Fixing the ACA Website: We’re not working on the right problem!
Although the ACA registration website has many problems, it is the synchronization of the various databases necessary to validate registrant input data that is of the most concern. For example, when income is entered, the site checks with the IRS database to see if the number is correct and that the registrant is not low-balling the system in order to qualify for a higher subsidy. There are lots of questions like this that need similar responses from who knows how many databases in how many agencies, insurance companies, and, well, you get the idea. Over a decade ago there was a healthcare industry data synchronization task force that was searching for a way to track the procurement of goods and services used by each patient to that patient. They soon discovered that the average hospital had about 250 separate databases and (believe it or not) 72 different ways to spell 3M. They threw in the towel after two years.
And this was just on the supply chain side. The ACA patient information side is infinitely more complex. Add in many more questions and 20+ million participants and you soon discover that it just can’t be done, really. It’s like trying to hear a thousand voices from a thousand different directions all talking at the same time. A fundamental change in system architecture is needed – one that supports the location of all relevant data in one place, in a single database. This architecture has what is known “as the single version of the truth” where a master copy of the data can be stored, easily maintained and unambiguously validated, and where no data synchronization is required.
Sounds simple, but it is not. How many years did it take the Vatican to accept that the Earth was not the center of our universe? Nevertheless, like Galileo, we have to keep trying because it is the only thing that makes any sense.