by Ezra Klein, Washington Post
Interesting report on the improvements in the consumer experience of healthcare.gov and what that is likely to mean for the next election cycle.
A report released by the Obama administration this weekend shows the consumer experience is clearly improved. More than 400 of the 600 fixes on the administration’s “punchcard” of repairs have been made. System response time has fallen from eight seconds to less than one second. The administration believes HealthCare.gov can now handle 50,000 concurrent users. The site, which was down 55 percent of the time in early November, is now functional more than 90 percent of the time.
Of course, that means the site still suffers a disastrous outage rate judged by the standards of major retail Web sites — and that’s not counting the time it spends down for scheduled maintenance. We have no idea whether the 200 fixes left on the list are the really important ones, or the really difficult ones. We don’t know what percentage of people who begin an application suffer some failure before completion. The administration hasn’t released information on the error rate in the eligibility determinations or the transmissions to insurers, so it’s impossible to judge whether the site’s critical back-end functions are reliable. And there are important pieces of the site, like the payment mechanisms, that have yet to be built.
So there remains reason for concern. But here’s what’s indisputable: HealthCare.gov is improving, and fast. Or, to put it differently, HealthCare.gov will be fixed. In fact, for most people, it is probably fixed now, or will be fixed quite soon.
The repair job is likely proceeding quickly enough to protect Obamacare from the most severe threat to its launch: Democrat-backed legislation unwinding the individual mandate or other crucial portions of the law. So long as people can actually purchase insurance through the federal exchanges, congressional Democrats are likely to support the basic architecture of the legislation they passed in 2010.
Republicans realize the Web site is quickly improving, and are planning a multi-phase attack on the law’s other disruptions. There are the insurance cancellations, of course, but there also going to be people who happily buy new insurance only to find their doctor isn’t covered, and there will be people who end up paying higher premiums in the new market, and there will be employers who raise deductibles to keep from paying the 2018 tax on high-value insurance plans, and so on.
Unlike HealthCare.gov’s technical problems, most of these issues will be part of the law working as it’s supposed to work rather than the law failing to work as it’s supposed to work. Tighter care networks, for instance, are part of how insurers will cut costs and increase quality in a more competitive market. As Dan Diamond writes, “insurers say that limiting the size of the network allows them to steer patients to high-quality facilities and doctors; participating providers, meanwhile, may agree to price cuts in exchange for new volumes.” It’s exactly what Republicans hoped would happen in health-insurance exchanges — an idea they thought of, and still support for Medicare.
Change hurts, particularly in health-care insurance, and it may well hurt Democrats in 2014. But Obamacare is now moving from unexpected problems that threaten the law to predictable disruptions that are, in many cases, intended by the law. And the Obama administration will have three full years to create millions, and perhaps tens of millions, of winners who are getting insurance or protection through the law. As in 2010, they may well lose on the politics in the midterm election even as they win on the policy in the long term.
