. I was like “David, they still have the bar napkin where a few dudes sketched up the first transistor.”

  65. 65
    Rob in CT says:

    I have no idea what my state did, but…


    Kevin J. Counihan, the chief executive of the Connecticut exchange, said Monday that it would license or franchise its technology, selling an “exchange in a box” to other states. It would offer a package of basic services, with an option for states to buy more.

    “We have something that’s working, and we want to share it,” said Lt. Gov. Nancy Wyman, who is chairwoman of the board of the state exchange, Access Health CT.

    The Connecticut exchange has performed better than the federal insurance marketplace and its troubled website, HealthCare.gov, and better than many state-run exchanges.

    Since October, about 55,000 people have signed up for private health insurance through the Connecticut exchange, far exceeding the goal of 33,000 set for the state by federal officials for the entire open enrollment period, which ends March 31.

    The results in Connecticut stand in sharp contrast to those in some other states — like Maryland, Minnesota, Oregon and even Massachusetts, a model for President Obama’s health care overhaul — which have had difficulties with their exchanges this year.

    Maybe we lucked out with the contractor. Maybe our state officials had more of a clue. I dunno. But I’m happy it’s working.

  66. 66
    Davis X. Machina says:


    All that money down the tube.

    It wasn’t destroyed, though. Money, like matter, is neither created nor destroyed, just moved and transformed….

  67. 67
    JoyfulA says:

    @Davis X. Machina: Down the tube out of the taxpayers’ pockets—

  68. 68
    Davis X. Machina says:

    @Another Holocene Human: It makes one wonder whether Nye Bevan could only have pulled off the NHS when he did, because there was no real medicine yet, not in the modern sense, just some surgery, and what amounts to really advanced nursing — and in those days a phone, the Royal Mail, plus typewriter and carbon paper was the only IT infrastructure.

    I don’t know if you could do it today, not at national scale, not almost all at once.

  69. 69
    Davis X. Machina says:

    @JoyfulA: Somebody’s got it… t’aint us though.

  70. 70
    Elie says:

    @Another Holocene Human:

    Hear Hear!!!

    Well said — agree completely

  71. 71
    Tommy says:

    @Rob in CT: I was wondering when somebody would do that. When Gore was VP he pushed through “Reinventing Government.” A ton of procurement related laws. The things run tens of thousands of pages.

    Two huge things.

    (1) COTS (commercial off the shelf technology). For years if the IRS needed a database, instead of buying one from Oracle, they would hire Oracle to write one from scratch. See every agency was “special” and needed their own “custom solution.” Heck the Navy spent tens of billions on their own email system, cause I guess Outlook or Lotus wasn’t good enough for them.

    (2) Past performance and not just price (and other factors) had to be taken into account when awarding a contract. If Contractor A was bidding on a contract, had four similar contracts they failed on, it wasn’t required to take this into account (no I am NOT making this up).

    IMHO things have gotten better, but not much.Years ago there used to be a phrase in government contracting, “Nobody ever got fired for hiring Big Blue (that would be IBM).” People in procurement circles though this would change, but alas it has not. For folks like CGI keep getting awarded these contracts.

    But back to your point, a COTS product of their exchange, that works “out of the box” that can then be tweaked for each individual state, well if I was the CIO of a state that was having problems, that would be the first place I’d look.

  72. 72
    Another Holocene Human says:

    @Higgs Boson’s Mate: Script kiddiez couldn’t even run an international hacking crewe without getting caught by the FBI; how would they manage dozens of agencies and contractors who can’t produce documents showing how their system works or is supposed to?

    That’s a social engineering problem.

  73. 73
    Anoniminous says:

    From the corporate POV, large IT projects take an enormous amount of up-front money for equipment, stomping on quarterly profits. Large IT projects need a cadre of experienced professionals who – IF you can find them! – demand serious money, stomping on quarterly profits. Large IT projects return money over the long term, not calculable by quarterly profit statements.

    So which is more important to corporate MBAs: getting the large IT project done correctly or having a continual rise in quarterly profits?

    (Sometimes asking the right question, in the right way, clarifies the situation.)

    From the government POV, it doesn’t matter if a large IT project succeeds or fails. You’re not going to get promoted for competence or fired for incompetence so who cares?

    The result: a continuous waste of time, money, and effort on large IT projects that inevitably crash and burn.

  74. 74
    opiejeanne says:

    The California website works very well from what I’ve heard and yet my sister was too timid to make a decision without talking to someone, so she called and got signed up at considerable savings.
    However, the insurance company rep bad mouthed the ACA, boohooed that they’d all be out of work by March, and pointed out how much worse the law had made the lives of people in Missouri bu forgot to mention why that was, so now she’s happy but the ACA=bad.

  75. 75
    Anoniminous says:


    Bell Labs used to invent everything. Then cost cutting and lay-offs ensured they didn’t and don’t.

  76. 76
    Another Holocene Human says:


    (1) COTS (commecial off the shelf technology). For years if the IRS needed a database, instead of buying one from Oracle, they would hire Oracle to write one from scratch. See every agency was “special” and needed their own “custom solution.” Heck the Navy spend tens of billions on their own email system, cause I guess Outlook or Lotus wasn’t good enough for them.

    I have a different perspective on this, Tommy. Granted, I wasn’t working for USN, although I heard some stuff from family members–horror stories–during the 1990s that kind of lends credence to this account. And that is that the USN switch to Outlook was at root a political job for the benefit of Bill Gates. What I heard is that they replaced what was essentially an enterprise-level email setup with Outlook, which, if you’ll recall, in the 1990s was meant for about 100 users, in other words, not enterprise class at all. I heard that ***** crashed like a God-Warrior in an apocalyptic anime. I’ve also heard a story … repeated often, but with little real evidence, that the USN did a test run with Windows NT on one of their carriers and had a really bad crash on a critical system and had to abort the test. IDK about that one. But a LOT of people experienced the Outlook migration first-hand.

    Why would Gore shill for MS? MS was giving a LOT of money to the Democratic Party, except for a few years when Clinton’s Justice dept went after them for their trade practices, specifically over Internet Explorer. (They had been running this restraint of trade crap for years with IBM compatibles manufacturers but never got prosecuted over that.) Gates made his billions selling his junk software and vaporware to top executives over the objections of the depts forced to use his crap, and that didn’t stop when he went after the big money in government. (He got local gov’ts by allowing piracy of Windows in the early days when he was trying to obtain a monopoly, then sicced his legal dept after them for site licenses once he had destroyed the rest of the market and they had nowhere to go.)

    I use Outlook today. It’s fine. It was not fine: 10 years ago, 15 years ago, 20 years ago. Not by any means.

    The US Government should not have been paying for Gates’ Beta software. Btw, comparing Gates’ 1990s crapware to Lotus is an insult to Lotus.

    But Tommy, I appreciate your perspective on this issue because it does explain a lot of things for me that I didn’t get at the time. And I am well aware of the realities of internal Federal IT projects in the 1990s and how THOSE used to go (10 years planning, 2 years coding, etc).

  77. 77
    Elie says:

    @Rob in CT:

    The contractor in common for many of the successful sites has been Deloitte

  78. 78
    Another Holocene Human says:

    Also, re: Al Gore, I don’t have tons of respect for him as a lawmaker. I had to do compliance on lawmaking that he did with Gingrich and it was a NIGHTMARE. Blah blah blah, the old law was antiquated, this is “fairer”–BULLSHIT. I wasted hours and hours and hours and hours on compliance, calls from federal agencies hounding me, calling other agencies trying to find out what the magic words were on submissions. Did it make any practical effect WHATSOEVER on ACTUAL, REAL WORLD compliance? Almost not at all. And we were probably among the minority to ACTUALLY FOLLOW THE FRIGGING LAW. If you didn’t how would anyone know?!

    Fuck you Al Gore. I’m glad you’re out of government.

  79. 79
    Elie says:


    You are incorrect that there are no consequences to failure in the government. While it may be less overt, government people have had their careers damaged and been sidelined for certain failures. Also, if you will note, there have been several high level resignations of appointed officials associated with the implementation of the websites…

    (I swear I read the same inaccurate antigovernment stuff from our own so called progressive side as the right. Is it any wonder that everyone thinks government can’t do anything right anymore?)

  80. 80
    Another Holocene Human says:

    @Davis X. Machina: Not, really, actually–you can pour money into a ponzi scheme or use it to build houses in Florida that get eaten by mold. If money goes into a working, productive asset, it makes more money… if it goes into waste, it’s lost.

    Just look at Ukraine.

  81. 81
    Another Holocene Human says:

    @JoyfulA: I love the thing where they hire contractors, have them work on something for years that doesn’t get finished and then cancel the contract and throw out all the work so far.

    I did see that USDOT tried to put out an app with their info about OTR coach operator safety but sadly the people developing the app don’t know how to make an app because you have to click over and over to get the info you need… on a smartphone. It’s easier to get the info on the regular website, which you have to fight to find because they want you to download the app.

    It seems like they do have some competent coders but not a single person–at least not a person with any power in the organization–who can do visuals/usability. (The way the app looks is really terrible too–it’s supposed to be bus wheels but looks like an audiotape when smartphone screen sized, just the kind of visual cue to make you question if they’ve gotten out of their cubicle warren since 8bit color went mainstream in the 1980s.)

    At least the app didn’t crash. So not a total fail.

  82. 82
    opiejeanne says:

    @Another Holocene Human: kaiser permanente did that years ago. My current (inferior to Kaiser) healthcare provider has just gone to a coordinated computer system and to hear them whine about it annoys me no end. Washington state seems to be a strange mix of backwoods and high tech living side by side. I mean, I’m 4 miles from the Redmond campus and getting wifi installed at my house has been a Dark Ages adventure. Part of it is me, not knowing what off the shelf stuff to buy to make it work (i have Comcast and they suck) and having been pampered by comparison by AT&T when we lived in Anaheim.

  83. 83
    Another Holocene Human says:

    I would welcome anyone to visit USDOT’s new website, since Obama and Foxx seem to have been kicking some butts… actually, it started to suck less under the first term DOT head, that Republican guy from IL, but more changes have been made. If you recall gov’t websites in the 1990s it’s really a different paradigm. Also, they’re soliciting user input on their site usability right now so go tell them what you think.

  84. 84

    BRAIN WORM!!!!!!!!

    We saw that movie. Now I can’t get that song outta my head.

  85. 85
    drkrick says:

    @Belafon: thanks, that was informative.

  86. 86
    MazeDancer says:


    Strangely, the “almost like what you had” selections are not always so “almost”. Like the Emergency Room co-pays that were $150 are now $450. And in a state where PCP’s are few and far between, the $150 ER fee was often used because there is little ability to immediately see your primary doc.

    Not quite understanding why ObamaCare is making RomneyCare more expensive. But the unsubsidized in MA – who have hefty rates already, like $623 a month for an individual with 2K deductible and 5K out of pocket – are experiencing the get less, pay more phenom Fox News oh, so wishes was everywhere.

    The other wacky thing about states and insurance is how in areas with little states and many borders – like Mid Atlantic and New England – is how there is now zero out of network coverage. So one might have to drive 20 miles to a hospital or doctor in one’s state when just over the border half as far is a better option. One happy day it will be national health. Alas, today is not that day.

  87. 87
    Another Holocene Human says:

    @MazeDancer: Maybe it’s time to suggest a New England states consortium for health coverage.

  88. 88
    Phoebe says:

    @MazeDancer: I give them some credit: they didn’t try to tell me that the closest new policy to the policy I had was really exactly the same thing. And it’s true that I have a yearly deductible now that I didn’t have before; it’s also true that my policy is still very expensive, as it has been for many years now. On the other hand, given that the new one’s going to cost $100 less a month than the one it’s replacing, I figure the new $1500 yearly deductible is basically a wash. If I don’t use the services over the year I save some money; if I do, I’m not out that much more than I would have been under the previous plan. And while the deductible is new, the co-pays for services and prescriptions haven’t changed. (I don’t think. I’ll have to double-check the ER visits to be sure. Which I can’t do unless the website is up, naturally; but I do know the other co-pays are the same.)

    It does sound as though others aren’t doing as well, though. And that doesn’t surprise me as much as I’d like it to. When I was choosing plans I spent about 30 seconds considering gold, silver, and bronze-tier plans before resigning myself to platinum: nothing on the lower tiers looked remotely equivalent to what I’ve had, and the premiums weren’t anything like low enough to make up for it.

  89. 89
    thalarctos (not the other one) says:

    @Phoebe: I was offered a “fast track” plan as well–at a 40% premium increase! Fortunately, for what it’s worth, it appears that I was able to create an account and sign up for a new plan with a new carrier this week, but not without some legwork on my own–the “plan comparison” tools are still busted.

  90. 90
    texasdoc says:

    @Another Holocene Human:

    Let me tell you about EHRs. Precisely BECAUSE they don’t all talk to one another (the major thing that would improve care and cut costs) they are more of a hassle than benefit. They do not make doctors more efficient, and in fact have turned us into clerks. The systems I have had experience with are badly designed, obviously written by programmers who know nothing about doctors’ work flow or efficient time management. It’s more difficult to review past information and synthesize it. It offends me that the system my oncology group bought is much less effective at showing a patient’s chemotherapy history than the simple piece of paper that we had in our old charts. And when you complain or request things that would be helpful (for example, a small file attached to a patient’s chart where I could type in serial tumor marker levels, when the patient can’t go to a lab synched with our system–instead of opening up all the previous dictations to see the trend) I am basically patted on the head and told to go away because I couldn’t possibly understand how impossible that would be. As someone who learned FORTRAN to get my PhD, I am offended. As they exist, EHRs are more for data collection than patient management.

  91. 91
    Mnemosyne says:


    It often seems that programmers are convinced that they know how to create a usable database just because they know how to program one. It’s not the same skill set.

  92. 92
    skwerlhugger says:

    @Another Holocene Human: How about a United States Consortium for health coverage?

    One curse of the PC is that sometime in the 80s, every nitwit high school kid learned to program and thought they’d mastered the craft. Programmers aren’t software engineers. It’s like your local mechanic designing a car.

  93. 93
    mle says:

    I live in Massachusetts, and recently got divorced. I continued to carry my ex’s insurance through my work until the policy turns over at the end of this month. We went on the Mass Connector site last month to find insurance for him. Healthsherpa.com no longer will show options for MA. Finally got everything filled out. Site said we/he would hear in a week or two. Heard nothing, so he went to nearest Navigator. Was told he was already insured (by MA) and would get something in the mail. Today got very apologetic letter from MA saying essentially “Oh, so sorry, website is so screwed up, and we are so backed up we can’t tell if you are eligible for a Connector Plan (subsidized, which he should be) or Mass Health (free) and won’t be able to do so for a while, so meanwhile you are covered thru Mass Health from Feb 1 of this year until July 30 or until we figure it out.” I am happy MA will step up to the plate and cover him, but not happy that CGI is costing us taxpayers these monies unnecessarily.

  94. 94
    mclaren says:


    How the hell is this CGI outfit even still in business at this point? They appear to be the most incompetent tech services company ever.

    Sadly, CGI is all too typical of tech companies.

    Gross incompetence remains endemic at every level in tech companies. I’ll throw out some examples to show just how bad it is:

    HP designed a laptop several years ago with a 100% failure rate on its graphics chips because of inadequate heat dissapation. Their response? Tell the customers “sue us.”

    In November the U.S. Air Force decided to scrap a major ERP (enterprise resource planning) software project called the Expeditionary Combat Support System after it racked up $1 billion in expenses but failed to create “any significant military capability.”

    A project that was intended to modernize case management for California’s court system was scrapped in March, despite the fact that officials deemed the software developed so far was viable. The problem? Not enough money to continue rolling out.

    California spent more than $300 million to develop a number of versions of the case management system. However, it would require another $343 million to implement and support the system in 11 courts through fiscal year 2020-2021, according to an independent audit.

    Chemical products maker Avantor Performance Materials lodged a suit against IBM, alleging that Big Blue officials lied about the suitability of an SAP-based software package it sells in order to land Avantor as a client.

    As it turned out, the Express Life Sciences Solution was “woefully unsuited” for Avantor and the ensuing software project took the company to a “near standstill,” according to its lawsuit.

    In fact, IBM workers told Avantor that the project was the worst they’d ever seen, Avantor alleges.

    In May, Pennsylvania construction firm New Enterprise Stone and Lime said it would have to hold off filing its fiscal 2012 annual report because of problems with an Oracle JD Edwards system rollout.

    “Unexpected delays and other issues” with system interfaces as well as operational and financial reports have made it impossible to collect all the data New Enterprise need for the report, the company said.

    Last October, for instance, the giant British food retailer J Sainsbury had to write off its US $526 million investment in an automated supply-chain management system. Merchandise was stuck in the company’s depots and warehouses and was not getting through to many of its stores. Sainsbury was forced to hire about 3000 additional clerks to stock its shelves manually.

    In 1988, Westpac Banking Corporation decided to redefine its information systems. It set out on a 5-year, $85 million project. Three years later, after spending $150 million with little to show for it, Westpac cut its losses, canceled the project, and eliminated 500 development jobs.

    But the all-time winner has to be the National Programme for IT in Britain, which blew through 12 billion dollars with nothing to show for it.

    Welcome to the wonderful world of large software projects, where 50% of all big projects get abandoned without ever showing any results.

  95. 95
    mclaren says:


    It often seems that programmers are convinced that they know how to create a usable database just because they know how to program one. It’s not the same skill set.

    In my experience, programmers are the most incompetent and at the same time the most arrogant professionals I’ve ever encountered. To the typical programmer, every possible problem is “trivial” — yet most programmers, when asked to write code to get the job done, right now, right here, on the spot, can’t do it. They can’t even produce minimally adequate basic code.

    I’ve heard programmers tell me that massive existential challenges like human-level speech recognition or real-time musical transcription or language translation are “easy” and “simple.” These same programmers typically can’t even write a basic bubble sort.

    Programmers are people who don’t actually know anything. Like lawyers, all they have is attitude and huge egos. Ask them to actually accomplish anything, and they fall apart.

  96. 96
    Mnemosyne says:


    How about a United States Consortium for health coverage?

    That would be a very unusual thing to do. A lot of people don’t realize that the NHS is actually four entities: England, Wales, Scotland and Northern Ireland each have a separate NHS (though, obviously, there is an umbrella organization similar to the HHS that oversees). In Canada, each province administers its own health insurance program.

    So having it set up state-by-state actually is the norm. We’re running into problems because so many states were fucked up well before PPACA was passed.

  97. 97
    boatboy_srq says:

    @JVader: There’s a dearth of people in IT able to do the work and clear the background checks who will accept the pay: my last employer (a public entity) spent three months looking for a Microsoft engineer, only to have the guy they hired stay three months and bail for a 40% salary bump – back to his old employer. Half the people interviewing for the spot were so uneducated they thought FSMO was a soft drink. FTEs there haven’t seen a decent salary increase in five years, haven’t been able to get a hardware or software refresh in 6-7 years, and have frozen headcount for longer than anyone can remember – all in the name of “fiscal constraint.” Penny-wise and pound-foolish seems to be the order of the day.

    I’m hardly a fan of H1B, but we need some incentive to get tech professionals to jump through all the public sector’s hoops to get employed, and getting stuck with a Centrino-based laptop running WinXP and connecting to Server03, and Exchange03 and SQL05 to do their jobs for the trouble.

    Yes, this is all geekspeak. But the technical language is part of the problem, especially when you’re a) dealing with the public sector and b) dealing with policymakers who have difficulties with basic English, never mind the technical stuff.

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