patrick.net

Homeboy says

bob2356 says

Taxes come from the rest of us, not the tooth fairy. Fail on this part of your argument.

Has your federal income tax gone up as a result of Obamacare? I still pay the same rate I always have. Unless there's a "Bob" tax that only applies to you, I would say your argument doesn't hold water.

I'm filing taxes for 2011 as we speak (I'm overseas I get 6 more months), So you saying that ACA was fully implemented and funded far enough in advance of the start of the 2011 tax year that the costs were budgeted in for 2011? I wasn't aware of this. Tell me more.

tts says

Fee-for-service is going away as we speak though. The insurance companies and Medicare/Medicaid are refusing to pay out like that. They're starting to pay out based on quality of care which in theory is a good thing and should be done though the way they're going about doing it is kind've stupid.

I have to believe your definition of going away is awful broad. Very, very few people are being treated that are not fee for service. Some HMO's work on capitation, but not all the many. Even when doctors become hospital employees it just means the hospital bills ffs instead of the doctor.

tts says

Fee-for-service is a weird feature of the American health care system and not a requirement of any sort of UHS, which is essentially what a Medicare-for-All program would be.

It's certainly not a requirement but I'm very curious how Medicare for all would be implemented without ffs. As far as I know all of medicare is ffs. Part A&B are as well as private ffs are. I'm always willing to learn something new. What part of medicare is using capitation or some other way to avoid ffs and what percentage of the care is this?

bob2356 says

I have to believe your definition of going away is awful broad...Even when doctors become hospital employees it just means the hospital bills ffs instead of the doctor.

Medicare started laying the legal/regulatory ground work for moving away from FFS back in 2009-10 and the insurance companies started to follow suit in 2012-13. The thing is its a gradual process and depending on which state and who you work for nothing may seem different at all -yet-. But that is going to change. This article isn't a bad read on the subject though it is a little old now and the Atlantic tends to be very pro business so their conclusions on the whole thing should be viewed as optimistic:
http://www.theatlantic.com/health/archive/2012/05/moving-away-from-fee-for-service/256755/

The short version is that captiation of sorts is only 1 of the ways they're slowly transitioning away from FFS. The main push has been to form ACO's out of local hospitals/doctors and just pay them a lump sum that in theory is based on performance and out comes of that particular ACO as a whole. The ACO then figures out how pay is distributed amongst the hospitals/doctors.

The private doctor's offices, diagnostic labs, etc. that try to stay independent will slowly be pushed out of business as it becomes harder and harder to collect vis FFS and patients generally don't have the cash for this stuff up front since the ACO will be the preferred/in-network health care vendor for everything locally gradually. Exceptions to that will only be with the exceptional doctor's/niche diagnostic stuff that are able to attract a clientèle that can afford to pay for most or all of service up front.

The wiki on ACO's is very good but dry reading:
http://en.wikipedia.org/wiki/Accountable_care_organization

bob2356 says

What part of medicare is using capitation or some other way to avoid ffs and what percentage of the care is this?

MSSP I believe: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html

I know in late 2012 it was about 10% of the US population covered via ACO...but the number of ACO's also more than tripled in 2013 to about 500 I think. 2013 coverage numbers aren't out yet but supposedly that many ACO's can potentially cover nearly half the US population. The number actually covered via ACO is going to do nothing but go up and eventually a majority if not the overwhelming majority will be covered by an ACO.

I don't know the details on how other countries with a UHS do payment unfortunately. I just know the few foreign doctors (German FWIW) I've talked to are flabbergasted about how our system works and how much everything costs.

tts says

I know in late 2012 it was about 10% of the US population covered via ACO...but the number of ACO's also more than tripled in 2013 to about 500 I think

The 10% number seems awful high. I didn't know Medicare was setting up ACO's yet although it doesn't look like any are actually up and running but it's a good thought. I read the federal register on medicare aco's. There is a lot of ways for things to go badly wrong there. The devils in the details. HMO's were supposed to save huge amounts of money also, then PPO's. Didn't happen at all. Maybe ACO's will have better luck. Time will tell. Outside of MC you would still have the overhead of corporations collecting insurance premiums, profits, executive salaries, advertising, lobbying, etc., etc., etc. that doesn't exist in a true single payer system.

ACO's would be workable for Medicare or the integrated organizations like Kaiser where the insurance company, hospitals, doctors, and patients are all part of one organization. I can't see how it could be used for the 90%+ of hospitals that aren't owned by the insurance carrier and see patients from dozens if not hundreds of different insurance carriers.

I know a lot about how other countries do payment. It's usually capitation with copay for gp's and salary for specialists. Private insurance is available if you want to see a doctor without going through the public system. There are some oddballs out there doing things is strange ways though.

bob2356 says

The 10% number seems awful high.

In late 2012. Apparently another report was released for Feb. 2013 and puts it at 14%.
http://www.oliverwyman.com/media/ACO_press_release%282%29.pdf

bob2356 says

I didn't know Medicare was setting up ACO's yet although it doesn't look like any are actually up and running

I'm confused...you quoted me saying there are around 500 up and running in 2013 but then say there aren't any actually running? If you want a good 3rd party source the report I link above says there are about 300 as of Feb. 2013. The wiki I linked on ACO has a Excel file that is up to date as of July and has 346 listed. 500 is the number that I saw back in Sept. So there could be even more of them by now.

bob2356 says

Maybe ACO's will have better luck. Time will tell.

The problem with ACO's will be the quality control process which will be how they measure performance and out comes. I already know that it is set up in a stupid manner. The good news is its fixable, since CMS writes the regs and standards Congress doesn't need to get involved, but CMS isn't known for responding to issues quickly or correctly. They are known for being heavy handed though too.

bob2356 says

ACO's would be workable for Medicare or the integrated organizations like Kaiser...I can't see how it could be used for the 90%+ of hospitals that aren't owned by the insurance carrier and see patients from dozens if not hundreds of different insurance carriers.

Its funny you'd say that. The whole push for ACO's came about because the govt./CMS/Congress/insurance companies looked at what Kaiser was doing and said, "hey lets have everyone do that, it works so well!" back in 2006. Some key legal frame work to get the ball rolling was put into the PPACA and the rest will soon be history. The hospitals are (some rural ones don't like it, can't remember why but I think it was for financial reasons) joining up since that is how they'll be able to collect money and have more control over the finances in the form of lump sum payments.

bob2356 says

I'm filing taxes for 2011 as we speak (I'm overseas I get 6 more months), So you saying that ACA was fully implemented and funded far enough in advance of the start of the 2011 tax year that the costs were budgeted in for 2011? I wasn't aware of this. Tell me more.

Try not to put words in my mouth, o.k.?

The question is: Is ACA causing you to pay a higher tax rate than you did in previous years?

. Homeboy says

Try not to put words in my mouth, o.k.?

Stop being silly then. The subsidies won't work their way into the federal budget for a couple of years at least. Almost no one has even signed up yet, much less having anyone get a tax credit. Even when that finally happens taxes won't be raised, just the deficit.

If you want to be a mindless cheerleader for obamacare then go for it. But when you refuse to recognize the many legitimate flaws in the bill you just look foolish. I think its a very poor piece of legislation. Any and all real cost savings were killed by the insurance industry.

tts says

In late 2012. Apparently another report was released for Feb. 2013 and puts it at 14%.

http://www.oliverwyman.com/media/ACO_press_release%282%29.pdf

Read the report a little closer:
"The total number of patients in organizations with ACO arrangements with at least one payer—both Medicare and non-Medicare—is now between 37 and 43 million, up from 25 to 31 million—or roughly 14 percent of the population."

Having an ACO arrangement doesn't mean that the entire patient base is ACO or even close. It doesn't say anything about the entire organization being ACO either. These organizations could be serving many thousands of patients with only a few on ACO pilot project in one facility. It doesn't even say ACO has to be up and running at all, just that an arrangement has been made. This is a publicity piece, nothing more.

tts says

'm confused...you quoted me saying there are around 500 up and running in 2013 but then say there aren't any actually running?

The medicare ACO's so far are pilot projects. Or organizations basically just on paper that are getting up and running. There's a huge difference between large organizations running is what, for a lack of a better term, I will call production mode. and pilot projects trying out a new concept. I notice medicare isn't releasing the number of patients actually being treated under ACO type of care. With the data sharing arrangements of ACO (medicare keeps your medical records basically) that number is trivial for medicare to produce. Why not release it?

I'm not saying ACO's are a bad thing, but it's very early in the process and a lot can go wrong. The way it works so far (if I understand the federal register correctly) with medicare is that medicare is funding this pretty much open ended with the hope that costs will be contained. The fact that there had to be major anti trust waivers to make ACO's happen is a little disturbing. ACO's are a very long, long way from displacing fee for service in any meaningful way.

bob2356 says

Read the report a little closer:... It doesn't say anything about the entire organization being ACO either. These organizations could be serving many thousands of patients with only a few on ACO pilot project in one facility.

I would disagree with your reading of the report here which skips or dismisses the 2 other points that precede it. It should be noted too that the report is not from a puff piece of journalism or from CMS or the govt. They're a 3rd party brought in for actuarial consulting who for the most part have a good history of doing their job right.

ACO's are also fundamentally top down organizations. Sure a pilot program is done with only a relative few patients to work the bugs out...but once that is done the entire organization is switched over fairly quickly. The entire process is effectively invisible to the patient for the most part. Very few even have heard of an ACO.

bob2356 says

Or organizations basically just on paper that are getting up and running.

I've worked for private practice in CA and watched it and the hospitals in the area transition to an ACO back in late 2012. I have no idea how you can believe they're pilot or paper only organizations....

bob2356 says

I'm not saying ACO's are a bad thing, but it's very early in the process and a lot can go wrong....ACO's are a very long, long way from displacing fee for service in any meaningful way.

You're misreading me I think. I'm not arguing for ACO's. The time for argument against/for them was back in 2008 or perhaps 2006.

That ship has sailed and now they are the future of the US health care industry whether you, I, or anyone else want or hope for. My personal opinion on them is they can be good or bad but the bad can be reformed away without "help" from Congress so I have some hope that things can work out.

You sound like a lot of the small practice people I knew back in 2011 when I first started hearing about this stuff. No one believed FFS was going away, how would anyone operate right? They don't ask that question anymore.

tts says

That ship has sailed and now they are the future of the US health care industry whether you, I, or anyone else want or hope for. My personal opinion on them is they can be good or bad but the bad can be reformed away without "help" from Congress so I have some hope that things can work out.

You sound like a lot of the small practice people I knew back in 2011 when I first started hearing about this stuff. No one believed FFS was going away, how would anyone operate right? They don't ask that question anymore

I've heard this song before several times. HMO's exploded out of nowhere too and were going to revolutionize health care. Capitation was going to make health care affordable. I'll believe it when it happens. It's all less than 2 years old. No one has any real experience in the nuts and bolts of it. If it works then good, but don't do a chicken inventory yer.

tts says

My personal opinion on them is they can be good or bad but the bad can be reformed away without "help" from Congress so I have some hope that things can work ou

I don't believe in the fox in charge of the henhouse business model. The people with the most to gain are the big health insurance companies. They can explode their profits with ACO's by eliminating the cost of billing and cutting down payments to everyone down the line. I have serious doubts that a huge percentage of the savings will flow on to the ratepayers based on the altruism of health insurance companies.

Call it Crazy says

Sooo... It's a "tech" issue, not a "volume" issue..... They can't get a web site right, but you expect them to handle your health care decisions correctly...

Ha Ha...

reminds me of California's "decades long" DMV system implementation / upgrade disasters.

even California own Payroll system became a disaster.. i dont know why of all things a simple PR system cant be implemented. Everyone elses is doing just fine.

Effort to upgrade to California's payroll system failing

http://abclocal.go.com/kabc/story?id=9208110

SACRAMENTO, Calif. (KABC) -- The 10-year effort to upgrade California's payroll system has been a disaster. After spending $254 million, it doesn't work, and may not be salvageable.

Lawmakers are upset because so many services and programs suffered budget cuts over the last few years.

"It is very painful for me to sit here today and for me to acknowledge that one-quarter of a billion dollars might have been wasted," said Sen. Norma Torres, D-Pomona.

if they would only upgrade to 56k all this would go away....

Call it Crazy says

Sooo... It's a "tech" issue, not a "volume" issue..... They can't get a web site right, but you expect them to handle your health care decisions correctly...

Ha Ha...

bob2356 says

Stop being silly then.

I'm not being silly. You're making up strawman arguments that I never made. Cut it out.

bob2356 says

The subsidies won't work their way into the federal budget for a couple of years at least. Almost no one has even signed up yet, much less having anyone get a tax credit. Even when that finally happens taxes won't be raised, just the deficit.

That is your opinion, for which you have no evidence. The law was designed to be revenue neutral. I do allow for the possibility that the law will not be successful, but so far I have not seen that. YOU, on the other hand, ASSUME it will not be successful, based on no evidence whatsoever. And even if we DO assume you can correctly see into the future, why don't you answer the question:

Have your taxes gone up?

bob2356 says

If you want to be a mindless cheerleader for obamacare then go for it. But when you refuse to recognize the many legitimate flaws in the bill you just look foolish. I think its a very poor piece of legislation.

It is not an easy position that I take, but I was never one to go along with the boisterous mob just because they are loud. With the current Pat Net crowd, you won't have much trouble getting a lot of "likes" by bashing Obamacare. You can claim it has failed before it has even begun because it is "mathematically impossible" if you like, and you'll find many allies in the Obama-hating, Fox News worshipping crowd. But that is complete bullshit, and you cannot know for a fact that it doesn't work until we SEE if it works. I will wait for actual EVIDENCE that rates have skyrocketed, or that it has caused a fiscal crisis for the government. Until you have evidence that any of this is happening, you are just talking out of your ass.

bob2356 says

Any and all real cost savings were killed by the insurance industry.

I think you are expecting too much. If everyone can be eligible for insurance regardless of pre-existing conditions, AND the poor/lower middle class can get help paying for their insurance, AND the rates for the upper middle class don't go up any faster than they did before ACA, then I will consider it a success. Are you upset because rich people won't get a piece of the pie? Don't you think they already get enough of the pie?

tts says

That being said the way the site development was handled and the cost are a damned travesty and some people need firing to say the least.

The people who need firing are the God damned HR hiring managers, and the fucking Microsoft centric CTOs, CIOs or IT programming directors as it were. That are clueless and Okeydoke every new cutting edge technology that comes down the pike because it's COOL or SLICK.

It fucking amazes me, how the IT departments in this country are ass fucking their Companies bottom line, and now that cancer has spread into government as well.

Now hear me out...

First there was Classic ASP, and RDO and ADO. It wasn't perfect but it got the job done. There were many security concerns about the Whole ASP and ActiveX thing, and then everyone became paranoid about cookies and JavaScript.

Then for good or bad came along .NET which turned the way you thought about your Microsoft coding practices and the database integration logic on its head. ASP classic became passe and ridiculed for those ugly alligator tags and the inline server side script that either exposed connection strings in the asp alligator tag inside the asp file. Or it was hard coded in a DLL that the ASP file called. Which was taboo, because the DLL had to be recompiled each time the data source changed.

So ASP.NET changed all that, now you had server side code behind, that you hide from the world and connection strings you could store in a config file. Along with enhanced security features, and the well lauded page lifetime cycle. Which brought greater control of the Session state. Which was great because it meant now the Website creator, didn't have to worry if JavaScript, ActiveX or Cookies were disabled or not. All of the important stuff happened in the back end.

All built on the HttpHandler which was the single best thing that came out of the Whole ASP.net library. It's lightweight, it's generic, and post and gets to your own generic or customer httphandlers, will out perform and will yield a 10 times faster loading page than a mere ASP.NET page response. But is only the entry point for the whole ASP.NET Webform post and get process, just like any other httphandler, that you would create your self using the .net library. From there that's where it starts getting piles and more piles of never ending layers in the Webform page life cycle, view state and what all.

That is until they realized that we still need cookies and java script enabled to make proper use of the ever increasing frameworks and extensions.

And with each layer, IT departments required you learn and implement them. Most of them more often than not could have been custom written controls to handle what it was those controls and extensions did. Like an asp:GridView for example. Or then some third party Gridview that the asp:gridview lacked. Like Infragistic controls, or the DevExpress asp.net controls. These damn bloated things, not only did they convolute the page with unwanted garbage and crap. They also threw a huge learning curve to the development team, who would then have to learn and implement these hogs. You have controls on your page, but you've got the whole library of this shit loaded into memory, and the CSS and the JavaScript involved to is loaded to the client further slowing an already slow page. The developers not only had to concern them selves with the page cycle nuances that were happening, and discovering where events for what fired where, they had to learn the a whole host of new objects and the associated syntax to initialize and create those objects.

On top of that, these controls were relying heavily on a new merging trend, that became known as jQuery. As well as understanding this new JavaScript syntax an patterns, the developer had to learn their CSS naming conventions for those controls.

Honestly though, I never understood it, I never cared for any of those grid controls. By the time you fiddle with just setting the UI portion of your grid in the designer, I could have just enumerated a generic object(Another great things to come out of the .NET framework.) parsed the items in the list, and created the DOM node by node on a page init event, and applied styling accordingly while doing so. And be done, finished, that's it see you latter. But NO!!! Not the 3rd party control developer, who now has to write code one for each in three places, in the page event cycles, and perhaps as many in the control even cycles. Init load and pre-render, perhaps even more, just to get one behaviour. ANd god forbid someone needs a goddamn drop-down list in the grid, why that would require you writing a custom extension to accommodate that. That's of course after hours and days of researching crappy limited documentation on where and how to achieve that simple feat.

The more convoluted it all got the more I just rolled my own controls or just and more I got to the point to where I would just build a page in the page events and have no controls in the aspx content other than the page declarations. You know what I found? Guess what? You don't even need .NET form controls, you can just place regular html in a string, or load new controls dynamically and append them to the document.

For me things were getting interesting. All I needed were in the Generic Objects, jQuery, CSS, and the page life cycle events.
I could load my objects just fine using what was available in the .net System.Data libraries.

So in the meantime the non Microsoft world started various flavours of the MVC pattern. It soon became a sticking point against Microsoft that one can't properly use the MVC pattern using the Page load and post back events.

So the developers at Microsoft created a prototype proof of concept MVC pattern built on top of the ASP.NET and page object.
It was not meant to be an actual product. But it was such a hit, it created a ruckuss in the IT departments across America. They wanted to use the MVC pattern and show those smug, open source Ruby developers that they too could overly complicate a simple single page with 5 or more areas one has to be concerned with to write code or configuration options, just to produce a "Hello World" string on the page. And to really make it work, JavaScript was back baby and so was those asp classic alligator tags, and in line scripts to load lists and build tables.

But that wasn't enough, Microsoft also created the Entity framework which would dynamically create all of your domain objects and classes, and handle all of your data mapping to a database somewhere. Just push next and finish and you're all done. And if you did that right, you can then push through several other wizards to get your controller and views set up.

Not only that, but they then created LINQ an excellent addition for the Generic Objects(which I believe is the best thing since slice bread).
What LINQ could do is allow the developer to use a SQL query style syntax to query generic objects, which is what the entity frame auto created for you based on your data schema.

What the Fuck!
That's pretty slick, but once again a misused technology. Because of it's slickness, LINQ crapped all over the basic common practice webwide in all programming languages in modern internet world. That is NOT having in-line sql statements in your code. But one is expected to separate all data calls to DAL, so that way if any of the logic in your stored procedure changed, you have a common place to make those data changes, rather chasing around all of the pages and classes that have sql queries in them. This was a big short fall of the datagrid, where you create a SQLDatasource and for the command string, you type in a sql statement or sproc.

Now I love LINQ as much as the next guy, but I use to to create anonymous data types from query two List or to filter or sort any enumerable object. Though really I'm not sure why, I thought it was slick, until I stepped through the debugger in one instance of a List and discovered that the final result, was produced by the good ole fashioned For each loop, that I always written. There was no magic going on here, just a bunch of over head to defer what must be done any way. But I still use it, because it's a lot easier to perform sort and filter functions rather than having to use nested loops. Though that's exactly what ultimately gets done anyway.

These IT and Technical directors of companies country wide were becoming like mooching party crashers that would take what ever crap was placed on a cracker, and served at the art gala no questions asked. Just as long it was slick. AND OH It was!

And to really sweeten the pot, by 2008 Microsoft included test projects, where you get to write your code twice once in your code, then again in a different context in your test project. It will test that all paths return data, and will tell you that your code is valid and will return the types it was expecting, but it wont tell you how your code will behave when your site is slammed by 10,000 hits a second.

Just a time waster, and once again the IT Technical Directors could defer bug free competent developers with experience that knows if code will work or bomb in production, to an the .net equivalent of the Idiot light, that is the Microsoft test projects.

Around 2009 to 2010 that's when these IT clowns really started getting mental. They were for the most part implementing click through next technology, YET they were demanding developers have MVC, Entity framework, and Test project experience, AND they must possess a full understanding of Object oriented programming. Or at least their Agile impression of what Object oriented programming is.
That's all fine, but really there's a huge paradox there.

First of all, if you're doing EF, MVC, and Test projects right, then you're really just clicking through dialogues until you end up with your auto generated project files. One big ole bloated kludge. Any self respecting developer would just rather write their own models, and controllers, rather than relying on some wizard to produce all of their class code for them. Just because it's easier for the Junior programmers to get.

Now if you're really a programmer and know how to create your own objects and classes. Then try to implement your own programming pattern into MVC, you will be met with a kick in the teeth. A simple page to manage crud functions for just one table, you'll have to write the equivalent code of 5 pages just to get that one table working.

OK I get it, it's the MVC pattern, though IT's NOT MVC, it's ASP.NET with a MVC wrapper on top.

Now back when I started in this business back in 1997, the guy you reported to was the Project Developer team leader. And the guy in charge of the IT infrastructure was called the IT director. That was the way it worked in 90% of the small companies everywhere. These guys were sharp as a tack and knew their shit. They laughed at Information weekly, ever time a new untried and true technology came about. That crap was more about impressing the business units as they would read on their flight home, then throw around new tech buzz words in technical meetings as to make them selves seem more in the know. Even though they were actually clueless about the technology that made their jobs possible.
These project developer team leader, were responsible for placing ads and interviewing potential candidates. There was no HR person, if the Developer manager hired you, you were to report to the Accountant so you could get set up in the books for payroll.

Then around early 2000's Bill Gates proclaimed him self the CIO, "The what?" CIO, "What in the hell is that?" Of the Chief Information Officer.
They have those now? Yeah and they are executives instead of developer leaders and peers.
Then like our American corporate Monkey see Monkey do mentality every company fired their most capable and senior technology persons in their companies, and replaced them with these stuffed suits, who came from the Business and Executive world more than the ranks of programming and developing. Or if they ever were, that was so long ago, that they were now considered dinosaurs.

These people are clueless they looking for Visual Studio end users, but claim they are looking for Developers.
They waste money and time on poorly implemented designs that they think is slick because the technology is COOL.

Case in point, my last gig, I was placed on creating the legacy database repository, where I had to take all their legacy customers. Which derived from many stand alone databases in offices around the country. So as you would imagine, the PK_ID in every table overlapped with the primary key in every version of those database. This was a database of time-share Owners and their referrals.
Many of the owners owned in resorts around the country. So to de dupe these people so I didn't end up with duplicate records.
I created a table hash key on 3(first), 4(last), 7(Address) and 5(zip) so for example.

John, Smith, 2432 Harley street, Yourtown, FL, 33026
became

JOHSMIT2432HAR33026

Now the jackass that was the project leader of the Application that my repository would feed data to, with out any collaboration with me, designed his own data schema for his database. And based those needs on his Entity frame work pattern he chose.
So now as a result he had a Persons Table, Owner Table, and a Referral table, OK not bad, BUT since Entity Framework gave him the ability to create his Owner object and the Referral objects as inherited from the Persons object this was the design he went with. Even though two types are two different things all together. The only thing they have in common is they have a name and an address. I foresaw many problems that his approach would present but my concerns all fell on deaf ears. Not to mention the two or three weeks it took the developers to sort out how to manage and code the classes and contexts for those inherited objects. On top of that he demanded the team use infragistics, which was a huge learning curve for everyone and a general pain in the ass. Every time we got a new developer or someone got a new machine. The infragistics control install would give this guy a .0000001 variation difference on the control version everyone else was using. It's like they release an update every minute. So then the whole team would have to update their controls, and spend a few hours just to get every thing up and runnig again.

Now let me stop right here, and just say, that I am in no way against Object Oriented programming. But that concept has been hijacked to mean just one thing. And that is every thing must be inherited, there must be abstract base classes, inherited objects must have overridden methods and properties, and every helper classes and functions must be written in Interfaces and implemented by a class. These are all powerful features, and are very important to the programming language. But inheritance should be dictated by the need, based on your schema or task at hand, and NOT because the Gang of 4 wrote about it in a book.

My rule number one of OOP is simple... "It either IS! or it ISN'T!". That's it, no extrapolation, no looping over things to get the type of the object to then do something else based case or if statements.

It gets ridiculous to have to check your object type everywhere in the code, and every person call has to filter the person type. Especially when these two things are totally different. One has contracts and financial transactions, the other has contact information and a call log.
But they were both people so in the OOP mind that is today's IT culture. You have two distinct objects that inherit from one class but then they are treated separately and your always doing type checks to manage program flow.

My rule number 2:
Don't use inheritance to dictate the flow of your code.

The above pattern is right, but instead of having 2 objects, there are 3 which one is shared by the other two.

Lets say you have two type of customers, a residential customer and a business class. I was asked this last week in an interview.
Now the Res customer has a SSN but the business owner doesn't, so I was asked how would check the object if it had a social security object or not. I don't know or care what answer he was looking for, as that question breaks my rule number 1 object oriented programming. "It either is or it isn't. no extrapolation" and it also violates my second rule of programming, never use inheritance. My code would know which type of object it is working with, and would never ask business owner for a ssn when it's not part of a business owner.

So I told him, I would have gotten it from the customer class. But before I could explain he assumed I meant that I was saying that I thought the SSN in the Residential class would just be exposed in the Customer base class. So he was then interrupted by phone call which he took and then quickly ended the interview afterwords as he was called to some crisis, assuming that I don't know crap about OOP. Though he was the Dumb ass having to run to do damage control on his half baked architectural design.

So here it is letting the program dictate what class they are rather than using any if or case statements to parse the customer type, or having to resort to reflection to check the type.

class Program
{

static void Main()
{
ResidentialCustomers rc = new ResidentialCustomers();
rc.ssn = "2233";
//do what ever processing the custoemr class needs to do.
string str = rc.retrunTestClass();

Console.WriteLine("The Residential Class doing some very important stuff with the ssn");
Console.WriteLine(str);
TheRealMCoy r = new TheRealMCoy();
Console.WriteLine("That residential customer has finished doing its processes, now send it to the customer processor.");
r.DoBusiness(rc);
Console.WriteLine("Now it's time to deal with a Bidness customer");

BidnessCustomers b = new BidnessCustomers();
b.taxid = "492";
//do what ever processing the custoemr class needs to do.
string str2 = b.retrunTestClass();
Console.WriteLine("The Bidness Class doing some very important stuff but it doesn't need a ssn");

Console.WriteLine(str2);
r.DoBusiness(b);
Console.WriteLine("That one processed a bidness customer");
}
}

public class TheRealMCoy
{
public void DoBusiness(ResidentialCustomers rec){
//the residential processes have all been completed and any workflow was accomplished,
//now split up and become a customer object so we call some
//customer bussiness rules.
Customers r = rec;
Console.WriteLine(r.numberOfInterest.ToString());
Console.WriteLine("I asked this class for the ssn because I know he has one.");

}
public void DoBusiness(BidnessCustomers bc)
{
//the Commercial processes have all been completed and any workflow was accomplished,
//now split up and become a customer object so we call some
//customer bussiness rules.
Customers r = bc;

Console.WriteLine("Oh I would never do that.");
Console.WriteLine("but I do need your number of interst for some business processing.");
Console.WriteLine(r.numberOfInterest.ToString());
}
}

public abstract class Customers
{
public virtual string numberOfInterest { get; set; }

public abstract string getTestClass { get; set; }

public virtual string retrunTestClass()
{

getTestClass = "I don't have any property from any customer type yet";
return getTestClass.ToString();
}

}

public class BidnessCustomers : Customers
{

public string taxid { get; set; }
public override string getTestClass
{
get;
set;
}
public override string numberOfInterest
{
get
{
return taxid;
}
}

public string gettaxid()
{

return "I don't have no damn ssn so don't ask but here's my taxid=" + taxid;
}
public override string retrunTestClass()
{

return gettaxid();
}

}

public class ResidentialCustomers : Customers
{

public string ssn { get; set; }
public override string getTestClass
{
get;
set;
}
public override string numberOfInterest
{
get
{
return ssn;
}
}

public string getssn()
{

return "my ssn=" + ssn;
}
public override string retrunTestClass()
{

return getssn();
}

}
It will then return the following...

"The Residential Class doing some very important stuff with the ssn
my ssn=2233
That residential customer has finished doing its processes, now send it to the
customer processor.
2233
I asked this class for the ssn because I know he has one.
Now it's time to deal with a Bidness customer
The Bidness Class doing some very important stuff but it doesn't need a ssn
I don't have no damn ssn so don't ask but here's my taxid=492
Oh I would never do that.
but I do need your number of interest for some business processing.
492

"

Notice not once did I use an IF, CASE or have to do any type casting to process both different classes using the same process?

This is what is wrong with the healthcare website.
This pattern of Shops demanding quite capable programmers, use resource hog libraries and frameworks, that were designed to make life easier for the junior programmers, in a RAD environment.

If you're going to go through all the trouble to find capable developers then why not look for developers that know how to write a custom web application that is tailored to your needs, utilizing a custom HTTPHandler. After all that is all ASP.NET webforms are built on, it was meant to show the developers what is possible with .NET. But it was embraced as the "everything you need" solution. Yeah it has everything you'll ever need, plus millions of things you'll NEVER need.

And if you're going to throw MVC and Entity Framework into the mix, that is just another layer on top of that. Then all bets are off.

Sure it works great for a company who only has 20 or 50 users using the application at any one time, and the Test projects all passed with flying colors. But let it get slammed by a 100,000 requests a minute, and you'll see what's up.

Now they are flying in Silicone Vally's brightest to fix it.

All of the good ones use Open source and their shit works, because they aren't using ASP.NET or MVC.NET.

And since those of us that DO know how to program the .net libraries without relying on the built in frameworks, are considered the ones doing wrong...

Go figure.

Somewhere in florida a pharmacy is wondering why catp shuddups meds are still sitting there.

Homeboy says

bob2356 says

Stop being silly then.

I'm not being silly. You're making up strawman arguments that I never made. Cut it out.

I'm making up strawman arguments? You stated that ratepayers wouldn't subsidize, it would be tax credits instead. That's silly, Paying out of the left pocket or the right pocket doesn't matter. You said taxes haven't gone up for this subsidy via tax credit. That's silly. Taxes went up Jan 1st, I don't make enough that my own taxes have gone up yet to answer your utterly ridiculous and meaningless question. Been taking debating lessons from Glenn Beck I see. You keep randomly mixing the concept of poor and uninsured in your arguments as in the poor go to the ER for care. That's silly, the poor have medicaid. The uninsured are not all poor, many are young and many could afford insurance, but don't choose to. You say ACA is revenue neutral. I don't call 1 trillion dollars in new taxes over the next 10 years revenue neutral. That number is from the CBO not fox news. Again paying from the left pocket instead of the right pocket doesn't matter.

Homeboy says

But that is complete bullshit, and you cannot know for a fact that it doesn't work until we SEE if it works. I will wait for actual EVIDENCE that rates have skyrocketed, or that it has caused a fiscal crisis for the government. Until you have evidence that any of this is happening, you are just talking out of your ass.

Trouble reading? Where did I say it will fail? What is fail? It will be very successful at shuffling the money around. That's what it's designed to do, which is why I think it's poor legislation. Lots of voters (up to 300% of poverty level) will get subsidies. Lots of politicos reminding those voters they are getting free money. Great stuff for politicians seeking reelection.

Problem is there is no real net savings in overall health care costs that I can see. Both medicare and the CBO say overall health spending will actually be higher with the ACA than without. Look up ppaca 4 22 2010 and the 2013 revision. Overall cost is the real issue, not which pocket you pay out of.

Any "Young, healthy people in their 30s" making over $15 an hour are gonna get screwed. They'll think they'll get subsidies, but guess what? You don't get a tax break, when you aren't paying any taxes....

And for those suckers that still want to try and get through the Obamacare website, you can get your inspiration from the Iowan who finally got in on the 100th try...

http://www.desmoinesregister.com/article/20131022/NEWS/310220047/Iowan-successfully-buys-insurance-after-100-tries?nclick_check=1

Hey cap'n, you should work for Obamacare. That post was ri-goddam-diculous!

http://www.youtube.com/embed/cQxmc498f3E

bob2356 says

I don't make enough that my own taxes have gone up yet to answer your utterly ridiculous and meaningless question.

That sentence is nonsensical. The syntax cannot be parsed. Does it mean your taxes have not gone up? Because that is exactly what I expected.

bob2356 says

Been taking debating lessons from Glenn Beck I see

Yes, you're so much better at debating:

bob2356 says

That's silly... That's silly.... That's silly.

Yep, debating skills of a 4 year old.

Call it Crazy says

Revenue Neutral???? Really think so????

I didn't say I thought so. I said it was designed to be. Try reading next time. Unlike others here, I do not assume my conclusions; I wait until data is available.

My point was that one cannot simply ASSUME that Obamacare will increase the federal deficit. If one is making that claim, one needs to provide evidence of such.

WHAT THE??? Jeanne Shaheen (D-NH), a 'moonbat's moonbat', is now suggesting (via tweet) that we delay Obamacare's Individual Mandate till March 31st, 2014?

Wait, WHAT???!!!

http://www.breitbart.com/Big-Government/2013/10/23/Report-All-Senate-Democrats-up-for-re-election-in-2014-will-back-delaying-Obamacare-s-enrollment-deadline

- Wasn't too long ago (2-3 weeks?) that Obama refused to negotiate on this?

- So, all you liberal flunkies calling Ted Cruz as 'extremist', blabla, was right after all?

- I've said it before, and I'll say it again. Obamacare is/was an ill-conceived shit-storm abortion, flawed beyond comprehension, rolled out 'still-born style', yet the sheeples shouted down those that had the hard numbers, ie, facts.

- Now Jeanne Shaheen's asking for a delay? Hmmmm? Why's that? Because the '14 elections are coming up, and those like her are running away from Obamacare faster than a rat on a sinking ship.

- The '14 elections will be about one thing, and only one thing: A referendum on Obamacare. When folks continue to get their company-provided insurance policies yanked between now and Nov '14, they will remember the promises that Obama did NOT keep (you get to keep your doctor, your coverage will be the same, your healthcare bill will go down), and will vote accordingly.....

AverageBear says

Wasn't too long ago (2-3 weeks?) that Obama refused to negotiate on this?

No--you've got it all wrong. Obama said he would negotiate as soon as the government was open and the debt limit raised.

He said he would not negotiate ANYTHING under the threat of the debt limit. Which is 100% the correct decision.

tatupu70 says

AverageBear says

Wasn't too long ago (2-3 weeks?) that Obama refused to negotiate on this?

No--you've got it all wrong. Obama said he would negotiate as soon as the government was open and the debt limit raised.

He said he would not negotiate ANYTHING under the threat of the debt limit. Which is 100% the correct decision.

So he said he would negotiate after there was nothing left to negotiate about? In practical terms, this means he would "not negotiate ANYTHING..." So AverageBear has it all wrong only in the most meaningless of pedantic interpretation.

One of the House proposals was a delay in the individual mandate, wasn't it? If the Democrats now support that, it becomes clear that the shutdown was indeed an irresponsible decision made on political caculus (how much can we make the Republicans take the blame for a shutdown...).

Paralithodes says

he said he would negotiate after there was nothing to negotiate about.

That's the point. There was nothing to negotiate about in the first place.

The President should not negotiate to get Congress to do its job. What's next? He has to give something up to ensure that Cantor comes to work?

Paralithodes says

One of the House proposals was a delay in the individual mandate, wasn't it?
If the Democrats now support that, it becomes clear that the shutdown was indeed
an irresponsible decision made on political caculus (how much can we make the
Republicans take the blame for a shutdown...).

Again--the President can't set the precedent that he will negotiate to get Congress to do its job. Congress is not making a concession by doing what they were elected to do.

tatupu70 says

Paralithodes says

One of the House proposals was a delay in the individual mandate, wasn't it?

If the Democrats now support that, it becomes clear that the shutdown was indeed

an irresponsible decision made on political caculus (how much can we make the

Republicans take the blame for a shutdown...).

Again--the President can't set the precedent that he will negotiate to get Congress to do its job. Congress is not making a concession by doing what they were elected to do.

They were elected to rubber stamp the President's wishes? As far as Congress "doing it's job," what part of that was not Congress "doing it's job?" What exactly is their "job" in your opinion? Some - crazy right wingers no doubt - would argue that rubber-stamping a CR for year after year for the intention of keeping a lot of the one-time stimulus in effect is an example of Congress NOT doing it's job. They might argue that rubber stamping anything is NOT Congress's job. Is formulation of an actual budget part of Congress's job? Yes or no? If yes, when is the last time a budget (not just a CR) was actually passed?

Also, this idea of the President not setting a "precedent" is nothing but current-day political narrative/talking point that ignores the "precedent" set by almost all previous budget fights, government shutdowns, etc. The President himself was part of this un-precedent when he voted AGAINST debt limit increases.

President Obama has stated that "we are not a banana republic." Maybe this was a complaint.

Paralithodes says

They were elected to rubber stamp the President's wishes? As far as Congress
"doing it's job," what part of that was not Congress "doing it's job?"

Their job is to pass a budget or a CR for the President to sign. Did I miss when that happened and he vetoed it?

But, even more importantly, their job is the pay the bills that come due because of the laws they passed. It's pretty simple, really.

Paralithodes says

Some - crazy right wingers no doubt - would argue that rubber-stamping a CR for
year after year for the intention of keeping a lot of the one-time stimulus in
effect is an example of Congress NOT doing it's job. Is formulation of an actual
budget part of Congress's job? Yes or no? If yes, when is the last time a budget
(not just a CR) was actually passed?

OK--vote in some legislators that will do their job and pass a budget then. Just don't imply that the President should have to negotiate to try to convince them to do their job.

Paralithodes says

Also, this idea of the President not setting a "precedent" is nothing but
current-day political narrative/talking point that ignores the "precedent" set
by almost all previous budget fights, government shutdowns, etc. The President
himself was part of this un-precedent when he voted AGAINST debt limit
increases.

No he wasn't. For you to imply otherwise is simply naive. He was making a statement with his vote, knowing that the bill would pass. Note that the government didn't shut down...

The precedent wasn't about the budget--it was about the debt ceiling. But either way, he was correct. You can negotiate on the budget once the government is open. Republicans didn't want to do that, so they got slapped around a bit before they came to their senses.

tatupu70 says

Paralithodes says

They were elected to rubber stamp the President's wishes? As far as Congress

"doing it's job," what part of that was not Congress "doing it's job?"

Their job is to pass a budget or a CR for the President to sign. Did I miss when that happened and he vetoed it?

But, even more importantly, their job is the pay the bills that come due because of the laws they passed. It's pretty simple, really.

We cross-posted on my edit.

Exactly, their job is to pass a budget. A CR is not equivalent to a budget. Again, when is the last time a budget was passed?

Every cycle has budget cycle has budget fights and negotiations. The only thing unprecedented now is some type of perception that this is NOT normal.

As far as paying the bills that come due - you must be referring to the fake "default" issue of which there was never any risk of, other than a political decision on the part of the President. Because unlike what you write above, it is the Executive branch's job to "pay the bills that come due... ("i.e., interest payments on the debt).

Without a CR or a budget, the government could not make NEW obligations without congressional appropriations. As most discretionary spending is year-to-year, and those that are multi-year are often appropriated in a previous year, an appropiation not made reflects a bill that will not come due.

Therefore, Congress is under no obligation whatsoever to rubber stamp a CR from one period to another.

Meanwhile, the House passed bills to fund certain parts of government (i.e., bills that come due as you call it) but not others, but the Senate took an all-or-nothing approach. Is this not a fact?

tatupu70 says

No he wasn't. For you to imply otherwise is simply naive. He was making a statement with his vote, knowing that the bill would pass. Note that the government didn't shut down...

The precedent wasn't about the budget--it was about the debt ceiling. But either way, he was correct. You can negotiate on the budget once the government is open. Republicans didn't want to do that, so they got slapped around a bit before they came to their senses.

Right - our post-partisan President made a very strong political statement along with a vote against the debt ceiling - things we can now conclude he didn't really believe - for purely political motives... He thought all along that the debt ceiling should be increased in 1996.... Is that about right?

Your claims regarding precedent with debt ceiling increases is current-day political narrative. That's all it is. There was nothing unprecedented going on here. As as far as the shutdown - Democrats were perfectly fine with a shutdown because of exactly what you say - the Republicans got spanked for it. This was of course the expectation regardless of who was at fault (i.e., including shared fault). If the Democrats now support a delay in the individual mandate, then any thoughts that the shutdown was purely due to one side's actions is due to one's own one-sided political bias.

tatupu70 says

OK--vote in some legislators that will do their job and pass a budget then. Just don't imply that the President should have to negotiate to try to convince them to do their job.

The president ALWAYS has to negotiate with Congress on spending issues. It is a set part of the actual budget process, which starts with the President's Budget Submission and continues through the passage of a budget.

As any President signifies his intentions with threats of vetoing budget proposals for one reason or another, he affects budget negotiations. Every President is part and parcel to the budget process. To imply otherwise is, as you say it, "naive."

Congress's job is NOT to give the President exactly what he asks for. Also, if you believe Congress must fund something because "it is the law of the land," then what is your excuse for the President picking and choosing which parts of a law to implement or enforce, despite it being "the law of the land?"

Paralithodes says

Your claims regarding precedent with debt ceiling increases is current-day
political narrative. That's all it is. There was nothing unprecedented going on
here. As as far as the shutdown - Democrats were perfectly fine with a shutdown
because of exactly what you say - the Republicans got spanked for it. This was
of course the expectation regardless of who was at fault (i.e., including shared
fault). If the Democrats now support a delay in the individual mandate, then any
thoughts that the shutdown was purely due to one side's actions is due to one's
own one-sided political bias.

What was the previous political narrative? It wasn't unprecendented for one party to ask that a standing law be negotiated away in return for allowing the governement to pay its bills? Please share when that happened in the past.

The President didn't negotiate because it was the wrong thing to do. And the public agreed with him. You've got the cause and effect backwards.

Paralithodes says

The president ALWAYS has to negotiate with Congress on spending issues. It is
a set part of the actual budget process, which starts with the President's
Budget Submission and continues through the passage of a budget.

Of course. And that happened last year as the Dems basically gave the Reps exactly the budget number they wanted before Mr. Cruz started his nonsense.

Paralithodes says

As any President signifies his intentions with threats of vetoing budget proposals
for one reason or another, he affects budget negotiations. Every President is
part and parcel to the budget process. To imply otherwise is, as you say it,
"naive."

Of course. And the President signaled his acceptance of the Reps number.

Paralithodes says

Congress's job is NOT to give the President exactly what he asks for.

And they didn't last year. The number was much lower than what the President and Dems wanted.

Paralithodes says

Also, if you believe Congress must fund something because "it is the law of the
land," then what is your excuse for the President picking and choosing which
parts of a law to implement or enforce, despite it being "the law of the land?"

I think you'll have to be more specific before I can comment on my opinion.

According to the advance statements, the system had been tested as required but still buckled under an unanticipated flood of visitors when it opened.

Cheryl Campbell, senior vice president at CGI Federal, will tell the panel that testing of the site met industry standards and "passed eight required technical reviews prior to going live on October 1," according to her prepared testimony.

Sebelius on the spot in Obamacare website fiasco

"Unfortunately, in systems this complex with so many concurrent users, it is not unusual to discover problems that need to be addressed once the software goes into a live production environment," Campbell's advance testimony says.

"This is true regardless of the level of formal end-to-end performance testing -- no amount of testing within reasonable time limits can adequately replicate a live environment of this nature," she added.

Oh Oh OH! Yeah so now the that the shit hits the fan, "NOW!" you realize what a do nothing fuck in the ass, the Microsoft Unit Test projects are.

What a bunch of bi polar morons, the IT industry has become, with their pretencious noses shoved up the Gang of fours Ass, and when shit goes wrong, then they say...

"Well it can't be the software's fault, we followed design pattern principals that everyone else is using..."

Has it ever dawned on anyone, that those patterns and principals are SHIT!

I mean if you're a software developer, who's job it is to automate a business process. And you're still around after 5 years, working on the 5th iteration of their software. Then those fucking patterns aren't working and they are for shit.

Funny how "Legacy" systems survive every ill-fated project attempt to replace those legacy systems, end up being replaced them selves several times, and the legacy systems are still an integral part of the business process.

I'm starting to get the impression that Legacy means, "Back when they did shit right."

tatupu70 says

No--you've got it all wrong. Obama said he would negotiate as soon as the government was open and the debt limit raised.

He said he would not negotiate ANYTHING under the threat of the debt limit. Which is 100% the correct decision.

My understanding is that the House would pass a bill IF the individual mandate was pushed back a year. THEN the debt limit would be raised... Obama refused to negotiate this, the GOP lost the fight, the debt ceiling was raised, the GOP ate crow, and the Obamacare Abortion show was launched, crashed and burned..... and NOW we have Shaheen and other Dems worried about losing their jobs because they are supporting this abortion... That's what I read.

AverageBear says

My understanding is that the House would pass a bill IF the individual mandate
was pushed back a year. THEN the debt limit would be raised... Obama refused to
negotiate this, the GOP lost the fight, the debt ceiling was raised, the GOP ate
crow, and the Obamacare Abortion show was launched, crashed and burned

Other than your colorful description, I think you've got it about right.

Paralithodes says

One of the House proposals was a delay in the individual mandate, wasn't it? If the Democrats now support that, it becomes clear that the shutdown was indeed an irresponsible decision made on political caculus (how much can we make the Republicans take the blame for a shutdown...).

Para,

Are you going to quibble over the semantics, or ignore the elephant in the room? That elephant being how many voters needing to find health insurance between now and Nov '14 are going to grab their ankles on Obama's broken promises?

Are you going to ignore how ALL the democrats wouldn't negotiate on ANYTHING Obamacare-related, and now that Obama's signature project is DOA, they are now suggesting delaying it; the same suggestion that the GOP has been asking for all along? (regardless of the details of the shutdown).

Because I'm loving this show. I'm loving how all the Dems that supported Obamacare that are up for re-election in '14, are now shitting in their pants...

Paralithodes says

So AverageBear has it all wrong only in the most meaningless of pedantic interpretation.

By 'meaningless', do you mean how Obamacare didn't work out of the gate (and probably won't for God-knows how long)? Or by meaningless, how Obamacare is going to convince young, healthy people to get reamed when they apply online? By this I mean submitting ALL personal info, BEFORE they get to choose how they get reamed. (just like Pelosi, you have to vote for it BEFORE you see it....)

Or 'meaningless' in the promises that Obama made when he dreamed up this wealth redistribution scam called Obamacare?

I think I got this nailed as far as my interpretation goes......