Summary: The technical problems with the implementation of the (Abdominable) Affordable Care Act are becoming the stuff of legend. The entire thing should be rebuilt. But that will not save the ACA, because the underlying policies and political pressures that have caused the problems are even worse than the systems so far created to deliver it. As Twitchy notes, the ACA continues to reap a bitter harvest. But the real problems of the law may come later. Even if the technical issues can eventually be worked out, because the policy errors and economic misconceptions driving it can never be worked out. There are two areas of abject failure in the ACA system implementation: the "front end" and the "back end." Sharp readers will note there is nothing else left to fail. The front end is the web site and systems used to communicate with the user. The back end consists of dozens of interlocking computer and communications systems among government agencies and their crony industry partners, reaching even into the examination room. Both the front and back ends are disasters, and both disasters are driven by the structure of the ACA itself. The Front End The front end has drawn much of the attention so far, and is not ready even though Health and Human Services officials said it would be: Initially, users were forced to create accounts before doing any shopping. HHS released a tool to let people see the prices in their area, but to see subsidy qualification they still have to create an account. The account creation process is filled with problems all of its own. This is Not How It's Done. Users of amazon.com or travelocity.com do not have to do that. Those sites know that account creation drives away users while slowing down the system, especially the part of the system used to register new users. Healthcare.gov seems to be more optimized for collecting Social Security numbers than in connecting people with the right insurance products. And the accounts appear to be permanent, with no facility in place to let users delete them. Industry observers say, and the compressed timelines attest, that nobody tested it. Because of the political need to open October 1 (resulting from the partisan nature of the law's origin), testing was not done. Experts said the decision to require that consumers create online accounts before they can browse available health plans appears to have led to many of the program’s technical problems. Consumers trying to create their accounts multiplied the volume of online transactions that have overwhelmed the website. The White House suggested they simply needed to improved the consumer experience. The incredible departure from best practices of the omission of testing can't be overstated. The Back End Health insurance expert Bob Laszewski says that only 5,000 people have signed up for insurance through the federal exchange. While the numbers are bad, the behind-the-scenes picture may be worse: For some reason the system is enrolling, unenrolling, enrolling again, and so forth the same person. This has been going on for a few days for many of the enrollments being sent to the health plans. It has got on to the point that the health plans worry some of these very few enrollments really don't exist. The reconciliation system, that reconciles enrollment between the feds and the health plans, is not working and hasn't even been tested yet. Read that whole thing. The bureaucracy is ill-equipped to solve these systemic problems, particularly when the bureaucracy itself may be part of the problem. HHS is treating these fundamental problems as help desk issues (emphasis added): Federal health officials declined to discuss the problem with the enrollment reports. “As individual problems are raised by insurers, we work aggressively to address them,” said Brian Cook, a spokesman for the Centers for Medicare and Medicaid Services, the branch of HHS that is oversee
