At last week’s congressional hearing on the healthcare.gov fiasco, there was a lot of finger pointing but few answers as to how the centerpiece of the president’s administration could be implemented so poorly. The hearing was in response to the dreadful user experience at the healthcare website, where those trying to apply for health insurance were met with interminable page loading, error messages, and server crashes.
Such technological ineptitude would be somewhat excusable if conducting transactions online was some kind of new-fangled technology that still hadn’t had the kinks worked out. But the process has been humming along for two decades now, and the technology has been successfully used by almost every sector of business and government. Banks like Citigroup and Chase successfully process billions of dollars a day online.
It’s true that a healthcare website has to electronically stitch together a multitude of insurance companies and individuals with varying eligibilities. While there are a few dozen health plan insurers that would have to be integrated into healthcare.gov, there are business sites that have achieved integration of thousands of different suppliers.
Let’s also not forget that this debacle has cost taxpayers $298 million so far, not to mention the countless hours Americans and insurance companies have had to spend navigating this mess. Startup companies launch fully functional web sites in a few months, usually with the capital of a few million dollars. Will taxpayers get their money back for a system that’s broken?
The contractors and government officials said that they were unprepared for the volume of users on October 1. Exactly what kind of volume did they expect when there is a law that requires every American without healthcare — approximately 39 million of us —to sign up for it? Besides, a heavy number of users is a technological challenge that’s easily solved with more servers and replicated databases. With current technology, any website can have access to an almost unlimited amount of computing capacity. What’s necessary to make high-usage web sites viable is knowing the anticipated load on the system and scaling the hardware and software accordingly.
There was a lot of mea culpa during the hearing about the absence of end-to-end testing. End-to-end testing refers to testing all components of the system together — the browser interface, the web servers and the software running on them, and the databases. Releasing software without full integration testing is tantamount to Boeing selling an airliner without fully testing all the parts together. Imagine if Boeing would test a new wing or engine without testing its performance when operating as part of an actual plane — and then assuring passengers that the new parts should work because they were tested separately.
Such poor judgment and lack of accountability calls into question not only the Obamacare disaster but the entire process of how companies are chosen to provide technology services to the federal government, and how the price tag for such services is computed. The main contractor, CGI Federal, a Canadian corporation, has been a newcomer to performing work for the federal government, only getting U.S. contracts since 2004. This poor choice begs the question of why American firms such as IBM and Microsoft, with deep experience in providing these website consulting services, were not given the contract. (Believe it or not, CGI Federal has another $8 billion worth of contracts with the U.S. government in its shopping cart.)
This lack of planning, poor judgment and sloppy implementation have broader and wider repercussions, as they call into question the government’s ability to manage a large part of our nation’s healthcare. And in fact the website woes are only a smokescreen for some of the unpleasant surprises some users are experiencing when they are finally able to use the site. They are seeing higher premiums in some states, a small pool of doctors to choose from and high deductibles. Some New Yorkers on Medicare Advantage received letters that they would no longer be covered for visits to their current physician. Obamacare has not only left a trail of broken hyperlinks, but of broken promises as well.
Certainly, our nation’s healthcare system needs fixing, but the clumsy and unfair way the Affordable Care Act is being carried out is violating the fundamental promise of medicine: the Hippocratic oath of doing no harm to those who need healthcare.