Tuesday, November 12, 2013

What did we expect? The not-very-shocking failures of healthcare.gov

So healthcare.gov's launch was a customer service disaster. As a merchant, I'm less surprised by it's failure than the fact that people are surprised it's a failure. The theater of mock astonishment that the media have acted out in the last month has reminded me of the scene in Casablanca when Captain Renault comes into Rick's gambling hall—where he had been gambling himself, the day before—to declare, "I'm shocked—shocked!—to find that gambling is going on in here." 

Think about your experience with healthcare and government websites. Have you ever dealt with any doctor through their website? How many times have you seen your health records as an electronic file? Ever looked up your itemized insurance bill online? How about the federal government—ever filled out your taxes at irs.gov? When is the last time you checked the balance in your account at socialsecurity.com? Arranged to ship a package at usps.com?

Doctors, insurance companies and most parts of the federal government live in a nearly a web-free world. They don't use the internet for much of anything, let alone working with customers. Why is it a surprise that when they had to build a consumer website it failed? Why is anyone shocked—shocked!—to find that healthcare.gov is a pile of crap?

Even if the contractors were brilliant, and I don't doubt many were, the deck was stacked against them. I've read what the site must do and it's very complex. Take the act of verifying that a person is who they say they are, a central part of determining their eligibility for aid. If you're like me, there have been plenty of times you've had trouble logging into a website that you've already logged into before. Now imagine that the website has to find out who you are before it can log you in for the first time. Then imagine the website contains 350 million people like you in the database. Then imagine the database doesn't really exist, it's a compilation of multiple databases. That's healthcare.gov.

Apple spoiled us. Before them software always broke. (It's worth reading this amazing piece, though, to see how broke the iPhone was just a week before Steve Jobs made his groundbreaking presentation.) All this isn't to say that healthcare.gov shouldn't work—it should. And because it was always going to have launch trouble they should have had a Plan B and Plan C ready to go. Backups to help the roll-out, like a longer period between launch and required sign-up, local sign-up offices for in-person guidance, and more advertising that customers can sign up on the phone. But all that aside, it's just good to remember that making software work correctly is hard. It's not shocking when it fails.

The Worst Run Industry In America is my look at the American health care industry, its service, prices and promises, from my view as a merchant.

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