Healthcare.gov is Merely a Preview of Obamacare

obamacareI don’t often feel sorry for the Obama administration, but in the case of the massive technical problems plaguing the Healthcare.gov website, I almost do. It has to be awfully embarrassing, after all of the heated opposition to the Affordable Care Act and the Democrats’ impassioned defense of it, to have the program’s technological interface completely crap out from the very onset.

I suppose my sympathy stems from my background in systems development. I’ve certainly worked on my share of complicated web-based systems over the years, and the truth is that not all of them ran smoothly at first. Heck, not all of them ran smoothly weeks later. I remember all too well those automated text messages that would occasionally wake me up at three in the morning, signaling that something was wrong with a server. It meant that I needed to quickly get dressed, throw on a hat, and drive to the office building where I worked, all while more and more text messages tortured my cellphone. When I got there, I’d meet with one or two other analysts and we’d spend the next couple of hours feverishly running diagnostic checks, rolling back updates, and debugging code in order to fix the problem before our customers on the East Coast began logging in.

Those were not fun times. Thus, I feel for the developers who are working hard to get the system working properly while the world is watching. I really do.

On the other hand, the vast problems with Healthcare.gov are far more than just simple “glitches” as the Obama administration keeps telling us. The problems have stemmed from poorly written code that can’t handle the heavy volumes of traffic that anyone older than the age of five should have seen coming.

Some people are citing the debacle as evidence that Obamacare itself is a failure. I tend to think that’s a premature conclusion. There are plenty of reasons for why Obamacare will fail. It’s an ill-conceived monstrosity. The least of its problems is website navigation.

Yet, one can’t help but look at what’s going on with the Obamacare website and find a metaphor for exactly why the Affordable Care Act itself won’t work.

Both were painfully naive undertakings. You can’t just take over 1/5 of the U.S. economy with a brand new entitlement program whose success relies on a desperately flawed funding system, and think that massive problems won’t come from it. Likewise, you can’t mandate that all uninsured Americans sign up for that program (or face a government fine) and direct them to do so through a website that can’t even handle heavy Internet traffic.

The cost of both was grossly underestimated. A few years back, when president Obama was selling the Affordable Care Act to Americans, he repeatedly stated that the program would cost $900 billion over 10 years. However, the Congressional Budget Office projected earlier this year that the actual cost of the ACA will be $1.8 trillion in its first decade. That’s double of what we were told. Likewise, the original cost of Healthcare.gov was projected to be no more than $93.7 million. The actual cost of the website, however, was well over $600 million. Yes, a whopping $600 million for a website that doesn’t even work.

To give you a little context for how truly obscene that dollar amount is, let me cite a paragraph from a recent column written by Andrew Couts of Digital Trends:

“Facebook, which received its first investment in June 2004, operated for a full six years before surpassing the $600 million mark in June 2010. Twitter, created in 2006, managed to get by with only $360.17 million in total funding until a $400 million boost in 2011. Instagram ginned up just $57.5 million in funding before Facebook bought it for (a staggering) $1 billion last year. And LinkedIn and Spotify, meanwhile, have only raised, respectively, $200 million and $288 million.”

Unbelievable.

Of course, no one in Washington cares about such costs because they aren’t the ones flipping the dime. We are. To them, its like Monopoly money.

Also like Obamacare, there’s no real concern with quality assurance when it comes to the Healthcare.gov website because the motivation just isn’t there to make things better.

When I was a full-time systems analyst, my coworkers and I understood that a failure of service and repeated usage problems would lead to a loss of customers. A loss of customers would mean less company revenue. Less company revenue would mean less company investment, including employee salaries. Less money available for employee salaries meant that our ability to provide for ourselves and our families was on the line.

So, we were always highly motivated to put forth our best effort, do everything we possibly could to please customers, and make every cent that was put into a system count. That’s is how the private sector works.

When the government’s in control of something, however, no one really cares about pleasing the customer (who is the American public). There’s little motivation to be efficient. It’s the reason why the DMV is such a nightmare. It’s the reason why no one in their right mind would ever choose to use a public restroom over a private one.

Private ventures are driven by success. Public ventures are driven by dependence. Which do you think are most likely to factor in quality and ease of use?

Speaking of ease of use, how many people do you think gave up on Healthcare.gov and the health care exchanges over the past week and seriously considered just paying the federal fine to avoid all the hassle? After all, according a recent AP poll, three-fourths of Americans who tried to register for health insurance through the ACA experienced problems. That, along with all of the reports from different states revealing how shockingly few people have actually signed up, suggests that people just don’t want to deal with the complexities.

That’s the same concern that medical professionals have with the Affordable Care Act. In a Deloitte survey of U.S. physicians taken a couple of months ago, 60% expect an exodus of early retirements among doctors over the next three years. The reason? Doctors don’t want to deal with another bureaucracy that requires them to fill out even more forms, write more letters, and respond to more inquiries. They don’t want to deal with the additional hassle of government reimbursements, less control over how they run their clinics, and less take-home pay that is all associated with the increasing costs and regulations that come with the ACA.

When a process becomes too complex, people abandon it. And that’s just another reason why Obamacare will fail.From a Dead Sleep - by John A. Daly

The good news for the Obama administration is that websites can be fixed, typically without having to start over. The Affordable Care Act, on the other hand, really can’t. It’s fatally flawed, resembling a computer virus more than an inefficient system. And maybe, as some have suggested, that was the point all along – a way of getting us switched over to the ultimate liberal dream of a single-payer system.

If that’s the case, I’m not sure even a system reboot in 2016 could save us.

Author Bio:

John Daly couldn't have cared less about world events and politics until the horrific 9/11 terrorist attacks changed his perspective. Since then, he's been deeply engaged in the news of the day with a particular interest in how that news is presented. Realizing the importance of the media in a free, democratic society, John has long felt compelled to identify media injustices when he sees them. With a B.S. in Business Administration, and a 16 year background in software and web development, John has found that his real passion is for writing. His first novel, entitled "From a Dead Sleep", is now on sale! He lives in Northern Colorado with his wife and two children. Like John on Facebook. Follow John on Twitter.
Author website: http://www.johndalybooks.com/
  • D Parri

    Please give the president all the credit he deserves. It is much easier to write “ACA” in referring to this law, but it really should be called Obamacare for now and forever. Let’s not forget who to thank.

  • D Parri

    “Private ventures are driven by success.” Government programs are driven by much different factors. It isn’t difficult to hand out money if you did nothing to earn it. The leadership behind this program is so far removed from the realities of its true operation and requirements that it is no surprise that is already a dismal failure.

  • D Parri

    “The cost of both was grossly underestimated.” Is it any wonder? What would have been the chance of getting the bill passed if accurate and honest information had been provided when the President was campaigning to have it pushed through “…one way or another…”? Not a snowflake’s chance in hell.

  • Brian Fr Langley

    Your conclusion about single payer (the Govt.) is on the money. It’s just that single payer is not the end game either? (Unless you believe the left is motivated more by altruism then power)?
    .
    First education to control the schools,
    turn patriot’s children into fools,
    then like a weaver,
    the economy lever,
    who holds the purse strings makes the rules.
    .
    Even traditionalists have a hard time with “conspiracy theories” but truth be told. The Marxist agenda for America (oh, and did I mention the world) continue apace.

  • Wil

    If Obama was smart, he’d come in with his own demands.

    1. Lift the sequester.
    2. Pass my jobs bill.
    3. The ACA is the law of the land so stop fucking with it.
    4. There will be no cuts to Social Security or Medicare.
    5. Give Medicare to everyone. Let’s have a single payer program as the rest of the industrialized world does.
    6. Balance the budget by increasing taxes on the rich.

    If the republicans have their own laundry list of things they can’t pass through the normal legislative process, let’s have our own list also that most people would actually benefit from.

  • sjangers

    For a few years now I’ve been seriously considering the idea of national health care. Most of us have decided that health care is necessary, and the private system for funding and delivering quality health care is becoming more and more inefficient and is experiencing increased difficulty in keeping customers satisfied.

    But when I think about turning health care over to the federal government, I get visions of disasters like the ACA roll-out. As you say, John, when private individuals and organizations are competing with others for our business, they have some motivation to offer better and less expensive service, else we’ll take our business to a competitor. And there’s even the federal government to fall back on for support if the marketplace becomes too unfair and abuses customers.

    With a government-run entity there is no disinterested government oversight. There is no competition. And when it comes to keeping customers (i.e., us) happy, their choices are: put a lot of effort into working harder and smarter to create a better customer experience, or put a little effort into blame-shifting, weasel excuses for problems, hiding the scope of problems, and maybe demanding that we all kick in another $50 bil a year in the hope that they will make small improvements toward the promised goal of a great national health care system. Based on decades of watching how government handles quality problems, I think we all know which solution they usually choose.

    • legal eagle

      The hole in your argument is this….When insurance companies raises rates, which they have done at about an 8% rate for the past 15 years, then you complain but it’s OK because “that’s capitalism”.
      When insurance companies deny care, overcharge for drugs or put limits on policies, that OK because “that’s capitalism”>
      When the government gets involved to attempt to cure these problems, “That’s socialism”…..and that’s bad..very bad..

      • sjangers

        Dammit, Eagle, you interrupted a perfectly good football game with this nonsense.

        When my insurance company raises its rate, I have the option of shopping around to see if I can get similar coverage for less money from another insurance company. I might even look into getting less coverage to save money. The costs are determined by the marketplace. If medical costs are rising in response to consumer demands for more or better services, insurance companies still have an incentive to keep those cost increases as low as possible because otherwise I might buy my insurance from a competitor who will keep my costs down. And I still have the option of seeking government relief if I believe that insurance companies, or medical professionals, are taking advantage of the marketplace.

        If government takes over the medicine business, I really have no options. I end up consuming what government offers or nothing at all. Perhaps I even end up compelled to consume medical services, whether I want to or not. I’m sure I’ll be compelled to pay, whatever I might be allowed to do. And the only hope I have to keep my expenses down, or to make sure the services I get are those that I want, and that I don’t get services I don’t want, is that government will be responsive to me as an individual. (Let’s take a moment to appreciate the humor of that concept.) And the idea that a three trillion dollar bureaucracy, with all sorts of resources to persuade me and others citizens that reality is something other than what it appears to be, and without any powerful recourse (WHO anybody?) to mediate disputes between little me and this huge bureaucracy, is going to care very much what I think is completely ludicrous.

        Capitalism isn’t good and socialism bad because they are what they are. One is good and the other is bad because they do what they do. One gives me an opportunity to get the goods and services I want at a reasonable price. The other allows me to get what it wants to give me at the price it wants to charge, and insists that I thank it politely on my way out the door.

        • legal eagle

          Are you talking theory of fact? If you’re talking theory then you are stating an opinion…I am quite familiar with the health insurance business so my question is simple…Are you talking fact or fiction?
          I don’t think you have a clue of what you’re talking about but when you want to discuss specifics I’m all ears…

          • sjangers

            So are you saying that I can’t change my insurance carrier if I think their rates are too high? Are you saying that I can’t change the type and cost of my coverage through private insurance? Are you saying that insurance companies never consider the rates and coverage plans of other providers when setting their own rates and coverage plans? What are you saying? Anything?

            Your previous post dropped a couple of facts on us that really have nothing to do with my original post. For that matter, what does the continued increase in health insurance costs actually prove? Perhaps that medical costs in this country are rising because consumers demand increasingly complex and costly treatments? That research and development expenses of consumer-demanded innovations in medical technology and new medications continues to drive up costs? That educational costs for medical professional are still skyrocketing and must eventually be passed on to consumers? That the threat of lawsuits continues to add tremendously to the cost of our health care? You certainly added no insight to the discussion about the merits of private payer health insurance versus a government-managed system.

            So come on, big bird, what’s your point? If you’re just doing your usual bit and trying to create distractions with semantics and misleading factoids then you can go elsewhere. I won’t waste my time on that kind of nonsense. If you really need to stroke your ego you can find another sucker.

          • legal eagle

            Here is my point…without you being defensive can you tell us why you cant keep your current insurance….Are you on an individual plan, a group plan, a small business plan etc.?
            What I am saying that , at lest in California and New York, there are ACA choices and then there are other plans from insurance companies that are not part of ACA….
            The fact is that in most states the only differentiation between price are deductibles, co-pays and prescription benefits. It is very difficult to compare costs because if an insurance company wishes to advertise a lower price, all it has to do is increase the out of pocket…

          • sjangers

            At the risk of sounding defensive, or even disrespectful, what the heck are you talking about, Eagle? I’ve never claimed that I can’t keep my current health insurance. Some people have made this claim. Some have even waved around documents they claim are from their insurance companies to support their contention. I’ve seen no evidence that contradicts their statements. But I’ve never said that I can’t keep my current insurance. So why are you asking me that question?

            I don’t live in California or New York, so I don’t know whether or not your assertion that those states have ACA choices is accurate, but I see no reason to doubt you. But what’s your point? Critics of the ACA have said that the President wasn’t telling the truth when he insisted people would be able to keep their current insurance under ACA. He didn’t say people in New York and California would be able to keep their insurance. He seemed to be saying pretty clearly that everyone would be able to keep their current insurance. There seems to be a fair body of evidence that suggests his assertion wasn’t accurate.

            Your point about insurance plan pricing is reasonable. But again, so what? All large and sophisticated organizations are pretty good at confusing ordinary consumers when they want them to do something. Even governments do it. It’s hard to compare insurance costs. It’s hard to compare car costs. It’s hard to compare the costs and benefits of political proposals. Sophisticated sales teams, commercial and political, know how to make those choices more confusing and how to influence our decision-making. All true. What’s your point?

            I don’t agree with your assessment that insurance companies are not competing. I do agree that they’d rather not compete, and they do try to maximize their income and minimize their expenses. But part of maximizing their income involves competing for more customers or to keep existing customers. It isn’t a pure and uncorrupted market model. But it is a market model that still confers to consumers at least some of the benefits of the market.

            If health insurance companies increase costs and reduce benefits too much they run the risk that existing companies will try to move into their markets, or that new companies will come into existence to serve those markets. I’ve seen this happen in my home state of Vermont over the past twenty or thirty years. There are at least a half dozen companies that provide health insurance to Vermonters. About twenty years ago a self-insurance organization even entered the market to serve not-for-profit organizations. I think they’ve now expanded their base and offer their service to for-profit businesses. If it doesn’t already exist, there’s no reason that this organization, or others like it, couldn’t offer self-insurance to individuals. The concept may not be much different from the way that mutual companies work (unless you’re one of the unlucky few that develop serious health problems and expenses), but it’s another option that could exist in this market.

            Marketplace competition is alive and well in the insurance industry, even if it isn’t as efficient as we would like it to be. Based on my observations of government sponsored services during my sixteen years in human services and mental health, I believe health insurance operates much more efficiently than it ever could if government took over the industry.

            I accept your contention that the U.S. health care system is the most expensive in the world. If you’re trying to tell us that the reason for this is the marketplace model, then I’ll respectfully tell you that you’re very confused about cause and effect. Please refer to my previous post for a partial explanation of the reasons health care is so expensive for us. I could probably add the cost of government regulation to that list, but that would open a whole new topic for debate.

            One thing I’ll say with absolute certainty- although it’s only a theory, since it hasn’t been tested directly- is that turning the management of health care over to the public sector would either drive up costs or drive down the quality of service, and would probably do both. I understand the frustration most people have with the failings of our current health care system. I share some of those sentiments. That’s why I started to give serious consideration to the idea of national health care. But after spending so long observing how inefficiently, and frequently poorly, government manages care of other social service problems, I can only conclude that it would be an enormous mistake to turn over our health care to our government. They aren’t equipped to handle it.

          • legal eagle

            I must have misunderstood…You were making a theoretical argument rather than a factual one…
            As to your opinion of government involvement in healthcare can you tell me what is wrong with the Medicare system…I know no one on Medicare who complains about it….Isn’t a Medicare type healthcare system exactly what you are claiming wont work?

          • sjangers

            I know a few Medicare recipients what aren’t too happy with the system. I worked pretty closely with clients who often received Medicare and Medicaid. They had few resources, so what they were getting was better than nothing. But the system is overly-bureaucratic, inefficient, and often difficult for consumers to interface without professional guidance.

          • http://johndalybooks.com/ John Daly

            A lot of doctors won’t even accept such patients as well, because of all of the hassle involved in getting reimbursed through the bureaucracy you described. My mother-in-law struggles with this.

          • sjangers

            We often struggled finding mental health care for Medicaid customers because of low reimbursement and additional regulations. Few psychiatrists or therapists wanted the hassle for so little return on their time. I’m sure there are similar stories with Medicare and health care.

          • http://johndalybooks.com/ John Daly

            … and with Obamacare. As I mentioned in my column, the hassle the ACA creates for doctors is significant enough to compel a good number of them to retire early.

          • sjangers

            That’s what I’m hearing from a few family friends who are doctors, John. I’m also a little concerned that my PCP, who has mentioned the possibility of another career before he retires, might decide that this is the time for him to leave medicine.

          • Bob Olden

            Thank you, Sjangers, for all the light you have shed by your thoughtful and well reasoned posts. Your patience with Legal Eagle is remarkable! But there are probably lots of people who have his kind of opinions and questions.

            I have a friend who administers Central Supply for a chain of hospitals and he gives lots of examples of why health care costs more and more. Doctors want the most advanced equipment to do complicated procedures, (partly to reduce the chances of making a mistake and the liability that results– in a lawsuit happy environment!) but the equipment is enormously expensive and the reimbursement for procedures performed keeps going down! That’s just one example of dozens that he has told me.

            Health care is going to cost more and more, no matter what happens with the ACA. But add a 20% surcharge (at least!) for government waste, fraud, and God knows what else, and you have to conclude that WE CAN’T AFFORD IT!

          • sjangers

            Thanks for your kind words, Bob. Eagle is an interesting character. A prolific writer, certainly intelligent, who has a different world view from me and appears to be quite certain he’s right about everything. In that final respect, he reminds me a lot of me about twenty years ago.

            I suppose I could go toe-to-toe with Eagle and be just as argumentative as he is, but that really isn’t going to help make clearer the issues we’re discussing for readers who are trying to form their own opinions. Too many of us today seem to spend a lot of time talking- or shouting- past each other. It doesn’t promote clarity or comprehension, and certainly makes it harder for us to come together and cooperate in the end.

            If the ACA leads to more government involvement in health care, I’ll be praying that the waste and fraud is no worse than the twenty percent surcharge you mention. I spent many years working closely with government human services programs and am convinced that they should have been able to do the same amount of good they were doing with about half the money they were spending. Efficient utilization of resources is something that just doesn’t come naturally to bureaucrats or politicians.

          • http://johndalybooks.com/ John Daly

            Just to weigh in here, my family’s individual plan through Aetna was indeed cancelled because the Obamacare regulations made it too unaffordable for the company to keep around. They were upfront about it in the letter we received.

            It’s a very real thing, and I know of several others personally who are now experiencing it as well.

          • legal eagle

            The real reason for “tort reform” by the Republicans has been to protect drug manufacturers/big pharma from lawsuits…Republicans can’t admit this because it would be politically unfeasible so they couch it as protecting your local doctor….That is pure B.S.
            California has had limits on malpractice damage claims for the past 10 years…It has not made an iota of difference in slowing down rate increases…

          • sjangers

            Eagle, there are a lot of political positions that provide cover for actual intent. You may well be right about the Republicans here. I don’t circulate at that level in the party.
            When you say California has had limits on damage claims, that’s encouraging. But can you provide any data about the total annual cost to medicine in California of medical malpractice claims since this law went into effect? That information would be a lot more meaningful for the purposes of our discussion.

        • legal eagle

          The health insurance industry model has been broken for years. Ever check a hospital bill? Think you can negotiate your hospital stay? The fact is you cannot…Insurance is the same way…Did you know that high blood pressure is considered, by many insurance carriers, a pre-existing condition. Your assertion that you can switch insurance companies at will, is often untrue because insurance companies will not take people with pre-existing conditions. Guess who determines what constitutes a pre-existing condition? The insurance industry.

          • sjangers

            PARABLE ALERT! Read no further unless you’re really bored; or, of course, you’re the Legal Eagle who requested this response.

            The health insurance model is far from efficient. But I won’t go so far as to say it’s broken, particularly when the alternative would appear to be a national health care system. You want to talk broken? That model would start at dysfunctional and gradually move from bad to worse.

            So the alternative appears to be to find ways to improve the current model. Pressure from consumers can make a difference. Consumers just have to decide what they want insurance carriers to fix and how to fix it, and therein lies the rub.

            As consumers, we occasionally have a hard time deciding what we want, particularly if the choices are complicated and our true interest uncertain. Buying apples from a greengrocer are one thing. The grocer finds a few suppliers, settles on one or two who provide a good product at a reasonable price, and he passes his choice on to his customers. They let him know they are happy with his decision by buying his apples, or that they’re not happy by looking to another grocer for apples.

            But what happens when a few people want their grocer to carry pomegranates? Pomegranates are a much more expensive commodity to bring to our market. The cost may be more than the customers who want them can afford. Is it fair to charge the apple purchasers a portion of the much greater cost associated with having pomegranates available in the store? What if the few customers that want pomegranates don’t just want them, but really need them? Should they be forced to suffer the consequences if they can’t afford the cost?

            And that’s where things get really complicated. A truly free market says that the product is available to those who can afford it and not available to those who cannot. Some compassionate few might offer to help pay for pomegranates for those who need them. Some compassionate grocers may increase their prices on other items and take a little less profit to reduce the price of pomegranates to those who need them. But some customers won’t want to spend a few extra cents for an apple if they can buy the same product for less elsewhere, so even the compassionate grocer can only do so much to reduce pomegranate prices. And most apple buyers will never stop to think about the possibility that they might need pomegranates some day, so all they care about is having good and inexpensive apples.

            So how do we make this work out for the grocers, the apple eaters, and for those who have to have their pomegranates? After reading so far, you’re expecting an answer, aren’t you? And the truth is that there is no easy answer.

            It isn’t right to allow those who need pomegranates to die if they can’t afford them, although it may be just. It isn’t just to demand that apple eaters and grocers pay to provide pomegranates to all who need them, particularly those who haven’t done everything in their power to raise the money they need or find some way to eliminate their need for pomegranates, but it certainly seems right. It might be worth educating apple eaters about the importance of keeping pomegranates available in the market at a fairly low price, because some apple eaters eventually develop a need for pomegranates. But there is no definitive, one-size-fits-all moral or practical solution.

            It’s an imperfect world. The market is imperfect. And if you’re ready to step in and suggest that we turn the whole problem over to the government, I’ll point out that government is also far from perfect. If you have trouble accepting that, please let me know. I’m sure I have another parable or two kicking around here somewhere that could help illustrate the point. All you have to do is ask for it.

          • legal eagle

            Do most people health insurance is a necessity for both themselves and their families….Pomegranates are not… Free market theories don’t always work well ie. oil markets, health insurance et al.
            I’m suggesting that the Medicare model which is a mix of government and private insurance works well and has worked well for the past 50 years….
            Tell me what you disagree with…

          • sjangers

            The pomegranate was an analogy, Eagle. We have to imagine that it’s a critical need for some people. Then the story makes some sense and might help promote understanding of the analogous situation.

            I’m not a laissez-faire capitalist. Free markets have deficiencies. I just know that they work better than any pure alternatives at our disposal. Hybrid systems often work best, in my opinion, but trying to find agreement on exactly how much free market and how much government involvement will work best can be a frustrating process as advocates for one extreme or the other make it very difficult for us to decide what’s really happening inside the model, or what’s likely to happen.

            You’ve offered a pretty abstract assessment of Medicare: that it “works well”. I know people, including family members, who don’t think it works well. I can’t get too deep into the weeds because Medicare doesn’t impact me personally, but I know family members who are purchasing Medicare supplement insurance because the Medicare coverage isn’t adequate. I also know that there’s a threat on the horizon that Medicare may soon not have sufficient funding to continue benefits at even the current inadequate levels. Is that enough disagreement?

  • Mike

    We’ll be visiting witch doctors for our healthcare before all is said and done…

    • legal eagle

      Black with doctors in the ghetto……Scary…

      • http://johndalybooks.com/ John Daly

        The ghetto? I’m not sure you know what a witch doctor is. Anything to play the obligatory race card, huh eagle?