The Tin Lizard

Healthcare.gov - Changing The Meaning Of Disaster

It seems to me that CMS Director Marilyn Tavenner got it about right in her testimony in Congress about the problems with the government healthcare website.  Apologies are nice and always make everyone feel better, but a calm, objective look at the situation comes down to one simple observation:   Mistakes happen.

In fact, as various observers have pointed out over the past few weeks, this is far from the first meltdown that has occurred when a new website, or a heavily revamped one, has been brought online amidst high expectation, only to fail miserably.  Such problems have occurred in a variety of settings, including the Pentagon, the FBI, and some of our leading software and online companies.  

Failures and crashes have become so predictable that they seem to be the norm.  Seriously, now:  If you've been told of major changes in a website, don't you approach it initially with some trepidation?  You hope for the best but you know, deep down, that "There Will Be BSOD."  That happened with me today when I spent a couple of hours entering data on the recently revamped website of an organization I'm connect with, only to find that when I saved the data, it just disappeared.  (It turns out they did not make the site compatible with the current version of Microsoft Internet Explorer, the most widely used web browser.  HUH?)

So, long story short:  To call Healthcare.gov a "disaster" is to redefine disaster.  A disaster is supposed to be a terrible unexpected, even unpredictable, outcome.  In this area of human endeavor, though, failure is only to be expected.

It looks as if there's a dirty little secret underlying all this.  I was struck by the fact the contractor for the health care site has been saying that it's not their fault because the CMS should have tested the program far earlier than it did.  Funny, when I hire a contractor for something, I would expect them to do the testing.  I suspect a lot of IT contractors know the various components of the systems they develop but haven't perfected how to make them work together smoothly.  It's like driving a stagecoach using a team of wild tigers, or giant cockroaches, instead of horses -- we don't know how to control tigers or cockroaches.

I think this all makes clear why it's nuts for Congress to be calling for HHS Secretary Sebelius's resignation.  They should criticize her more legitimately, perhaps, if she had been devoting her management time to overseeing details of work far below her pay grade, where the contractor was expected to have the expertise.  Besides, let's imagine what kind of a website Congress would design, if it tried...

TTT Smarts

One Christie Aschwander, whoever she may be, says she doesn't want a mammogram even though her doctor recommended it as "routine."  She's researched the matter, the different types of breast cancer, the odds, and so forth, and made an intelligent decision to bypass a procedure that she calculates could do as much (or more) harm as good. 

Good.  You may question her decision, you may not agree, you may choose to go the other way.  But at least she's thought about it and involved herself in the decision-making process.   

Doctors aren't gods - demigods at best. It's only natural that they will recommend the safe alternative, the extra test, the diagnostic procedure that eliminates even the most remote possibilities.  That's because of the lawyers, who if the least little thing goes wrong (or even if it doesn't) may instigate lawsuits charging negligence and malpractice.  Insurance companies will pay for duplicative or unneeded tests and diagnostics for the same reason.  In this environment, many doctors are discouraged from the true practice of medicine. 

The intelligent future of medicine is to get involved and make your own health care decisions. Turning down Tests and Treatments (TTT) may be the smart thing to do. 

Our Changing Earth

Geology was never something I knew much about but lately I've had occasion to learn a little more and I find two things fascinating:

(1) How much of what we know now about the geologic history of the earth is fairly recently acquired.  For example, I can remember reading articles about tectonics and continental drift in the 1960s.  At the time, I thought, "OK, that's really interesting,"  but hadn't really wigged to the fact that this was entirely NEW scientific thought at the time.  I assumed it had always been that way, but in fact it was new studies and techniques that brought us to general acceptance of tectonics a mere fifty years ago.

(2) The extent to which the term "solid ground" is meaningless if your time frame is billions of years.  Rocks liquefy and are returned from the earth's surface to its core over time; mountain ranges rise up and are eroded away; our "solid earth" (i.e., our continents) is actually a fleet of immense floating battleships, slowly but ever-so-surely being pushed hither and yon to new locations on the planet's surface. 

As a most recent evocation of our long-term transience, a recent item by Ivan Amato deserves attention, exploring how even the shape of our "sphere" is continuously being altered, and how that in turn affects time.  Our days are growing imperceptibly longer. 

Nothing to worry about in our own lifetimes, yet somehow, I suspect the rabid fans of daylight saving time will find some way to give us still "more daylight" well into the eons to come.   

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