Healthcare.gov: Centralized chaos vs. States right of way?

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12 November 2013
Chuck Johnston
It’s not surprising that consumers wonder why we can’t trust in an Apple or Google to deal with the technical intricacies of the US public health exchange, as my colleague Donald Light points out in the previous blog post. I also agree with him that they are not necessarily the best choices for high transaction throughput regulated systems, but do set a higher standard for consumer service than our government. What I find fascinating is that we (the American people), had any expectation that the federal government could be successful. Celent did a survey of consumer expectation of services for various vertical industries including government and the findings show consumers felt that the only industry that had a poorer potential to provide on-line service than insurance was…government. This reflects well on insurer’s pleas to be allowed to circumvent the healthcare.gov site and get direct access to subsidy data to enable direct enrollment on insurer’s web portals. Of course, that does take the competitive, free market aspect of the exchanges out of the equation, creating a huge advantage for larger carriers with strong brand and consumer mindshare. However, people would have insurance coverage. The federal public health exchange is a frightening intersection of a regulation-driven, massive one-time usage spike; tied to a complex process and IT project requiring huge scalability, under tight timeframes and limited supervision. Arguably, the better approach was the federally funded, state exchange that reduced both scalability issues and complexity for this initiative. The 12 state exchanges (soon to be 15) that are currently enrolling citizens have their issues but nothing on the scale we see with healthcare.gov. Also, the 15 or so private independent exchanges run by commercial brokers are enrolling customers as well. Thinking like a risk manager instead of a politician, perhaps distributed deployment at the state level should not be an option but a requirement, mirroring the US state-based insurance regulatory model. This would meet the needs of the consumer in creating a neutral exchange that would enable transparent price competition, reduce the size and complexity of any one exchange, and allow the federal government to declare victory and move on to help somewhere else. Please.

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