Why Silicon Valley Can’t Fix Healthcare.gov

Healthcare.gov screenshot

Senator John McCain is hardly a darling of the tech community. But he expressed a sentiment widespread among techies when he said of the woes of the Obamacare enrollment process: “Send Air Force One out to Silicon Valley, load it up with smart people, bring them back to Washington and fix this problem.” Would that it were that simple.

Silicon Valley is, or course, full of many of the best software engineers in the world. But the odds that they could quickly rebuild a complex government system are close to nil. Let me say that I have a strong belief that the problems of Healthcare.gov will be dealt with in time for people to sign up by the yearend enrollment deadline (along with the phone enrollments that President Obama is promoting in lieu of the semi-functional web site.). Any problem that time, money, and skill can fix will be fixed. It may not be perfect, but it will be a lot better. But understanding why Silicon Valley doesn’t have the answer requires knowing something about legacy government IT.

A crew of crack HTML coders could undoubtedly do wonders for Healthcare.gov’s clunky web front end. But that’s not where the real problems are. The enrollment process set up by the Affordable Care Act is excruciatingly complex. The Department of Health & Human Services runs the central system. To verify all types of eligibility, its computers must check citizenship status with Citizenship & Immigration Services (Homeland Security), ascertain income from the Internal Revenue Service (Treasury), and check Medicare and Medicaid status with the Centers for Medicare & Medicaid Services (another part of HHS.)[pullquote]A crew of crack HTML coders could undoubtedly do wonders for Healthcare.gov’s clunky web front end. But that’s not where the real problems are.[/pullquote]

All of the backend systems involved in this process can politely be described as legacy. And by that I don’t mean just that they run on mainframes. These systems depend on a lot of very old, often poorly documented code (some of it COBOL) and some use antiquated technologies such as IBM’s Systems Network Architecture. And they were not designed to communicate with each other and do it badly if at all. CMS alone has multiple incompatible databases, and that’s before you consider the 50 state systems that hold Medicaid data.

This, to say the least, is not Silicon Valley’s métier. If the problems are to be fixed, the job will end up being done by the people who built Healthcare.gov and those who are responsible for maintaining (and often running) its constituent systems. This means a lot of the work will go to traditional government IT contractors such as CGI Group (the prime contractor on the front end), IBM, Accenture, Lockheed-Martin Information Systems, and CSC.

The good news is that despite the tendency to disparage these old fogeys, there actually is plenty of engineering talent out there. Healthcare.gov needs a lot of help but it will come not from Valley hotshots whose skills run to HTML 5 and Amazon Web Services but to engineers who know how to run a rigorous testing program on a complex, heterogeneous system and quickly fix the problems that turn up.

Of course this should all have been done before launch and the public should not have been used as guinea pigs for user acceptance testing. But it wasn’t, and that’s water under the bridge. The job is to get it fixed now.

Published by

Steve Wildstrom

Steve Wildstrom is veteran technology reporter, writer, and analyst based in the Washington, D.C. area. He created and wrote BusinessWeek’s Technology & You column for 15 years. Since leaving BusinessWeek in the fall of 2009, he has written his own blog, Wildstrom on Tech and has contributed to corporate blogs, including those of Cisco and AMD and also consults for major technology companies.

2 thoughts on “Why Silicon Valley Can’t Fix Healthcare.gov”

Leave a Reply

Your email address will not be published. Required fields are marked *