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In Corporate America, when a slipping project hears that from a sponsor VP, that means, get aligned, step up and deliver, and quit playing games. Moving go live isn't an option, and it had better work well after spending 20 million or so dollars.

Obama tells his people to own up to the roll out issues.

This is similar for these guys. This is Obama's legacy (like it or not) that's on the line, I'd say that would be his "goals". If I were those cabinet members who sponsored this by choosing CGI, they had better start polishing up their resume.

To be fair, the insurance exchanges were supposed to be state based, with the fed system serving as a backup for states unable to put a system together. Many states, including Michigan, resisted any participation in preparation for Obamacare. These arguments at the state level went on right up to the critical limit.

At the last minute, planning wise, it became clear the fed sign up system and exchange would be the primary system. The size of the contract suddenly ballooned from $93 mil to over $400 mil. Imagine trying to integrate 80-90 insurance options from 25-30 states in a last minute rush job fashion. The communication difficulties alone would be monumental.

Then factor in the hardware difficulties of all the vendors and states, all with slightly different hardware/software configurations.

If there had been buy in early on, and the state level exchanges developed as initially expected, and all these political obstacles were not in place, everything would have rolled out much better. As someone who has done project management around the $20 mil dollar level, I'm surprised this thing is anywhere close to ready as we speak. Too many changes in timing and scope.

In other words they weren't ready for the roll out.

Solution: Postpone it as our fearless leader did for unions, bug biz, along with a few other sweetheart deals he made.

Lord knows those evil Tea Partiers tried, but as do nothing Harry Reid said, "dead on arrival," followed by our leaderless commander and chief who said he wouldn't sign it if it passed.

Fine, let it flounder for all to see. Let people go on his beloved exchange to find out they're rates have sky rocketed because insurers now have to insure preexisting conditions, 26 year olds (adults) who are still under mommy and daddies plan, as well as do it with a pool of clients that isn't quite working out. In order to succeed they lots of young healthy people to sign up for $2000 plus yearly premiums, in order to have the funding to cover the oldsters who are also seeing massive increases. Problem is those young folks won't sign up, but rather will pay the $95 IRS fine. Plain and simple it isn't going to work.

One thing that would help is to stop treating people at emergency rooms if they ignore the sign up.

But that would really be tough love.

(Guy shows up with broken arm and no insurance) sorry sir, you'll have to tape it up yourself. Ouch.

(Appendicitis.) "But I'm allowed to give you this single edge razor blade and three aspirins. But you can't do it in here, you've got to go back out in the parking lot. Sorry!"

Funny how everyone is a PMP these days and knows what to do regarding projects. I have to laugh. Gives me clarity to the other discussions we have had for sure.

I think it was incredibly passive aggressive by the states not to setup exchanges. Nothing new in politics there.

(10-20-2013 06:57 PM)Dirty Ernie Wrote:  One thing that would help is to stop treating people at emergency rooms if they ignore the sign up.

But that would really be tough love.

(Guy shows up with broken arm and no insurance) sorry sir, you'll have to tape it up yourself. Ouch.

(Appendicitis.) "But I'm allowed to give you this single edge razor blade and three aspirins. But you can't do it in here, you've got to go back out in the parking lot. Sorry!"

I may have told this story, but I'll repeat it. I was talking to an ER nurse at UM last year. Asked him how much of the traffic through the ER was needless. He said probably 1/3.

He related this story. A girl came in and thought she was pregnant. She asked them to do a pregnancy test. He told that when they do a pregnancy test they basically use the same over the counter units that you can get at Walgreens for ten bucks. He explained to her that by the time they did it, and gave her the results her bill would exceed a $1000. His co-worker informed him that he shouldn't be telling her this, but he felt it was in her best interest financially. None the less, she dismissed his explanation and had the hospital do the test. Paid for of course by medicaid, i.e. you and I.

Under Obamacare she would could get private insurance and because she has no money she would qualify for subsidies. So in the end the tax payer and those paying full boat premiums are still paying her bill. Not a lot changes eh, other than our premiums are all going up to pay for this unworkable scheme. Yes, we were paying for these folks before in our premiums, but now those premiums are going even higher.

One of the biggest scams in the O.R. is people trying to score drugs like Codeine or Oxycoten. "I have a terrible pain in my gut." Doc runs tests, finds nothing, patient suggest a pain killer.

When my son worked in Detroit he was answering the phone constantly. Patients and non-patients calling to complain of oral pain, and needing Vicadin or some other pain reliever. When he refused and suggest Tylenol they'd get angry and hang up.

For those who think nothing good came out of the shut down, try this.

The sign up sites for the "Affordable Care Act" don't ask for any verification of income or monetary status. You could make a 100k, and have a million in savings and still apply for subsidies, based simply on what you report as income (reminds me of how we got into the housing crisis).

One of the few things that was signed onto by both parties was income verification. Think of the money that will be saved by that one little thing. Now people can't game the system for subsidies, they actually have to prove they qualify.

Yes, those awful freeloaders are breaking our nation, that's it, they're the problem!!

Why does every effin discussion turn into a lame straw man supported, anecdotal discussion like this?

I dont blame the free loaders, they are simply a product of the system.

Can't afford a doctor, just go to the ER. Never mind that it costs those playing by the rules, never mind that the ER costs ten times what a trip to a doc would cost.

These people couldn't game the system if the system didn't help them do it. And why shouldn't they. Keeps those federal employees all employed. God knows they're not going make it better if it means they lose their job in the process.

Rather than pay out 10k a year to a family who makes a dozen trips to the ER (mom, dad, kids) why not give them a federal account with 5K in it for them to spend at a doctor of their choice. Then give them catastrophic insurance in case of a major medical illness.

Ever try to ask a doctor in a hospital what a procedure will cost? Most have no idea or don't want to discuss it. Give the patient control of a medical savings account and I think we'd save far more than clogging up the ER with kids who have a flu bug or a bad cold. Not to mention the patient would have some dignity.

(10-20-2013 09:10 PM)Chipdip2 Wrote:  

(10-20-2013 06:57 PM)Dirty Ernie Wrote:  One thing that would help is to stop treating people at emergency rooms if they ignore the sign up.

But that would really be tough love.

(Guy shows up with broken arm and no insurance) sorry sir, you'll have to tape it up yourself. Ouch.

(Appendicitis.) "But I'm allowed to give you this single edge razor blade and three aspirins. But you can't do it in here, you've got to go back out in the parking lot. Sorry!"

He related this story. A girl came in and thought she was pregnant. She asked them to do a pregnancy test. He told that when they do a pregnancy test they basically use the same over the counter units that you can get at Walgreens for ten bucks. He explained to her that by the time they did it, and gave her the results her bill would exceed a $1000.

THIS is the problem. How did it get to be that a simple test could cost over a thousand dollars? Whats the cost breakdown on that? They can get away with it because they can just charge our insurance, and our insurance doesnt' mind, because we se the bill and say "thank god I have insurance! I'm really getting my money's worth"

Just completed two major projects at health care and a major hospital, worked with a consulting firm that had a large footprint in the health care sector all of last year, from what I'm seeing, their (the health care) world is changing big time. Before they determined prices the old fashioned way, costs divided by customers x a desired markup. Good work if you can get it.

Now that's not the case, still though, I'd like to see insurance, govt or the big insurance companies NOT determining the prices like they do now, nothing free market about the old or the new.

(10-21-2013 09:09 AM)DesertBronco Wrote:  Just completed two major projects at health care and a major hospital, worked with a consulting firm that had a large footprint in the health care sector all of last year, from what I'm seeing, their (the health care) world is changing big time. Before they determined prices the old fashioned way, costs divided by customers x a desired markup. Good work if you can get it.

Now that's not the case, still though, I'd like to see insurance, govt or the big insurance companies NOT determining the prices like they do now, nothing free market about the old or the new.

I assume many of you read/heard about this article from earlier in the year.

It truly is crazy how the pricing works:

http://www.npr.org/blogs/money/2013/02/2...pital-bill

And this one, from a couple months ago:

http://www.npr.org/2013/08/07/209585018/...-so-pricey

(10-20-2013 03:57 PM)Chipdip2 Wrote:  Fine, let it flounder for all to see. Let people go on his beloved exchange to find out they're rates have sky rocketed because insurers now have to insure preexisting conditions, 26 year olds (adults) who are still under mommy and daddies plan, as well as do it with a pool of clients that isn't quite working out. In order to succeed they lots of young healthy people to sign up for $2000 plus yearly premiums, in order to have the funding to cover the oldsters who are also seeing massive increases. Problem is those young folks won't sign up, but rather will pay the $95 IRS fine. Plain and simple it isn't going to work.

This suggests it was a clusterfark from the beginning - WHY did they allow 'kids' to stay on parents' policies, IF THEY NEED THEM TO SIGN UP to ensure the viability of financing the system?

Doesn't make sense, but there is a lot in this monstrosity that doesn't make sense. As designed, it can't work.

The concept of kid has changed.

26 and under, that's under the parents wing still. Then some employment at the entry level but not expected to be self supporting until 35 or so.

Seeing lots of that.

It might be valid in today's economy.

In the Middle Ages you'd be dead around 35-40. Now you are just hitting your stride.

(10-22-2013 05:25 AM)Dirty Ernie Wrote:  The concept of kid has changed.

26 and under, that's under the parents wing still. Then some employment at the entry level but not expected to be self supporting until 35 or so.

Seeing lots of that.

It might be valid in today's economy.

In the Middle Ages you'd be dead around 35-40. Now you are just hitting your stride.

I truly don't understand it. I graduated at 21, moved to Ohio, got a job, bought a house at 23...

...but you're right, it does seem to be common these days.

Proud of you, stdat. We need more like you.

(10-22-2013 02:15 PM)Dirty Ernie Wrote:  Proud of you, stdat. We need more like you.

Why thank you.

And, if I'm being totally honest, the house probably would have been a few years later had the economy not tanked and gov't not tossed me $8K.

But hey, such is life. Economy stimulated. Or whatever.

(10-22-2013 10:41 AM)stdatwmu Wrote:  got a job, bought a house at 23...

...but you're right, it does seem to be common these days.

Sadly so did I. But that put my house purchase right at the height of the market... Whoops! At least I was smart enough to buy in an extremely rentable established neighborhood and not one of those pulte POS treeless island "communities"

Ubish, you have a lot of company in that decision.

I lost money on a couple of stocks that couldn't miss back in 90s.

Everyone has a couple of regrets, no life goes perfect.

Life drives real estate/home purchasing decisions. I've been lucky with the timing, and then been unlucky when I bought in late 2005 in Colorado. The market lately there has jumped big time, I'm finally feeling like completing the updates and putting it on the market next year, while now in Arizona this is an incredibly soft market (not Phoenix) that I have some trepidation about buying in due to poor economy.

Can't beat yourself up too much about needing a home and when you need to have it, and in the long run it usually works out. I think that the real estate dynamic and realization that I had lately in that space, got me out of trying to time the stock market and move towards a full on dollar cost averaging strategy.