Healthcare Behind the Scenes

Politico has a piece describing problems in the overall healthcare.gov system, mostly in the backend linking the signup process with the insurance companies, and extending into handling payments and change of life events.

Sounds a bit familiar from the good old days of the System/36.  One of the enduring lessons I learned was that for everything, whether it's a building or a software system, highways or ships, everything requires maintenance.  What that means for new systems, like healthcare.gov, is that you may implement and release a set of processes while planning to come along later with additional features.  But once you have the first release out, your time gets absorbed in the maintenance of those features, and the schedule for releasing version 2.0 slides.  And the sliding means that the jury-rigs to cover the gap grow and grow, and the problems of transitioning from the jury-rigged current system to the version 2.0 system, once available, also grow.

Improper Payments, FSA, and OIG

From today's Farm Policy, reporting an exchange in a hearing with House Appropriations and OIG:

"[OIG] In some of the other programs, say the RMA and NRCS programs, the improper payment rate is much higher, in the teens, maybe near 20%. There are probably a number of reasons for that. We are paying very close attention to that. And let me just offer the chance to comment to Gil and Ann.
Gil Harden, Assistant Inspector General for Audits: The thing that I would add to that, too, I mean, we are mindful of it, but the FSA percentages for their high risk programs for FSA are lower, some of the lower percentages. But we do keep them on the radar screen.
Ann Coffey, Acting Assistant Inspector General, Investigations: And I’d like to just address the question you had raised about what sorts of resources we’re allocating towards FSA investigative work. Historically, we have focused quite a bit of our resources on the SNAP program, but FSA is an area that we are definitely looking for an increase and expecting to increase our investigative work in those areas. We have had some very good cases within the last recent year with high dollar amounts, and so we do anticipate that within FY16 we will be increasing our work in FSA.

The Challenges of On-Line Versus Bricks: Banking and FSA

Had an experience the other day which IMHO shows the hurdles FSA and other agencies face when they try to combine bricks and mortar offices with online service.

The situation: dealing with my bank, with which my wife and I have several accounts, savings, checking, brokerage, IRAs, etc., basically operating under an umbrella which they call the PMA. They're the result of a history which started back in 1968 when I set up an account in DC in a bank which has been merged and remerged and remerged, and as my wife and I made decisions about savings and investments and consolidating accounts.

Anyhow, we have a branch office near our home, but we mostly do our banking online.

Though I haven't seen an organization chart for the bank, I deduce that they have a unit responsible for their branches,  a unit responsible for PMAs, a unit responsible for their brokerage accounts and IRA accounts, and a unit responsible for online banking. So we go in the branch to get a safe deposit box and straighten out a situation with the 1099 for 2015 taxes (I won't go into detail on that, because it's an embarrassing story--recalling the old lesson for software: when all else fails, read the manual.)

So the banker with whom we talked couldn't resolve our problem, so she made a call to the PMA help desk unit. We talked with the PMA person, without success, because she needed to talk to the online banking person.  At that point we decided to go back home and work the phones from there. I called the online banking help, who couldn't resolve it, and wanted to talk to the PMA people.  About that point I realized that it was my screw-up so I said thank you and hung up.

What's my bottom line:  in the old days dad would take the egg check and milk check to the bank, deposit them, get cash.  He knew the tellers and the bankers because it was a locally owned bank.  I'd imagine the general operations were very similar to those of the ASCS county office back in the 60's or before.  But as banking got more complicated, with different lines of business,, and more automated, that's changed, as witness my frustrating day.  More complexity means less mastery by the teller/clerk--even though the person is likely more educated, specialization means less total comprehension.

And the effect of the specialization/automation online operation is to create a frustration trap for customers and operators: 90 or 99 percent of the time it's a routine operation which goes smoothly, but the minority of the cases become much more problematic simply because there's a lack of centralized knowledge. [added--The point with my bank is the interaction among their various silos/units; the point with FSA would be the same.  The fiscal silo and the conservation silo and the payments silo all look separate to the Washington bureaucrat; they're one thing to the producer in the field.]

How successful has FSA been in moving its producers into online program servicing?  I don't know.  But organizing and educating to make that process work will be very challenging.

Eggs--Score One for My Mother

My mother used to get very upset in the 50's and 60's.  Not upset at me--I was the apple of her eye.  But upset at the people who were dissing the "perfect food", perfect in her mind, the egg.  On our farm dad did the cows and mom did the hens, so she was far from an unbiased observer as doctors and experts declared that cholesterol was the key to heart attacks, and we should all eat healthy by avoiding cholesterol-rich foods. Hens were her thing, a part of her identity, and she was a hard-headed German-American, so no one could persuade her that government experts knew better.

So today, some years after she died and many years after she gave up her hens comes word that the government is changing its advice.

Mom, you were right and us government types were wrong.

Cross Agency Collaboration

Steve Kelman in FCW on cross-agency collaboration:

"There is a common view among public management experts in academia and government that, as problems government faces become more complex, successful collaboration across agency boundaries grows increasingly important for delivering good results.
That collaboration is not easy. I remember reading in political science courses I took in graduate school decades ago about cross-agency coordinating councils. The view then was that it is extremely difficult for these activities to be effective, because agencies simply used them to advocate for the approach they took to problems, and tried to get other agencies to go along with that, rather than actually adapting their own behavior. Furthermore, these tended to be low-priority activities, to which organizations assigned the people least likely to be missed from their regular jobs."

 That's exactly what happened in Infoshare days--each agency had their pet idea which we tried to sell to the other agencies.  SCS wanted a laptop for field work, for example.  I wanted a new basic producer and farm data setup.  We didn't have the power to commit our agencies, not really, so when the impetus from the top faded, the whole house of cards collapsed. 

Actively Engaged

Politico anticipates the proposed rule defining "actively engaged" in farming, as the lead bit in an interview with Secretary Vilsack. 

The Agriculture Department is getting ready to tell a lot of people who’ve been getting farm subsidy checks without lifting a hay bale, swinging a pitch fork or driving a tractor that they’re cut off

Read more: http://www.politico.com/story/2015/02/usda-city-farm-subsidies-114955.html#ixzz3QyJyf6vf

It will be interesting to see what's proposed and how it fares.  My own bet--nothing will be finalized in this administration. 

Definitions Revisited

USDA is posting about its data and the brave new world of open data.  Among its goals for the coming year is this:

 " Work with AgGateway on standards and definitions – so “corn” or Common Land Unit (CLU) has the same definition for the data producer and the data users "

Now that aim isn't bad--presumably it can be met by being explicit in the definitions, but I'm reminded of the difficulty in the previous century of getting to common definitions.  To the layman and the big shots a common definition of "corn" between RMA and FSA and NRCS just makes sense.  But when you get into the nitty-gritty there's the qualifications and conditions which entangle the definition into the agency's mission and programs.  A Venn diagram would show circles which overlap maybe 95 percent of the area, but not 100 percent.

Acreage Reporting

Ever since 1933 reporting and checking crop acreages has been perhaps the biggest single workload item in AAA/ASCS/FSA's portfolio.  Hence threats to it raise the alarms:  

"Continuing on the subject of acreage reporting I want to assure you that NASCOE is leaving no stone unturned as we monitor the acreage reporting project that allows producers multiple options to file a report ( at FSA, with crop insurance, on line or other). Your leadership team understands that acreage reporting is the bedrock of all that we do at FSA and it is important that integrity in this process is maintained"

With the development of precision agriculture, and the growing value of having data tied to a specific tract, twill be interesting to see how acreage reporting changes in the future.


From the NASCOE newsletter

Farewell to System/36?

From the NASCOE newsletter

While I am sure most of your NASCOE officers will be covering some of the highlight of the past Calendar Year I will be focusing on the NEA Programs side of NASCOE. This year we should finally say goodbye to the wretched beast some call the 36 or AS 400. Of course, this good bye brings something new(ish).
We just received MIDAS release 2.0 which we’re told will work without a single hiccup.
We will at last have one system of record for maintaining Producers name, address, and TIN.
We are also anticipating new MPP software, new MAL software, and as well new software for ARC/PLC, which is already out. We’re also now using different software for FSFL’s.

 Those were the days, my friends. I remember them well (cue Maurice Chevalier in Gigi, a stage production of which is now at the Kennedy Center).   I remember Chris Niedermeyer as "trail boss" in 1989? talking about running out of space on the System/36 and the need to immediately get new hardware.   And I'm pleased to see the "one system of record," only about 16 years late.

WTO-Doha Restrictions on Agricultural Payments

In the late 90's, IIRCC, we were just starting to deal with our commitments under the WTO, commitments which restricted nations' ability to provide support to their farmers. There were different color categories, depending on whether the payments had the effect of distorting trade.  One reason for changing from deficiency payments tied to planted acreage to direct payments based on past history (i.e, the Freedom to Farm formula in 1996) was to change the categorization.  The theory was that payments based on planted acreage increased production in a country, payments based on historical base acreage delinked payments and production.

Anyhow, years have passed.  Generally countries have reduced their supports and because negotiations for new WTO agreements failed, we haven't heard much about the subject in recent years.  Today though  Farm Policy quotes an article:

"...only the United States wouldn’t be able to meet the commitments assigned to it under draft 2008 Doha texts. However, that calculation is based on U.S. subsidies from 2012 and doesn’t factor in changes in U.S. agricultural policies in the new farm bill.
“Under the proposed commitments, the United States would have exceeded its trade-distorting subsidy limits by $3.6 billion in 2012. A diplomatic source said it’s unclear whether the farm bill will help or hurt in this area particularly because it’s not clear whether the U.S. will classify crop insurance as trade-distorting in its next subsidy notification.”

 My impression is that crop insurance used be considered as something which encouraged production; certainly EWG believes that, especially with regards to the Great Plains.