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Obamacare: Bad Getting Worse

Much has been publicized about the problems with the roll-out of Obamacare (specifically its website, Healthcare.Gov). Media outlets are expressing dismay and disappointment as their reporters waste precious broadcast segments in repeated failed attempts to demonstrate the website to the public. For many, they have tried multiple times at different times clamouring for that interaction that they can label a "success".

In the short span of 3 weeks, those segments have transitioned from live attempts to tape-delayed admissions of continued failure. When they could navigate to the site at all, Users received errors registering, errors attempting to login, or errors trying to use site functionality. On the off chance that they did not get errors, they were met with messages instructing them to return during "off-peak hours" or contact already-overburdened support staff.

Throughout, it has been a national investigative endeavour to find and identify Users who have actually successfully used the site to enroll. Administration officials have been silent in announcing any actual success metrics which suggests that they too know there is little to celebrate. The public numbers that are being released of successful enrollments are 50 or less for entire states! In many states, the primary state university football team has more lettermen than the entire state has actual enrollees.

To say that this roll-out has been an unmitigated disaster might be generous. However, the worst is likely still to come!

The problems being uncovered are not "glitches" or "underestimations of demand". Plenty of websites exist today that serve vastly larger User bases and they do so meeting high standards of User experience.

It has been known in technology circles for a while that Quality Assurance / Testing for Healthcare.gov and its supporting infrastructure was embarrassingly delayed and woefully inadequate. Testing that was to have started in March 2013 had not even been officially scheduled as late as September 2013 (a scant four weeks prior to the official launch).

Final requirements were reportedly still being delivered up to the week prior to launch which would have allowed for only days of testing before it opened for usage. Insurers working with the exchanges have quietly grumbled of the lack of integration testing that would be expected and required for an initiative this large.

It appears that there was no one in leadership of this effort who understood how to deliver something of this scale.

The bad part is the current problems are only the parts of the iceberg floating atop the water.

Based simply on reports, the outcomes / data that is being produced by this small subset of successful Users is riddled with errors that require further human intervention if it is usable at all! This represents a second level (and much more daunting) problem whereby the software appears to work, but doesn't. It is one thing for a site to be non-functioning. It is another thing altogether to appear functional, but produce results that require further human interaction to complete. Many times, and this will likely be a case, the human capital required to fix the problem is more than would have been required to do the work if the website never existed.

Lastly, all of the problems that are being highlighted as transactional in nature. Transactional actions include registrations, logins, enrollments, etc. The real crush of usage and problems to come involve the content provision functionality of the site.

Healthcare, as a market and under Obamacare, is expected to be much more patient-centered and patient-focused. Patients will be required to perform their own research, weigh options, and make decisions about their care. The content requirements for Healthcare.gov will dwarf what we see today.

If this site is unable to process registrations, logins, and enrollments now, it will completely crumble as patients investigate and evaluate providers, procedures, and the myriad of care-related decisions.

Get your rain jackets out - those are dark clouds on the horizon!

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Comments

Kudos to @PatrickRuffini for saying very similar things from a different perspective.

http://patrickruffini.tumblr.com/post/64718592703/how-healthcare-gov-dis...

As he points out, at the heart of the problem lies the reality that huge "comprehensive" solutions are rarely successful. They rarely solve anything and tend to exist only to propagate themselves.

Many Liberals, philosophically predisposed to looking to big government for big solutions to big problems, refuse to acknowledge their own experiences favoured agile, targeted solutions to specific problems setting & achieving measurable goals. Somehow, the "bloated leviathan" model which fails in almost all organizational cases is expected to succeed in the government / political realm.

Matthew Yglesias on Slate.com goes so far as to defend liberal ideals like socialized insurance / health care by noting that the failure of Healthcare.gov does not presuppose the inability of government to do other "good things" (like Social Security & Medicare).

http://www.slate.com/blogs/moneybox/2013/10/21/healthcare_gov_and_libera...

Ignoring for a moment that those bloated programs have systemic problems of their own, the very fact that government would fail so miserably at a commercially-repeatable task like creation of a User-focused, community-based website is evidence that bureaucracies are poor providers of big solutions.

The best way to predict success is to review past performance and evaluating what (if anything) will be done differently the next time.