Obamacare website is a mess. Now what?
Profit Protection Act
It has been tough to watch the rollout of the Affordable Care Act. Having followed the twists and turns in the attempts of politicians to address our national health insurance mess since the 2008 presidential campaign, I cry for our country.
The Affordable Care Act should have been called the Profit Protection and Unaffordable Care Act because it further entrenches the underlying cause of the mess: the use of for-profit companies to collect and process our payments for our own health care. The ACA is unaffordable for the country. It protects the profits of these companies, wastes tens of millions of our dollars on even more companies to attempt fixing a horribly flawed law, and hires yet more companies for additional millions to explain this mess to us. And, by the way, we spend 20 cents of every dollar that goes to the insurance companies just on their overhead, before any money gets spent on your health care.
Just for comparison, Medicare has an overhead of about 1.4 cents. Languishing in committee is HR 676, which is vastly superior to ACA. Affordable, universal and putting in place an efficient, effective system, HR 676 was initially held from going to the floor by Speaker Nancy Pelosi, who received well over $1 million in campaign contributions from the insurance/pharmaceutical industry while President Obama’s campaign received more than $21 million. So instead of a smoothly functioning health insurance system we now have this mess.
Tip of the iceberg
The problems that have been identified with the Obamacare rollout are just the tip of the iceberg. All the problems they’ve experienced have to do with nothing more than the data-entry front end of the system. Just wait until they get into actually using the system – e.g. the reimbursement system, the billing system, the collection system, the interface with myriad other government systems, the fraud alert system, the actual medical care system, the doctor enrollment system, the insurance company compliance system, the subsidiary disbursement system, etc. As Al Jolson used to say, “Folks, you ain’t seen nothing yet.”
An expensive sham
Healthcare.gov is an expensive sham. It serves only two functions.
Its first function is to explain the new health care law, which it sometimes does, but often with inaccurate information. More often it refers you to other websites, such as the health care bill or to the IRS website. The second function is a referral site for whatever insurance companies are available in your state providing this specific type of health care.
Neither the website nor the federal government provides this health insurance and does not need to create an account for anyone or collect any personal information other than your state, whether you smoke, your age, and the number of people being covered. From those four pieces of information what the website should do is provide a spreadsheet of the available plans and a link to the company that provides them.
As with the Medicare plans, there are a confusing set of deductibles and co-pays that result in everyone playing roulette and hoping that they have signed up for the least-expensive plan. Health insurance does not provide any health care and costs 30 percent more than either paying out-of-pocket or a single-payer, universal health care program. Making everyone have health insurance was a really bad idea. John McAfee estimated 15 programmers could create a website that worked for $5 million, but most of the functionality of healthcare.gov, the creation of accounts, and linking to government websites to verify information, is not needed, a sham that has cost us approximately $500 million.
(The writer is a candidate for mayor.)
Keep it simple!
A national health care system is as complex as any imaginable system that serves people, and registering and enrolling people in the national health insurance marketplace is complex as well.
These systems are difficult to engineer because they are largely concerned with institutions and individuals who interact in unpredictable ways. Adding to the difficulty is our inexperience in designing a national health insurance system. Finally, software engineering as practiced today is not an engineering science: It has no agreed-upon standard methods for structuring a set of complex requirements into a system that runs correctly.
In order to achieve a successful outcome for the failing HealthCare.gov system, we should reduce its scope to include only the following capabilities:
1. Let people browse health insurance options without determining eligibility or setting up an account. This simpler system should enable people to enroll more quickly later.
2. Register people and provide them with information such as how to contact a local office where they can receive advice and enroll. This will give administrators an estimate of the distribution of potential enrollees and allow them to staff health insurance centers appropriately.
3. In paying our taxes, we have the example of an easy-to-fill 1040. We can look for simple cases in health insurance enrollment that could be implemented in the first iteration of the system. The rest of us can for now enroll by telephone and/or by visiting a local office. Keep It Simple, Stupid!