A Healthcare Death Spiral Caused by Bad Website Design?

By  |  October 28, 2013, 2:53 PM

Media coverage of the HealthCare.gov debacle is plentiful, but two of the more poignant pieces to describe the cause and possible aftermath of the failed website rollout appeared in The New York Times in the past week.

Last Thursday, Clay Johnson, lead programmer for Howard Dean’s 2004 campaign, and Harper Reed, the former chief technology officer of Obama for America, gave an insiders’ perspective on why only a small fraction of the 20 million Americans who have logged onto Healthcare.gov have succeeded so far in obtaining insurance. Johnson and Reed blame “the way the government buys things.” Their take: the complicated code that guides government contracting all but guarantees that the companies that win contracts “are those that can navigate the regulations best, but not necessarily do the best job.” CGI Federal, the largest vendor on the HealthCare.gov job, is their case in point.

Johnson and Reed write:

“HealthCare.gov is only the latest episode in a string of information technology debacles by the federal government. Indeed, according to the research firm the Standish Group, 94 percent of large federal information technology projects over the past 10 years were unsuccessful—more than half were delayed, over budget, or didn’t meet user expectations, and 41.4 percent failed completely.”

Most Americans are blissfully unaware of this track record. But the well-publicized consequences this time could be dire. Annie Lowrey reported in the Times on Sunday that if website frustrations cause applicants to skip signing up for coverage, economists warn that “rising prices and even a destabilized insurance market could result.”

Lowrey offers the example of an uninsured, 32-year-old Ohio sports journalist frustrated by repeated failed attempts to get into the HealthCare.gov account he created on October 2. The Affordable Care Act scheme hinges on young, healthy people like him buying coverage to balance risk pools that include old or ill people. Without them, Lowrey reports, economists say the worst case outcome could be “a death spiral of falling enrollment and climbing prices.”

Both reports, however, end on an optimistic note: Johnson and Reed have faith that HealthCare.gov will be fixed “in a few days,” and the 32-year-old Ohio man hasn’t given up. He says he’ll snail-mail a printed insurance application by the end of the month.

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