Glitch, Please: Propaganda Campaign Against Health Reform Missing the Point

(Okay, title preamble borrowed from Stephanie Miller!)


Yesterday, President Obama spoke about the Affordable Care Act, its benefits, and the recent launch of Healthcare.gov, a site handling health insurance marketplaces for more than half the states. The president acknowledged the fact that glitches and frustration made up for some amount of the user experience on Healthcare.gov and promised to quickly fix the problems. We already know that some of the best and the brightest from the industry are being recruited to smooth out the rough edges.

In the mean time, instead of helping and figuring out why the glitches exist and what can be done to fix them, you have Congressional Republicans promising witch-hunts (I mean, uhm, "hearings") against Kathleen Sebelius, the Secretary of HHS. Suddenly, the Republicans are very concerned that after they blocked as many states as possible from operating their own exchanges (where things are actually working better), the national site, picking up many more times the traffic than initially designed is sometimes slowing down and making things frustrating for those looking to buy health insurance.

The media is a witting accomplice, as they have been with every other GOP-generated phony "scandal", with few outlets bothering to investigate the challenges of undertakings this big. They are instead busy talking to "political analysts" who know nothing about technology. I love Barney Frank and Robert Gibbs, but they are no tech wizards, and neither, I might say, is noted Blackberry "inventor" John McCain. This is of course the common disease among the media: they are more interested in the political fallout of everything rather than understanding the actual science and technology behind something: whether it is the economy, climate change, modern weaponry, surveillance, or health reform.

The technological issues will be discussed in the following paragraphs, but consider the following facts of Healthcare.gov: more than 20 million people have visited Healthcare.gov (that's 20 million unique visitors for our tech nerd readers, not 20 million hits), and half a million applications have already been received even with the glitchy system. As the president pointed out, that's half a million applications, and many of them are for family coverage, the number of people who have already applied for coverage may well be approaching seven digits already. Given the administration's goal to sign up roughly 7 million people by the end of March, even this "disastrous" rollout is on or ahead of schedule.

Now, let's talk about the technology a little bit. I am not exactly an expert on web design and Internet technology, but I have built multiple websites, and I do have a basic understanding of what it takes to operate something as complex as Healthcare.gov. Traffic is a big part of the equation. I don't care how efficiently your site is built, if you open the floodgates all at once, and the interest is overwhelming, the best sites will go down. It's simply a matter of resource allocation. You can build a damned good dam, but there is always a water pressure point that will break it.

Consider a couple of examples. USA Today interviewed a software expert who brings to light why Healthcare.gov is a more difficult underaking than the world's most popular social media site, Facebook. First of all, notes the expert, El Mehdi Marhoum, Facebook began with just a few hundred users in a private network, as opposed to opening the floodgates all at once. Opening it to everyone at once instead of a incremental rollout caused something similar to what would happen if a ton of people were to flood into a building without forming a line through all of its entraces. Facebook got to add capacity over time, whereas Healthcare.gov had to be open to all from the first second.

Now consider the example of a product launch: about a year ago, Google launched a new phone, called the Nexus 4 (I'm a proud owner). From my personal experience in attempting to buy it for days I can say this: on launch day, and for weeks on end after that, Google Play (Google's online store through which the Nexus 4 sold), was a fiasco. You couldn't get on, you couldn't order, and when you could order, the damned phone would disappear from your shopping cart, and the back order cue was often turned on its head (people who back-ordered weeks later began receiving their phones earlier). This went on for weeks, if not months.

This happened for a product launch from the top Internet company in the world for a product that is much simpler to order than buying health insurance, and that generated far less interest than health insurance marketplaces. For comparison purposes, consider that by January of this year (from a November launch), the phone had sold only about 375,000 units (far less than the number of applications already received through Healthcare.gov).

But Google and Facebook aren't even proper reference points, as Healthcare.gov is several orders of magnitude more complex and difficult. The integration required is mind-boggling. Healthcare.gov not only has to account for states' choices - for example, whether a given state is accepting the Medicaid expansion or not - but also regional differences in choices in plans offered and insurers who offer those plans. The system has to know where an applicant is, what plans are offered in that area, who offers those plans, what the premiums are, how much premium credit a given applicant is eligible for, and whether an option like Medicaid is available. Then, it has to take the applicant's data and send it to the correct insurer. These are layers of complication that hardly any private vendor has to deal with.

I can understand the crocodile tears from the Republicans - they never wanted this president to succeed in implementing health care reform in the first place. They fought the opportunity for Americans to get affordable health insurance tooth and nail, even shutting down the government and bringing America to the brink of default over it. The Republican propaganda around health reform took advantage of the website difficulties, pretending its faults alone are the entirety of health reform.

But - and I may be asking a fool's question here - what is the media's impetus to sign on to that propaganda narrative? Isn't it their job to point out the fact that despite the problems, more than a half million applications have been received? Isn't it their job to inform Americans that Republicans have made the problem worse by keeping 36 states from building their own marketplaces, dumping the responsibility instead on HHS? Isn't it their job to tell their audience that should they get stuck, they can call 1-800-318-2596 to sign up?

Most of all, it's the media's job to investigate just what it takes to build an online marketplace of the magnitude that Healthcare.gov has to be.

This isn't about making excuses for the website's poor performance - this is about getting the story right. The president isn't making excuses, and neither am I. The president is taking responsibility to fix the glitches, make the system better, and once and for all end the shame of being the world's only industrialized nation that does not provide affordable healthcare for all of its citizens. This isn't about excuses. This is about explanations. This is about examining the issue instead of political point-scoring.

Not that I am expecting our cable "news" shows to take my admonition to heart, though, given their admitted propensity to believe that it is not their job to report the facts (Chuck Todd just said out loud what most of the newstainers believe).

But if they believe their joining up with the Republican propaganda parade will keep people from accessing the affordable health care they need, they are in for a surprise. This is no simple product. Health care is personal. Those - including the young and healthy - who go without insurance for the greatest part do not do so because they want to be one accident or one diagnosis away from financial ruin, but because they can afford nothing more. People will get the affordable coverage they need. They will find their options, and they will sign up. The millions of people on Healthcare.gov and millions more in state exchanges prove that. Obamacare is here to stay because the actual product is dispelling the myth. That's why the propaganda is destined to fail.