Healthcare delivery in America is broken. While our doctors and medical professionals are able to conduct some of the most amazing and effective procedures, a shocking number of Americans don't have access to quality medical care.
We have the technology, science, and medical skills. The problem is not medical. The problem is economic and political -- and it's brutal.
Back in 2009, I spent more than twelve months researching healthcare delivery as an essential element of my book, How To Save Jobs (free download). Because healthcare is so inextricably linked to employment, it was a necessary area of research. The conclusions I came to then were disturbing.
Back in 2009, about 46 million Americans didn't have access to health insurance. That's roughly the population of America's 44 largest cities. Even worse, one in three Americans went without health insurance sometime during 2007 and 2008. That brings the number up to 86.7 million people, or all the people of our top 273 cities.
Of course, one issue with all these folks experiencing gaps in their coverage is that many of them lost coverage for conditions previously covered. Once they resumed their health coverage, they suddenly had preexisting conditions that were no longer covered.
This is one area where the Affordable Care Act is critically important because it no longer allows insurance providers to discriminate against preexisting conditions. The 2007-2008 stats aren't unique. Because health insurance is so tightly linked with employment, whenever Americans lose their jobs and their COBRA runs out, they lose their healthcare.
In other words, it's not just the "great unwashed" who need help, it's people just like you and me, people who have worked for large corporations and small businesses.
Here's another interesting statistic: because so many companies in America are small businesses, in reality, only about 12 percent of US companies actually offer health insurance to their employees. That one surprised me.
Our healthcare cost is uniquely expensive. Remember that Americans are now competing for jobs all across the world. Yet it costs a typical American company 24 times more to provide a health insurance benefit to an employee with a family (not counting that employee's actual pay) than the the total cost of wages for a typical Chinese employee.
Combine that with the fact that most other first-world nations offer some sort of government-provided healthcare coverage, and you realize that American companies employing American workers are competing at a severe disadvantage, simply because of how much healthcare costs add to overall expenses.
What's worse, even when healthcare is delivered, it might not be all that good. In a nationwide survey of nurses a few years ago, almost half said they, "would not feel confident having someone close to them receive care in the facility in which they work." Ouch.
I'll give you one more one-two punch and then we'll move on to the Healthcare.gov issue.
The American Journal of Medicine did a study that looked at bankruptcies. They used data from before the economic downturn that we've all recently experienced. They concluded that more than 60 percent of all bankruptcies in America were healthcare related.
It gets worse. Three quarters of the people going through those bankruptcies already had insurance. The insurance -- insurance they or their employers paid good money for -- didn't help. They still lost.
I went on to write a couple of hundred pages on this topic, showing example after example of just how troubled the American healthcare system was. I also pointed out that the American healthcare industry was the largest single industry in America, which makes it the single largest industry in the history of mankind.
And that brings us to Healthcare.gov and Obamacare.
I've said this before and I'll say it again here. The Affordable Care Act was bad governance. It went out of its way to accommodate the healthcare industry to the detriment of American citizens. It was negotiated by lawyers and politicians, which is never good.
But regardless of whether Obamacare is good governance or not, the fact remains that Americans were and still are in deep trouble when it comes to healthcare. If 87 million people drop out of coverage relatively regularly, if 60 percent of our bankruptcies are health-related and of those, 75 percent had active healthcare insurance, something is very wrong.
Obamacare, kinda-sorta, aims to fix that. In my opinion, based on my research, it goes the wrong way. My analysis shows that for America to be competitive globally for the next hundred years, we're going to have to have some form of Medicare for all. Obviously, that's not where our politicians took this thing, and instead we have mandatory insurance buy-ins and a crappy website.
But, for now, it's all we've got. And it's in trouble from at least three vectors.
The first is simple. It was built by the government after going through the normally terrible government procurement process. It's badly designed and full of compromises. That comes as no surprise, but it's troubling nonetheless.
One problem is that, on the back end, Healthcare.gov has to interface with hundreds of insurance companies and all the states. It's a data interchange nightmare, made worse by the fact that the entities it's exchanging data with don't want it to succeed. The insurance companies never wanted this thing, and so they've certainly not put their A-teams on getting the data interchange right.
Now comes the unsurprising news that on the front-side, Healthcare.gov has been the subject of a number of poorly executed distributed denial of service attacks. According to Bloomberg, various social networking sites have been distributing a really poorly implemented "Stop Obamacare" DDoS toolkit. So far, this thing hasn't done much harm because (a) it's really badly designed code and (b) the Healthcare.gov site hasn't been up enough to be brought down.
What concerns me about all this isn't the Three Stooges-level hacking job this toolkit attempts. What concerns me is when China and Russia and organized crime get into the game and try to gain access to the system -- which by that time will store a tremendous amount of personal information about Americans.
That's where this transitions from another vaguely humorous, disturbing story of your tax dollars at work to something that's very worrisome. Americans' identity and health security is now at risk, unless all of the various elements of the online exchanges get their security act together quickly.
So here's where we are. We started with a healthcare system in bad need of reform. We passed a reform bill that itself is deeply broken. We have a new, highly complex, interconnected healthcare exchange system dependent on the interchange partners who would prefer to see the system fail. An entire industry is in upheaval over these changes, and the only alternative proposed by the opposition party is a complete reboot, returning back to the original, very broken system.
The problem with a reboot is that our original system was absolutely terrible for many Americans. A reboot would attempt to reinstall that system, but after all these changes, the collateral damage of a reboot at this stage of the game would be disastrous.
My fellow Americans, we are not in a good place here.
Looking at Obamacare, there are a few components I think are critically necessary for Americans' health security. Elimination of denial of coverage for preexisting conditions could help millions of people. Another element is the elimination of caps on medical care. These two components could reduce the bankruptcy rate considerably -- as long as citizens can get coverage and the insurance companies pay out on covered claims, both of which are, by no means, guaranteed.
The rest is a mess that I think we're going to have to live with. The opposition tried to prevent passage, they tried a case all the way up to the Supreme Court, and they even tried to elect a different president. All failed.
Clearly, Healthcare.gov is going to need a lot of work, hopefully by people who aren't simply good at landing government contracts. Health will obviously be an ongoing and important area of IT practice in the years going forward.
Interestingly enough, the doctors couldn't fix healthcare. The lawyers couldn't fix healthcare. The politicians certainly couldn't fix healthcare. So now it's up to us in IT. I know how good American IT professionals are, so I know we're up to the task. I just hope that the politicians and insurance companies will get out of the way and let the real professionals go do their work.