HealthCare.gov really is the purest political failure

While the US was distracted in its negotiations over whether to have a government, the health insurance exchange, HealthCare.gov, launched. It was beset by technical issues. Put simply, it couldn’t handle the load. This isn’t surprising. The right way to design a site like this is for robustness in on-going use — that is, for the stable flow of applicants — and not for the initial influx — that is, the stock of currently uninsured. The problem is that the launch was open to all and so you have the flow trying to handle the stock with inevitable consequences. It is claimed that these troubles were unexpected but I find that pretty near impossible to believe. Enough people knew this problem was coming. The question is: why was it ignored?

To understand this, we need to think about what should have happened. HealthCare.gov needed a private beta whereby the stock was managed into a flow via specific invites; basically, a queue was needed. The problem was that the queue meant that some would get health insurance earlier than others. And that was when the idea of a private beta became politically unpalatable. There would be a queue and someone, somewhere was worried that the media could find someone not getting medical care and another insured but not using medical care and there would be a really bad looking story.

The alternative was technical chaos. But the one thing that was true about the chaos is that it could be perceived as fair. Everyone is having trouble! It is, of course, the worst kind of policy to deal with inequity; make sure no one is getting a better deal than others by giving everyone the worse deal.

I don’t think it is much more complex than that but this narrative really puts the political decision-makers on the hook for responsibility. This type of political failure is endemic in democracies. The problem is that it is rewarded and not punished. Instead, some technology officer will likely take the hit. That doesn’t sound too fair really.

What could they have done? The most politically diabolical way of having a private beta queue would be to put the states whose legislatures are refusing to implement Obamacare at the end of the list. You could reward those who were apparently keenest for it. I suspect that this might pose a constitutional difficulty.

The alternative was to randomly allocate invites. Think of the opportunity this would have borne about to study the effects of health insurance coverage. It would be the Oregon experiment (which by the way was a counter example to the political failure argument here) on a national scale. You could learn in a scientific way what works about Obamacare and what doesn’t. Great policy.

Finally, the most obvious thing to do would have been to separate health insurance coverage start dates from the date you signed on to HealthCare.gov. Basically, tell everyone that you are covered from October 1st so long as you sign up by December 31st. No need to rush. To be sure, some people will get suck in that time and switch from being not covered to being covered. But that seems a small price to pay for a sensible launch.

[Update: Apparently they did do the “most obvious thing.” Steve Waldman tells me that you are covered from January 1 if you enroll any time between Oct 1 and Dec 15. Well that is almost the right thing. But why not be covered from October 1?]