The Train Wreck Known as HealthCare.gov

HealthCare.gov is a disaster. It has been been well documented here and here as well as by our very own Lt. Dan here. Let me start with my experience trying to use HealthCare.gov.

This all took place last weekend and Monday of this week. It took too days because — and I couldn’t make this up — I fell asleep in front of the computer waiting to compete the registration. It kept hanging and then logging me out and I eventually fell asleep waiting on one of the refreshes. I did eventually complete the application, but had to enter my family information multiple times because the site kept deleting it. It wasn’t like I used it the first day it was launched. It was after it had been proven that it couldn’t scale and that a whole lot of organizations claimed to have been working on it 24/7.

So yes, it was very unpleasant. Contrast this to my experience of getting insurance quotes for seven new employees. This is very fresh, as I just completed the census info for the employees last week. We used Maxwell Health and got a pretty quick turnaround and nice-looking portal for enrollment and self service. HealthCare.gov had more systems and data sources to integrate and was used at a scale that Maxwell hasn’t achieved, but Maxwell just raised $2 million and I’m sure hasn’t spent most of it yet.

Ultimately the reason HealthCare.gov’s performance is a disaster is not because of the extremely unpleasant experience, which is something that is not uncommon in new product launches. I use tons of new apps and services that are buggy and often crash. I’m OK with that. I’m a good early adopter. And I’m not trying to say that HealthCare.gov is easy to build. It’s not at all. It’s complex and connects to lots of different data sources.

As an avid and accepting early adopter, why do I think of HeathCare.gov as a disaster? The reason HealthCare.gov is a disaster is because of 1) the expectations, 2) the ridiculous cost, and 3) the responses to the failings by those associated with the program.

First, the expectations. I’ve been watching what HHS has been doing with health IT and putting out to the press over the last year or so. I’ve have been really impressed with the caliber of people that are associated with programs like Blue Button+. Then there was the specific buildup to the launch of HealthCare.gov. It was all about things like agile and modern web services and Github and a host of other buzzwords that are almost never associated with government technology. That was exciting to me. I think that buildup, coupled with the impressive fellows HHS was recruiting, lulled me into into a sense of optimism about what HHS would actually build.

What I should have done is remembered the time I spent as a government contractor. Way back when, before medical school, I used to work for one of the larger entrenched contractors that got some of the money from HHS for HealthCare.gov. I saw first hand, specifically on projects at the NSA and SSA, how much money was spent and what little was produced. I saw it so much I accepted it as the way things work. Somehow I forgot those experiences and chose instead to believe the hype around HealthCare.gov.

Second, the cost. The amount wasted by HHS on HealthCare.gov, even if it worked perfectly, is sickening. No untested technology or product should cost that much. It’s also sickening because it’s money wasted while HHS cuts reimbursements and forces providers to shoulder the financial burden of EMR implementations.

Last is the responses from all parties involved, or at least those who are speaking out. HealthCare.gov didn’t work and still doesn’t work. That’s hard to argue with at this point. Whether the root of the problem is the technology or the demand, it doesn’t much matter. I just want the buck to stop somewhere. Can somebody please step up and just say, "We screwed up" or "We made mistakes?" I don’t care if the screw-ups relate to predictions about demand or about building crappy technology. Just acknowledge mistakes and stop being defensive. I’d have a lot of respect if somebody just said, "We know we screwed up and this didn’t work how we thought. We’re actively trying to fix what’s wrong and learn where things went off course."

Ironically we’re all about incorporating accountability into healthcare for providers and payers. It’s a good thing HHS isn’t accountable to itself. Thank you, HHS, for knocking me back down to earth and lowering my expectations of "government innovation." I’ll be sure to keep the bar lower going forward.

TGphoto

Travis Good is an MD/MBA involved with health IT startups. More about me.

  • TheMDofTruth

    Travis- IMO, this is the best post you’ve written. I couldn’t have said it better and you nailed all 3 points.

    Great read and thanks for the content.

  • Ann Farrell

    Travis, I challenged Dr. Gregg to a tit for tat session in response to your post. We’ll see if he takes me up on it.

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