Opinion

The Edgy Optimist

Healthcare.gov is just the beginning

Zachary Karabell
Nov 1, 2013 20:52 UTC

The Obamacare blame game is in full swing, and without other news to fill pages and airtime, it’s likely to continue for some time. Attention is shifting from the myriad problems with the official website Healthcare.gov, and toward the health plans that are being canceled, even though President Obama promised that they would not be.

But the longer-term story isn’t the rollout and its many severe glitches. No one recalls whether the first batch of Social Security checks was sent on time in the late 1930s. The story that will matter, and linger, is that the Affordable Care Act was the first major law implemented almost entirely online. It’s the template for the future, and rather than using its launch as an excuse to renew attacks on the law, we need to learn what we can because, like this bill or not, it is part of the next wave of government.

The past two weeks have been filled with various individuals testifying to Congress about the design and implementation of Healthcare.gov, the web portal that allows individuals to access the new health plans and exchanges. The tenor of these hearings, convened by the Republican-controlled House, is that the design of the website exposed the fundamental failings of the law and government incompetence. But what’s actually been exposed is that the U.S. government has not yet made the transition to a digital age. While the administration could have and should have done far better, the reasons for its failure are less about a flawed process than a system currently ill-designed for this type of legislation.

It’s safe to say that Congress has never before passed a federal law whose primary mode of delivery is a web portal that will be used by tens of millions of people. And not just one portal, but a portal that serves as a gateway to numerous state healthcare exchanges along with the federal exchanges; a portal that must link up newly designed web pages and interfaces with legacy systems stretching from the Internal Revenue Service to the Veterans Administration to the Medicare and Medicaid systems, none of which are easily compatible or speak the same language.

Many in the tech community have tried to analyze what went wrong with the web launch. Some think the government shouldn’t have hired low-bid contractors, choosing agile development teams instead. There was also a lack of sufficient testing of the site before launch, but the site went live anyway because of political considerations. That the site’s code is not public has limited the ability of even savvy tech-heads to fully explain the many problems.

The Obamacare plot twist

Zachary Karabell
Jul 18, 2013 18:25 UTC

For months, we’ve been told that the impending implementation of the Affordable Care Act (aka Obamacare) will lead to soaring healthcare costs and more expensive premiums. That narrative has taken hold, even for those who otherwise support the suite of reforms. And that’s why the recent front-page article in the New York Times, reporting that premiums in New York State may actually fall 50 percent or more, came as such a surprise.

Only a few weeks prior, the Wall Street Journal announced that “Healthy consumers could see insurance rates double or even triple when they look for individual coverage under the federal health law later this year.” Their analysis did acknowledge that ailing individuals could see rates fall, but the driving point was one that has been made ad infinitum by critics of the reforms: costs will soar.

So entrenched is that view that the Republican-controlled House of Representatives continues its quixotic quest to repeal the bill, and voted this week for the 38th and 39th times to repeal parts of the bill, including the “employer mandate” that the Obama administration has already decided to delay. Paul Ryan said about the latest vote: “This law needlessly raises healthcare costs. And this law will cause millions of people to lose the health insurance that they have, that they want to keep.”

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