2001: a space odyssey in healthcare
I write software. Medical software. I write some of the most complicated medical software on the market. It’s difficult work. Thankless. One of my peers recently reviewed some of my work and described it as “the cream of the crap”. I understand. Doctors have thousands of inputs that can change the way we see things, and we expect our software to keep up. Computers do not do well with multi-axial decision trees, but I know what needs to be done, and I work at it, making progress every year.
In 2001: a space odyssey, one of the central themes revolved around HAL the computer in charge of … everything. HAL was a wonderful program, but was given contradictory data, essentialy multi-axial decision tree. As a consequence of conflicting inputs, HAL failed.
In order for a human designed process to work well, it must be clear and well defined. If you drive your car faster than this speed around the corner, negative consequences may ensue.
But the health care law is not like that. It is anything but clear and well defined. It does not take 2000 pages to describe a simple system. Pieces of the law interact with income, previous health history, geographic location, age, marital status, availability of insurance from an employer, and God knows what else. 2000 pages of what else.
It comes as no surprise at all to me that the Healthcare.gov does not work. I suggest it will never work. I suggest it is like HAL, doomed to failure by means of contradictory data inputs. You probably don’t believe me. You think: ”there are smart people out there who can make it work”. I don’t think so.
Let’s look at another boondoggle. The tax code. Yes, there is tax software out there that “successfully” navigates the tax code. If you have used this software, you know how careful you need to be or else it will box you into a corner and there is no way to get it to print your return. You have to scrap everything and start over. Every software program that does taxes comes up with a different answer, given the same data. In short, tax software doesn’t work, but it is “good enough”. I believe that Healthcare.gov may get to the point where it is “good enough”, but not soon. And it will never work right. There will always be people who it fails.