World View: Aetna CEO Predicts Obamacare IT Failures Until 2017
- Aetna CEO predicts Obamacare IT failures until 2017
- Assad says loss of chemical weapons a blow to Syria's morale
- EU officials demand more privatization from Greece
Aetna CEO predicts Obamacare IT failures until 2017
Aetna CEO Mark Bertolini
As I wrote yesterday ( "14-Oct-13 World View -- HealthCare.gov IT systems a continuing disaster"), the Obamacare IT systems are a continuing
technical disaster, much worse than the "glitches" that the
administration are describing. It now turns out that the technical
issues are much more serious than even I realized.
Mark Bertolini, the CEO of insurance company Aetna Inc., has been
personally involved in the implementation of Obamacare from the
beginning, from both a policy and an IT perspective, and he's always
been a supporter of Obamacare, albeit perhaps a reluctant one.
Bertolini was interviewed on CNBC on Monday, and his technical
assessment of the Obamacare websites is that they're so bad they
won't be fully working until 2017.
Since yesterday, several people have written to me to complain that I
was being too negative about the Obamacare web sites, and I didn't
really know, since I wasn't involved in their development. But that's
not true of Bertolini, who knows as much as anyone in the country
about what's going on.
I transcribed the interview. Questions from the interviewers are
enclosed in [brackets]. Bertolini was first asked if he knew from the
beginning how bad it would be:
We were one of the alpha testers. We got pretty
nervous as we got further along. We helped them build blueprints,
on how to put the system together, and as they started missing
deadlines, we were pretty convinced that it was going to be a
[Did you tell them - don't do this - move the date?]
We started to help them prioritize how to move ahead with the
project. They have their perspective on when they wanted to start,
so we did our very best to help them get started on time...
[How long will it take to actually get them fixed to work, get out
all the kinks?]
That is a big question. When you implement a project of this
size, the first thing you do is unit testing, then you do
application testing, then you do integration testing, and then you
do scalability testing. And that plan is usually a lot longer than
some of the application development itself. That's happening on
[It wasn't done beforehand?]
All of it's been on the fly. We didn't get code drops until a
month before the system went live from a user testing
This is already devastating. Yesterday I was criticizing the
contractors who implemented the web sites as incompetent, and this
proves it. For a full-scale rollout of such a large system on October
1, any competent IT manager would have provided testable code several
months earlier. As Bertolini says below, this should be a career
ending mistake for the people involved.
So if you think about ... you don't know what
scalability issues you have until you have all the functionality
working, and everybody starts hitting the system, so you've
actually gotta get the functionality up, and the integrated
testing working, cause you don't know how many files you're going
to hit, how many people are going to hit them, until you get it
working together. And then scalability is the last thing you
[What happens January 1 - if people are having troubles now - if
it's that bad of a situation, is everyone going to be able to sign
up by January 1?]
No, and that's why enrollment is gonna still be open until march
31. But I think the bigger issue is whether enough people will be
able to sign up to make it work.
[You need buy-in by a lot of people -- need a lot of young
I think the attention span of the younger generation in using
technology - if it doesn't work the first time, it's going to be
pretty tough to get them back the second time. And so as a
result, with the web site technology, we are actually testing it
with the types of users who we want to use it.
[So there's not much time to get it right.]
It's the law of the land, number one. Number two, public
exchanges are gonna be here to stay, so we need to make them work
somehow. And I think the question is how we get there from here.
[The six months between now and March 31 - that's not a long time
- to do all of the testing and prototyping and evaluation and
scalability of the system this large. Is that enough time, in
I don't know. We're in a place now where there's so much wrong,
you just don't know what's broken until you get a lot more of it
fixed. And we have to plow through it. I've been here one or two
times in my career, it's nothing you ever want to repeat, cause
it's very difficult. It's a career ending event in a lot of
[Taking the politics out of it -- Are you worried that if it's
delayed a year - once you get people into an entitlement, you
never get them out, so you wanted to get started, right?]
If the program blows up because people don't sign up, then the
program's not going to move ahead either for all that while.
So this is gonna be a three year thing.
[Should they delay it by a year?]
I would have [delayed it], if I'd been in their seat. So the
politics got in the way of a good business decision.
So this is gonna be 2017-2016-2017 before it grows. I think the
bigger issue for folks to think about is that private exchanges
have now kicked off, as a result of the private sector innovating
against the law. And as these private exchanges move ahead, and
they're very good experiences in a lot of cases, we'll be
launching a number of them, we'll be in 15 this year alone, what
will happen is that you'll start to attract people to a different
kind of marketplace. What will do in juxtaposition to the public
exchanges over time, and how will that work?
The important points in Bertolini's interview are these: Almost no
testing has been done; implementation should have been delayed for a
year; it's going to take three years to get it working.
I've been a Senior Software Engineer for decades, and I've been a
technology journalist for almost as long, so I'm very well aware of
what's going on here. I've been a personal participant in several IT
disasters, and I've been an outsider reporting on several IT
disasters, and I can tell you that this smells to high heaven like an
There are two kinds of IT projects. One kind is like digging a ditch.
You know that if you keep digging, you'll eventually get the ditch
dug. It may take longer than expected, but sooner or later it will
always end successfully, because there's no real risk.
The second kind of IT project is like building a bridge, and the risk
is extremely high. You can keep building, but if one day the entire
bridge collapses and falls into the river, then you have no choice but
to either start over or just abandon the project. The Obamacare websites are in this category.
This project should have cost $10-25 million, as I described
yesterday, but it's already cost an astronomical $93.7 million. Now
the Obama administration has to decide whether this "bridge," which is
in the process of collapsing into the river, should be repaired, or
whether the project should be started from scratch. It's quite
possible that there's no choice but to start it from scratch. But
either way, it's going to cost many more tens of millions of dollars
to get working, if it ever works. And the Obama administration is so
desperate to save Obamacare, they'll do anything, no matter how
desperate the action.
There's one more thing worth noting: Bertolini talks about "private
exchanges" that are springing up in competition with the federal
exchanges. This is a very interesting development worth watching.
Assad says loss of chemical weapons a blow to Syria's morale
It's always nice to know that even genocidal maniacs can have a sense
of humor, so it's worth a chuckle that Syria's president Bashar
al-Assad said that he should have been a winner of the Nobel Peace
Prize. Actually, I've made the same suggestion in the past -- that he
deserves the prize by exterminating as many innocent people as
possible, so there's no one left to fight a war.
However, it's possibly more interesting that al-Assad, who until
recently denied that he had chemical weapons, is now saying that
losing them would be a loss of morale for all of Syria:
There is no doubt that the loss of chemical weapons
has resulted in a loss of morale and a political loss for
Syria. Since 2003, Syria has demanded that the countries in the
region dismantle their WMDs, and the chemical weapons were meant
to be a bargaining chip in Syria’s hands in exchange for Israel
dismantling its nuclear arsenal.
The chemical weapons, which have lost their deterrent value over
the past few years, were meant to be used only after Israel used
its nuclear weapons.
Today the price has changed and we have agreed to give up our
chemical weapons to remove the threat of the US attacking
So why are they a loss of morale for Syria? Because "Israel would
distribute gas masks to its citizens when there was a rise in tension
in the region." Jerusalem Post
EU officials demand more privatization from Greece
Greece was first bailed out for 110 billion euros in 2010, but when
that failed, it got a second rescue in 2012 worth 130 billion euros
plus a private sector debt write-off totaling more than 100 billion
euros. But it still isn't enough. Greece would like to issue bonds
in 2014 for 4.4 billion euros to pay for debts that will come due
next year, but Greece's debt is already 175% of annual output. European officials are refusing to permit Greece to go even deeper
So there's still a 4.4 billion euro funding gap in 2014 which will have to be made up somehow, and an ECB executive board
member puts the figure at 6 billion euros. Instead, the ECB is
demanding that Greece sell off more government assets and privatize
more government run businesses. At any rate, European officials will
not make any decisions until December. Kathimerini and AFP
KEYS: Generational Dynamics, Aetna, Mark Bertolini, Obamacare,
Syria, Bashar al-Assad, Israel, Greece
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