HealthCare.gov: Changes show programmers were forced to play politics. But we’re still all arguing about the wrong thing

HealthCare.gov
HealthCare.gov

Much of the criticism around HealthCare.gov has focused on the initial decision to force visitors to complete an application before they could see health care plan pricing.  Critics say so-called “anonymous shopping” was killed late in the design process for political reasons. A completed application is required to determine each consumer’s eligibility for a discount/subsidy, and the administration did not want consumers to see prices without these subsidies because they might be higher, and make Obamacare seem less palatable.

I think the site itself makes clear that this is true.  On Wednesday, some variation of the message on the screen shot to the left appeared on every single page of HealthCare.gov’s “See Plans Now” click-through route, a repeated call-out that I’ve never seen in the history of web design. “Prices here don’t reflect lower costs you may qualify for….”

Many had predicted that the success of failure of HealthCare.gov lie, sadly, in warring anecdotes. If there were more “Hey, my monthly bill is going down!” posts on Facebook than “OMG, look what this will cost me” posts, the administration would score big.  Awareness of the potential for warring anecdotes impacted website design.

Republicans in the House Oversight Committee leveled this accusation in a letter sent Monday to Todd Park, Obama’s chief technology officer, demanding that he turn over documents related to development of the site.  The letter is full of off-the-record comments pulled from newspaper stories and vague surveys, which don’t help much when trying to assess what really happened. But this assertion seemed reasonable enough to me when I read it:

“Many IT experts have suggested that the decision to disable the anonymous shopping feature contributed to the failure,” it says.

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Why would that be so? Giving the window shoppers a separate, simpler menu to browse offloads a lot of traffic from the guts of the operation — the identity and income verification, the communication between the IRS and Medicare computers, and so on.  Also, pages served to lookie-loos could be static  – based on simple criteria, like zip code, age, and gold/silver/bronze choices.  They wouldn’t be much different from displaying stats for major league baseball players.  To my outside eyes, prices served to consumers who fill out full applications are dynamic — created on the fly, individual for each consumer. Those take a lot more programming resources.

How much pressure did creating an anonymous option relieve? Well, let’s rough it out.  The administration said last weekend that 19 million people visited HealthCare.gov, and half a million started an application.  Let’s assume about half that 19 million just didn’t get anywhere because the site was too busy, and cut that first number down to 10 million. That means nearly 95 percent of visitors that first three weeks would have been happy with a static page — the real HealthCare.gov machine would have been dealing with only 5 percent of the traffic.  

Another warning message. Somebody really wants you to see this.
Another warning message. Somebody really wants you to see this.

The decision to insist on full applications surely invited disaster.

And let’s not forget — e-shopping cart abandonment rates, even after all these years of e-shopping. Ask consumers to enter their address, and they click away in droves. Programmers knew abandonment rates would be enormous for healthcare apps, that consumers needed to know what the benefit was (a cheap price) before going to all that trouble.

Back to why. I’m not a political reporter, and I in fact hate political reporting. But it seems undeniable that someone involved was very concerned about showing health care plan pricing without showing the subsidies; it’s undeniable, because the site doth protest too much, with a warning message on every page right now.

Who’s to blame? In our current political system, every step is an overreaction to the other side’s overreaction. It was programming suicide to not simply show plan costs; but it’s probably also true that Obamacare critics would have unfairly seized on the higher prices in an attempt to throw the baby out with the bath water. So, someone, somewhere, decided it was politically necessary.

Also, credit must go to the programmers and managers who managed to add back anonymous browsing on short notice. As a programmer friend said to me this morning, this means two things: “the design isn’t so terrible that it takes forever to make changes; and .. whoever is in charge has made sure that changes don’t get caught up in QA/Change Management Hell.”

Putting on my real hat as a Gotcha reporter, I’ve got to say this entire discussion sickens me a bit, because all this talk of monthly premiums is very nearly a complete waste of time. At least, it’s a huge misdirection, the same way auto dealers confuse car buyers by focusing on monthly payments rather than the cost of the car. Healthy care costs involve much more than monthly premiums. They involve co-pays, they involve caps, they involve covered and uncovered treatments. What will healthcare cost you for the next 5-10 years? That’s the real question. And while we argue about website design, we are a world away from talking about the real problem.

 

 

About Bob Sullivan 1367 Articles
BOB SULLIVAN is a veteran journalist and the author of four books, including the 2008 New York Times Best-Seller, Gotcha Capitalism, and the 2010 New York Times Best Seller, Stop Getting Ripped Off! His latest, The Plateau Effect, was published in 2013, and as a paperback, called Getting Unstuck in 2014. He has won the Society of Professional Journalists prestigious Public Service award, a Peabody award, and The Consumer Federation of America Betty Furness award, and been given Consumer Action’s Consumer Excellence Award.

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