One Graphic Explains How Complicated Healthcare.Gov Is

This graph above explains the utter complications surrounding the setup of Obamacare's keystone site Healthcare.Gov. You can see why it crashed.

Chart on How Healthcare.Gov works

As you can see above, things get messy quickly if one thing goes wrong.  (Image Source: Xerox)

There has been a lot of damage done to the brand of the Affordable Care Act, also known as Obamacare, in the last week, while the government shutdown took hold due to its existence.  But the shutdown was not the cause of that damage:  Rather, it was the activation of Healthcare.Gov, the site for accessing and order insurance on various state insurance exchanges, that caused the reputation drop, simply because it did not work.  The crashing of's servers is of such a scale of magnitude that it makes the debacles of My Bloody Valentine's third album and Sim City earlier this year look like dropping your phone on accident.  Even when we tried to sign up, the site failed on us.  Now, this chart above by Xerox explains why:  Healthcare.Gov is so complicated, failure was a likelihood from the beginning.

The big problem with the Healthcare.Gov's system is that it has to do two very big and separate things at once, linked together at a small point:  Determine a subscriber's eligibility for either Medicaid expansion or tax credits used to buy health insurance, and to enroll and purchase insurance, with the eligibility information being the linking point.  While the latter is relatively easy to the develop, the first half of determining eligibility is very complicated:  At least six agencies are involved, including the IRS, the Department of Health and Human Services, even the Department of Homeland Security.  There also state agencies involved to handle state-related matters.

The current consensus is that the reason a lot of applications on Healthcare.Gov did not process over the last week is due to problems in the eligibility stage of enrollment:  In other words, very few applications even got around to looking at what insurance options they have, let alone enrolling in them.  This has been the primary focus of site repairs and reinforcing servers, and some progress has been made.

Still, the likelihood that Healthcare.Gov was going to fail was huge.  The reason is the same reason that an Irish shoegaze band's 20-years-in-development album and a long-awaited game about being a mayor also crashed:  Numbers.  Testing servers and sites under the load of a massive amount of users is very difficult, and the expected amount of users to visit a site when it launches is almost always underestimated by the site's owners and creators. 

Of course, in the case of Healthcare.Gov's situation, the problem was a scale of magnitude that may have been impossible to test:  Only 15 states in the Union actually set up their own local insurance exchanges.  The other 35 states, either due to financial strain, using hybrid tactics, or just having a temper tantrum over the opposition setting up a new national program, decided not to set up their own programs and forced their residents to use Healthcare.Gov.  These 35 states represent approximately two-thirds of the entire country's population, or more than 200 million people.  Odds are, this site was built to handle, at most, one-third of the nation's population, the same number that happen to be on state-run insurance exchanges.

In a way, for that last group of people that refused to set up a health insurance exchange, it is an insidious tactic, if clever:  Oppose the insurance exchange to the fullest, to the point that you deny your residents the ability to register on a local exchange, forcing them on the national site  Then, when the site crashes because of the undue burden you placed on it, you can point to that as a reason to oppose and destroy the service even more.  Pretty clever, when you think about it.  Also, pretty childish.