There is an old joke about a wise man from a primitive tribe telling the youth of the village about the universe. “The whole world sits at the center of the universe, resting upon the back of a giant turtle,” he says to his class of rapt listeners.
Unfortunately there is one particularly inquisitive child in the audience. This young child thinks a bit, and then asks earnestly, “but wise man, upon what does that turtle sit? What keeps that turtle from falling?”
The wise man is startled, as no one has asked such as question before. He strokes his beard, thinks a bit, and then replies, “Why my child, of course the turtle sits upon the back of another turtle.”
The young child immediately asks again, “Upon what does that turtle sit”.
The wise man, getting angry, says right back, “Upon another turtle, of course.”
The child says “and upon what sits that turtle?”
The wise man says, “Shut up kid. It’s turtles all the way down.”
I asked a good friend of mine, who is an excellent programmer/DBA and deals with websites that handle millions of transactions daily, what he thought was the issue with Healthcare.gov, the now infamous website that is the backbone of the Affordable Care Act (AKA Obamacare), which has so far defied efforts to make it work properly, and in fact seems to be getting worse. “Can it be fixed quickly?” I asked.
His answer was not encouraging—it’s problems (turtles) “all the way down”. In other words, he doubts there is a quick fix to this, since based on the way it is behaving it appears to be basic structural issues in the design, rather than just some specific coding errors that once found can be fixed.
Now I haven’t seen the code, and if I did see it I’d probably be none the wiser, but the cause of the problem looks to me like absolutely no one was in charge of the entire project. How else can you explain that no one bothered to buy up the similar sounding domains to Healthcare.gov, and for that matter, still hasn’t. For instance, Healthcare.com is just sitting there, faking people out that it’s the real site. The first thing you do when picking a domain name for something even close to this big a deal is make sure you’ve got all the potential other similar domain names tied up, so people can be sure they are on the right site. In this case it’s mission critical—you certainly don’t want people keying their most private information into a scam site—it’s like those Nigerian oil scams…..just key in your social security number, bank account number, credit card number, etc. and you’ll be rich (or have health insurance). It’s a mindboggling oversight, and the only possible explanation is that the entire project was divided up into chunks, and each ‘politically connected’ consulting group got a piece, but no one put it all together. No one was paid to do it, so no one did it. It’s the classic rap on consultants—courtesy of despair.com…..“if you are not part of the solution there’s still plenty of good money to be made prolonging the problem.”
This site is not the real ACA site--it's healthcare.com not healthcare.gov. Don't key your personal data into the wrong website
Why do I say it’s getting worse?—for one thing, even the site in Massachusetts is now having issues. From reports coming in, potential enrollees are required to say they are incarcerated (in jail) to proceed, as a ‘no’ answer hangs them up. Similarly for whether they suffer from mental illness—a no answer gets you stuck. Plus, you’d better not have a hyphen in your last name, as those won’t take either.
On the main site, the number of enrollees is filtering out and it’s not pretty. Six people signed up in the whole US on the first day. To date NC has 1 paid enrollee. The log in screen is coming back now with jumbled letters, which is a new issue. People are getting “secure” data for other people. Calculations are incorrect. The site keeps crashing. It’s possible they’ll make the end of November date, but I doubt it. That’s now just three weeks away with Thanksgiving in the way. Sounds like turkey in the office for a lot of unlucky programmers.
This is far more than just a website problem, which is why I noted that it might be the biggest screw up in the history of technology. The entire implementation of the Affordable Health Care law is in jeopardy, because you really can’t just call in to a call center and talk to a person, or work with a ‘navigator’ (who might be a criminal since there are no background checks), because even they have to go through the website. There is no other route. It’s the only way to sign up. This disastrous website rollout is focusing attention on all the other ‘not so desirable’ aspects to the law, like insurance cancellations and steep price increases, and perhaps most importantly, it’s discouraging people who really don’t want to get insurance but are required to (AKA the young and healthy). They won’t be signing up in the numbers required because it’s such a hassle, it’s expensive, and the fine is just $90 a year. Their insurance will cost them that much a month, so why would they sign up? If this implementation had rolled out smoothly perhaps no one would have noticed, but it didn’t, and now the spotlight is on high. This website rollout has become the main subject matter for all late night comedians, not just Jay Leno. And they are very funny.
As noted in my previous article, there is a funny side to all this, but a serious side too. One of the great failings of our current insurance system (actually it should be our old system, but it isn’t yet) is the exclusion of people with pre-existing conditions from the market. That was a completely unacceptable situation that went on way too long, and one that the ACA was supposed to remedy. There might have been simpler ways to do so, but nevertheless, this is a huge problem for these people with pre-existing conditions. That’s who is sitting there, night after night, trying to get coverage. It’s the people with no insurance and serious illnesses, joined now by the millions of people who have had their insurance canceled by year end, not even two months away. This is an incredible mess and I hope it is resolved soon, but I’m afraid it’s “turtles all the way down”.
Update: Today I read something that makes me more optimistic. Todd Park, the White House’s CTO, has been moved over to fix the site. Mr. Park is, to quote Politico, “one of the most accomplished Health IT entrepreneurs in the country” and his crew built a similar although much simpler site back in 2010 in 90 days, and it worked. It sounds like the right person is finally on the job. However, the time pressure is still enormous, since the insurance cancellations take effect at the end of the 2013, which is only about 7 weeks away, and for all practical purposes no one has been able to sign up. If it really is ‘turtles all the way down’ we could be looking optimistically at February 2014 as a more realistic timeframe, and that’s too late without some radical action.