As discussed on the first and second post in this three-part series, Massachusetts' left-wing journalists -- as has been the issue with all the reporting on the Patient Protection and Affordable Care Act (PPACA) nationally -- can't separate the web site from the law. So I try by previously explaining what happened to the people forced to change insurance plans in Massachusetts by PPACA and explaining below what the situation is with Massachusetts' Obamacare1 exchange.
Here's where I can add my most knowledgable perspective. Looking just into the Massachusetts Health Connector Obamacare web site -- alternately called an "exchange" and a "marketplace" -- is especially interesting to me because of research I did 20 years ago into such web sites for the Datapro division of McGraw Hill and International Data Corporation. I cannot say I invented the use of the terms "exchange" or "marketplace" in this context (we also tried "portal" and a few others), but I was probably in the room when they were first used this way.
Ten or 15 years ago, companies such as MediTech in Canton, McKesson/HBOC (which I think did some development in Cambridge), a division of GE in Burlington, VT, and many others were enabling much more sophisticated exchanges than what the Massachusetts Connector Authority wanted to do (basically the bottom line of the illustration) last year. How could this relatively simple effort (when you compare it against Amazon and Expedia and even 40-year-old airline reservation systems) get so screwed up.
The answers are in a diplomatically worded January 2014 study by Bedford-based MITRE. The easy answer: the government is involved. The longer answer is classic 50-year-old "garbage-in/garbage-out." According to MITRE (if you read through the diplomacy), every aspect of the $100 million effort was handled badly
- Project structure and reporting lines (simply put, there were/are three bosses of multiple different service providers with none of the bosses seemingly able to easily make a decision or communicate with any of the service providers when they do make a decision)
- Project planning and execution (no clear explanation of how you and I would use the system or why; to some extent this was the Federal government's fault in delaying the rules behind Obamacare insurance)
- IT governance (everything was done poorly from conception to testing; to be fair, the testing was not done poorly; it just wasn't done)
- Technical choices (the list is too long and too technical for my blog but let me try to explain it this way: in 2013, the state of Massachusetts and its Connector Authority was bascially trying to manage and execute a $100 million IT project for people still using IBM keypunch machines that were retired in the 1970s using multiple Excel spreadsheet processors that were retired in the 1990s implemented by people trained in Lotus 1-2-3, which was retired in the 1980s; that's a gross exaggeration to make a point but the Excel spreadsheet statement is almost true--it used a very minimalist project called Microsoft Project)
I don't want to pretend that similar things don't happen in the private sector. The most famous was a huge foul-up involving the leading German software supplier SAP and Hershey about 10 years ago. But when they happen, people get fired. That does not seem to be the case here.
So when press reports say the Health Connector Authority is making progress, it means the back-up paper-intensive process described in Part II is starting to sort out which bucket people really belong in and putting them there manually. But the technical side of the effort is still in complete disarray and apparently will be completely abandoned.
1Obamacare is the insurance enabled by the Patient Protection and Affordable Care Act (PPACA) of 2010 as amended; PPACA is the law