{"id":6062,"date":"2013-11-07T10:17:46","date_gmt":"2013-11-07T15:17:46","guid":{"rendered":"http:\/\/www.xonitek.com\/?p=6062"},"modified":"2022-09-16T13:23:16","modified_gmt":"2022-09-16T17:23:16","slug":"you-only-get-one-opportunity-to-make-a-first-impression","status":"publish","type":"post","link":"https:\/\/opexsociety.org\/body-of-knowledge\/you-only-get-one-opportunity-to-make-a-first-impression\/","title":{"rendered":"You Only Get One Opportunity to Make a First Impression"},"content":{"rendered":"

Imagine this scenario:<\/i><\/b>\u00a0 An upstart high-tech firm in Silicon Valley has an idea for an offering which promises to transform the lives of tens of millions of people across the United States.\u00a0 It has adequate funding and an abundance of time for product design and development leading-up to its launch.<\/p>\n

To be sure, there are a large number of people who are suspicious and cynical.\u00a0 Some people believe the offering is over-hyped.\u00a0 Some believe that it simply won\u2019t work.\u00a0 Some believe it is runs counter to legacy, nostalgia and tradition.\u00a0 Some believe that it will benefit few and harm many.\u00a0 And some believe that the status-quo is satisfactory, so why change it?\u00a0 But most have a \u201cwait and see<\/i>\u201d attitude.<\/p>\n

On the day of the big launch, the offering fails miserably.\u00a0 The problems range from not being able to access the system at all, to system failures when trying to place the order, to errors in the logic imbedded in the ordering system (with those forced to give inaccurate information just to proceed to the next step).\u00a0 Only single-digit percentages of those who want to buy the offering are successful in placing an order.\u00a0 Even those who are successful spend half the day just trying to place their order.<\/p>\n

The company admits the launch was an abysmal failure \u2013 but promises the \u201cglitches<\/i>\u201d will be fixed (they just don\u2019t know when).\u00a0\u00a0What would be the impact on the company?<\/i><\/b><\/p>\n

Would the consumer continue their rush to purchase the offerings?\u00a0 Would they retain their confidence in the company to deliver what was promised?\u00a0 Would they retain their faith in the company\u2019s leadership as stewards of the company\u2019s viability?\u00a0 Would they look to alternatives?\u00a0 Would they decide what they have is good enough \u2013 or that they can do without buying?\u00a0 If this were a public company, what do you think the analysts would say?\u00a0 What would happen to the stock-price?<\/p>\n

And what if, by some series of events or even a miracle occurring, the company was able to launch its offering \u2013 albeit at some later date.\u00a0 Would the people be trusting and as keen to rush forward and buy?<\/p>\n

You only get one opportunity to make a first impression.<\/p>\n

\"Non-partisan\"Such is the case of the \u201cPatient Protection and Affordable Care Act<\/a>\u201d (PPACA) \u2013 commonly referred to in the media as the \u201cAffordable Care Act\u201d<\/i>\u00a0(ACA), or simply\u00a0\u201cObamacare\u201d.<\/i><\/p>\n

Regardless of whether the purchase is from an individual, a company, or the government; there are a few requisites that must exist for a person to agree to engage in a purchase transaction with another.<\/p>\n

    \n
  1. Assess the need: Is there a marketplace for the offering?<\/li>\n
  2. Create an offering to meet (or generate) the need.<\/li>\n
  3. Generate market awareness for the offering.<\/li>\n
  4. Expedite purchase execution by consumer<\/li>\n<\/ol>\n

    1st \u2013 Assess the Need:\u00a0 Is there a Marketplace?<\/b>
    \n<\/b>The first step in creating an offering is to assess the potential marketplace for the offering.\u00a0\u00a0Who is the customer?\u00a0 Why would they buy?\u00a0 Who is going to actually buy?\u00a0 And why would they buy under PPACA versus some other vendor?\u00a0<\/i>I am certain that nearly everyone in the United States would agree that the costs associated with healthcare and health insurance for value received is ever-widening and that the bureaucracy is crushing. I am also certain that nearly everyone in the United States believes that the healthcare and healthcare insurance industries \u2013 when considered as a whole \u2013 are in dire need of end-to-end reformation and transformational change.<\/p>\n

    But for the purpose of this article, I am not going to debate whether I believe that transformational structural reform of the healthcare and health insurance industry in the United States is necessary (which I do), or whether I believe everyone in the United States must have some form of health insurance (which I do), or whether I believe that the PPACA is the piece of legislation that will deliver that transformation (which I don\u2019t \u2013 but I also believe it should be re-engineered, not repealed).<\/p>\n

    \"\"<\/a><\/p>\n

    You can read more of my analysis and thoughts on the on the subject of healthcare and health insurance value-for-cost in the United States in a previous article of mine; \u201cHealthcare: No End in Sight \u2013 Poor Value at Unsustainable Cost<\/a>s\u201d.\u00a0<\/b>Who is the customer?<\/i>\u00a0\u00a0In this first step, I believe the government correctly identified their target customer namely as: those who are uninsurable, those who are presently uninsured, and those likely to remain uninsured.\u00a0 Not surprisingly, and according to the\u00a0Kaiser Family Foundation<\/a>,\u00a0 38% of the estimated 47.3 million without health insurance have an income which is below the\u00a0Federal Poverty Level<\/a>\u00a0(FPL) as established by the\u00a0Federal Department of Health and Human Services<\/a>\u00a0\u2013 and over 75% have an income which is under 250% of the FPL (for a single, 250% is $28.7k and for a family of four it would be $58.9k).<\/p>\n

    \"Graph<\/a><\/p>\n

    Why would they buy?<\/i>\u00a0 As with any insurance, the person who is likely to buy health insurance wants to protect something of value (namely, their property and assets), has the means to pay the premium, and makes a risk-assessment as to whether the insurance might be necessary during the period of coverage.<\/p>\n

    Who is going to actually buy?<\/i>\u00a0\u00a0\u00a0Given the above, it therefore stands to reason that a young single person without any assets to protect might go without insurance knowing that they will get the necessary care anyway in the case of an emergency (the most likely need) and also knowing that the healthcare provider is not able to be a threat against assets that do not exist.\u00a0 Whereas those who actually buy the insurance will be those; i) who have the ability to pay the premiums, ii) who have a very serious illness and need more intensive treatments than a visit to the emergency room will provide, or iii) have accumulated some wealth or property which might become at-risk should debts be accumulated due to healthcare related issues.<\/p>\n

    However, it is very important to keep in mind that the insurance offered under PPACA insurance is for costs related to the delivery of healthcare and not against lost income \u2013 so a protracted illness might still result in a threat to any accumulated wealth or property.<\/p>\n

    \"Tracking<\/a>Why would they buy from PPACA versus some other vendor?<\/i>\u00a0 In a word, \u201caffordability<\/i>\u201d as it is on a more moderate cost escalation trajectory than healthcare insurance premiums from private insurers.\u00a0 As in Medicaid and Medicare, there is tremendous pressures from the government on healthcare providers to contain costs.\u00a0 The trade-off, of course, is that private insurers have more flexibility and will (mostly) cover charges incurred by healthcare providers who might decline to participate with patients in the government programs and therefore considered more \u201celite<\/i>\u201d.<\/p>\n

    For this step, I believe that the\u00a0\u201cneed\u201d<\/i>\u00a0exists and was properly assessed in general, but\u00a0the Fatal Flaw at this First Stage<\/i><\/b>\u00a0of market analysis was that not enough market research was performed on the actual consumer \u2013 who was clearly misunderstood by the lawmakers in Washington when they crafted the Act.<\/p>\n

    If we examine the data on Poverty in the States from data obtained by the US Census Bureau as shown in the graph, it is unsurprising that we can see that those who stand to benefit most from the PPACA are the those who are at or near living in poverty (75.9 million people, or nearly 25% of the population).<\/p>\n

    \"Poverty<\/a>The question then becomes; what amount, if any, can a person or family living in or near the poverty level afford health insurance?<\/p>\n

    Is the right question even being asked?\u00a0 Maybe the question is not about affording health insurance, but being able to afford healthcare?<\/p>\n

    If we look further into those who are living in poverty, we see (unsurprisingly) that those with lesser levels of education are more likely to live in poverty.<\/p>\n

    As such, the question begs; do the uneducated and impoverished have the means and ability to log onto a website and accurately navigate to completion to apply for PPACA coverage?<\/p>\n

    2nd \u2013 Create an Offering<\/strong><\/p>\n

    Once a need is determined and the marketplace identified,\u00a0the next step is to craft an offering to suit the demand.<\/p>\n

    \"UglyUnfortunately, the results of the gyrations and contortions
    \nnecessary to get the Act passed through both the Senate and the House of Representatives and also signed into law by the President was an     \"InfoGraphic<\/a>Act that can only\u00a0be described as an \u201cUgly Baby\u201d\u00a0\u2013 a legal \u201cRube Goldberg Machine\u201d.<\/a><\/p>\n

    Not even the President can seem to describe the Act, its specific benefits, and how it is intended to operate. \u00a0As\u00a0Albert Einstein<\/a>\u00a0famously said,\u00a0\u201cIf you can\u2019t explain it simply, you don\u2019t understand it well enough.\u201d<\/i><\/p>\n

    No matter how many articles I read, no matter how many summaries and \u201cWikipedia\u201d references I dive into, and no matter how many times I visit the\u00a0Kaiser Family Foundation<\/a>\u00a0\u2013 I still cannot make sense of the terms, conditions, processes (and their navigation) of the Act.\u00a0 Nor have I heard anyone who was able to clearly articulate such.<\/p>\n

    In some States, there is the option of private insurance or signing onto the States Medicaid.\u00a0 In others, it\u2019s private insurance and the \u201cexchanges\u201d set-up by the Federal Government.\u00a0 The prices and coverage are nearly impossible to compare.<\/p>\n

    Most people will believe that the website(s) necessary to support the PPACA are at the heart of the failure.\u00a0 But I would argue that the real root-cause of the failure is the complexity in the construction of the Act itself.<\/p>\n

    Since nobody really understood the breadth or depth of the implications in the Act, the design of a website was all but impossible \u2013 with countless \u201cexceptions\u201d and changes being discovered during the design engineering and deployment phases.\u00a0 It all but assured the abject failure of the roll-out.<\/p>\n

    For this\u00a0Second Stage of Creating an Offering<\/i><\/b>, I believe it was\u00a0Fatally Flawed from nearly every aspect<\/i><\/b>\u00a0imaginable and should never have been passed\u00a0\u201cjust to pass something\u201d.<\/i><\/p>\n

    3rd<\/sup>\u00a0\u2013 Generate Market Awareness<\/b><\/strong><\/p>\n

    Certainly, there was a lot of outbound communication regarding the PPACA, from all sources.\u00a0 Some communications were from proponents of the PPACA and some were from opponents.\u00a0 Some were (supposedly) knowledgeable of what the PPACA was to provide and how it was to work, but many sources of communication were entirely unknowledgeable.\u00a0 And all sides had their \u201ctalking heads\u201d, sound-bites, and propagandists.\u00a0 From a consumer\u2019s prospective, trying to become knowledgeable to the point of being able to make a reasoned decision became all but impossible.<\/p>\n

    But, if one considers that the primary beneficiaries of the PPACA were those who were in or near poverty and under-educated \u2013 well, it\u2019s easy to predict the results that were experienced.<\/p>\n

    <\/div>\n

    Even President Obama made statements which were inaccurate \u2013 if not outright wrong \u2013 on many occasions during the development of, and campaigning for the PPACA; with the most notable being in regards to\u00a0\u201ckeeping you plan and your doctors, if you wish\u201d.<\/i><\/p>\n

    Compare and contrast that miss-information with those who spoke of the creation of\u00a0\u201cDeath Panels\u201d \u2013\u00a0<\/i>especially Fox News and Sarah Palin.<\/p>\n

    Who can the people turn to for accurate information if not from the Nation\u2019s Leaders and News services?<\/p>\n

    <\/div>\n

    It\u2019s not unreasonable for people to want to get accurate information.\u00a0 Probably the most comprehensive source of information I found on the PPACA was at the\u00a0Kaiser Family Foundation<\/a>. \u00a0 I am certain that the under-educated would find the information on the website confusing, and there is bias in favor of the PPACA that makes every attempt to minimize its shortcomings and failings (from intent, to design, to deployment).\u00a0 For instance, there is an article published on October 29th<\/sup>\u00a0that is entitled\u00a0\u201cObamacare Vital Signs Not Just Numbers\u201d<\/i><\/a>\u00a0\u2013 and this is anathema to any\u00a0\u201cOperational Excellence\u201d\u00a0<\/i>professional.<\/p>\n

    But answers (even if biased) to most of the questions that a person might have can be found there.<\/p>\n

    Another topic which was inaccurately communicated were the costs \u2013 both to those who already had \"How<\/a>existing coverage and those who would soon be able to gain coverage.\u00a0 Those who had coverage were largely expecting no changes beyond the annual increases to which they have become accustomed (some were even expecting a decrease in their premium costs).\u00a0 And many of those who did not previously have coverage, but were looking forward to the opportunity for coverage, were expecting to obtain that coverage at no cost.<\/p>\n

    In the end, \u201cThere is no such thing as a free kitten\u201d.\u00a0 Somebody always pays the party, but this should have been known and this should have been communicated openly and honestly.<\/p>\n

    4th<\/sup>\u00a0\u2013 Expedite Purchase Execution by Consumer\u00a0<\/strong><\/p>\n

    \"TrainBy any stretch of the imagination, the launch of the website(s) for, and related to, PPACA is completely off-the-rails and has been an abysmal failure \u2013 however measured.\u00a0 And to claim otherwise is simply a canard.<\/p>\n

    It is so bad, that the program has become a laughing-stock, destined to be a future idiom like \u201cjumping the shark<\/a>\u201d \u2013 whose meaning is to \u201cdecline in quality to the point where it is beyond recovery<\/i>\u201d and whose origins is the \u201cHappy Days<\/a>\u201d episode where\u00a0Arthur \u201cFonzi\u201d Fonzarelli<\/a>\u00a0literally jumps over a shark whilst waterskiing.<\/p>\n

    According to a\u00a0report<\/a>\u00a0from\u00a0CBS-News<\/a>\u00a0on October 31st<\/sup>, the goal of the systems is to enroll 39,000 subscribers a day \u2013 and 7 Million by April 30th<\/sup>.\u00a0 Citing a myriad of problems, on the first day of operation there were 4.7 Million \u201cunique visitors\u201d<\/i>\u00a0to the \u201cHealthcare.gov<\/a>\u201d website on the\u00a0first day<\/b>\u00a0\u2013 and a\u00a0total of six (6) enrollments<\/b>.\u00a0 According to a November 1st<\/sup>\u00a0article<\/a>\u00a0in\u00a0Bloomberg<\/a>, after the first two (2) days in operation (October 1st<\/sup>\u00a0 thru 2nd<\/sup>) and with \u201cdirect enrollment still not working\u201d,\u00a0<\/i>only 248 people had completed the registration process at the \u201cHealthcare.gov<\/a>\u201d website with another 40,000 applicants with a status of \u201cin process\u201d.<\/p>\n

    The States which had set-up their own exchanges where having greater success with enrollment, since their websites are (largely) functioning more reliably and completely than the Federal website.\u00a0 But with success comes problems \u2013 namely, most of the applicants at the State-sponsored exchanges were destined for the Medicaid systems of those States, as opposed to private insurers.\u00a0 Although the analysis is incomplete, there is a risk that the increase in Medicaid participants\u00a0might generate<\/i><\/b>\u00a0an ever-increasing and disproportionate burden on the taxpayer.<\/p>\n

    To illustrate, according to a November 1st<\/sup>\u00a0article<\/a>\u00a0in the\u00a0Washington Post<\/a>\u00a0and as the graphic from that article below demonstrates, those enrolling in the Medicaid programs of States that offer the option (of those who have reported) are far greater than those enrolling in plans offered by Private insurers.<\/p>\n

    \"Medicaid<\/a><\/p>\n

    \"Healthcare.gov<\/a>So, what went wrong with\u00a0HealthCare.gov<\/a>?<\/p>\n

    There are many who make the bold statement that the PPACA and its website is one of the largest and most complex projects ever undertaken by the Federal Government \u2013 ever.<\/p>\n

    Bigger than the\u00a0Louisiana Purchase<\/a>?\u00a0 Bigger than the\u00a0Manhattan Project<\/a>?\u00a0 Bigger than the\u00a0Interstate Highway System<\/a>?\u00a0 Bigger than the\u00a0Apollo Program<\/a>\u00a0and the\u00a0race to the moon<\/a>?<\/p>\n

    It\u2019s a website (see graphic) \u2013 and a complex website to be certain.\u00a0 And it\u2019s a deal, but not a big deal.\u00a0 So it has a number of contractors, has to interface with a bunch of other systems \u2013 so what.\u00a0 Many others, with far fewer resources at their disposal, have done far more with greatly better results.
    \n\u2026\u00a0    Amazon<\/a>,\u00a0eBay<\/a>,\u00a0Google<\/a>,\u00a0Facebook<\/a>\u00a0\u2013 to name but a few.\u00a0 These are all far bigger deals than Healthcare.gov.<\/p>\n

    To see for myself, I tried (and failed miserably) to apply for insurance coverage through the exchange.\u00a0 In the few opportunities I had to actually begin the process (the site kept crashing on me), I didn\u2019t get far before I was thwarted by some required piece of information which I didn\u2019t understand.<\/p>\n

    And given my suspicion that the site was not well engineered and well designed, I was very hesitant to provide my personal information (name, address, date-of-birth, and social security number) not for any \u201cHIPAA<\/a>\u201d concerns, but concerns over \u201cIdentity Theft<\/a>\u201d.
    \n\u2026 I even called the phone number to apply via telephone where I was on hold for 1hr-12min before someone answered \u2013 and even then, could not begin to take my information.<\/p>\n

    According to a\u00a0November 1st<\/sup>\u00a0article in Bloomberg<\/a>, the condition and state-of-readiness of the Healthcare.gov website is so bad that Google and Facebook have volunteered to contribute their software engineering resources to overcome the problems.\u00a0 Calling it a \u201cTech Surge\u201d, the Federal Government has accepted.<\/p>\n

    And the customers?\u00a0 What became of the intended customers of the system?\u00a0 They have become even more confused and skeptical \u2013 and increasingly less likely to engage.\u00a0 And why should they, really?<\/p>\n

    Those people who are the intended beneficiaries of the PPACA are sidelined.\u00a0 From the specifications of the Act, through the attempts of deployment, I feel the \u201cvoice of the customer\u201d was never heard \u2013 I am not even sure reaching out was ever considered.<\/p>\n

    How far and how deep is this new-found cynicism?\u00a0 People don\u2019t make fun of the successful \u2013 certainly we don\u2019t hold them to ridicule.\u00a0 We never see skits on\u00a0Saturday Night Live<\/a>\u00a0(SNL) poking fun or otherwise ridiculing\u00a0Steve Jobs<\/a>,\u00a0Apple<\/a>\u00a0and\u00a0Pixar<\/a>, or anything associated with the person or the company.\u00a0 The same is true of\u00a0Elon Musk<\/a>\u00a0and his companies\u00a0PayPal<\/a>,\u00a0Tesla<\/a>\u00a0or\u00a0SpaceX<\/a>; or\u00a0Sir Richard Branson<\/a>\u00a0of the\u00a0Virgin Group of Companies<\/a>, or\u00a0Larry Ellison<\/a>\u00a0of\u00a0Oracle<\/a>.<\/p>\n

    People are also kind to those who tried and failed \u2013 so long as they are humble as a person and even possess an appreciation of self-deprecating humor.\u00a0 For instance, take\u00a0Groucho Marx<\/a>\u00a0when he said;\u00a0\u201cI don\u2019t care to belong to any club that will have me as a member.\u201d<\/i><\/p>\n

    But people are ruthless when it comes to hubris undeserved or, better yet, failed.<\/p>\n

    So, you know you have reached the pinnacle of the absurd when people roast you and your program on Saturday Night Live and\u00a0Jon Stewart<\/a>.\u00a0 You know you have arrived in this hallowed ground of the anti-hero when someone (many in this case) have created a \u201cHitler Rant\u201d.<\/p>\n

    \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0