Obamacare vs. Medicare Part D



Prior to the rollout of Obamacare's health insurance exchanges this month, there were a lot of comparisons to the launch of Medicare Part D, the prescription drug benefit for seniors that started up in 2006. Supporters of Obamacare pointed out that the Bush-era drug program rolled out to a fair amount of confusion, but eventually went on to become quite popular. 

But a week after the launch of the exchanges, it's not as easy to make the Part D comparison, at least not in terms of website design.

The Washington Post spoke with the top IT coordinator for the Part D effort about the differences between that program's rollout, which also involved getting large numbers of Americans to sign up for a health plan (to cover prescription drugs), and the start of the exchanges:

David Brailer, who worked as HHS's first national coordinator for health information technology during the launch of the Medicare drug benefit in 2006, said the administration could have anticipated that the opening of the federal exchange would trigger a rush of Americans onto the Web site, either as onlookers or outright buyers.

He pointed out that the exchange was built to accommodate 50,000 to 60,000 visitors at a time — fewer than half as many as the enrollment site for the Medicare drug benefit could handle. The number of older Americans eligible for the drug benefit was far greater than the group of uninsured people who will be allowed to buy insurance through the health exchange, Brailer said, but many elderly patients didn't have home computers at the time, compared with the near-universal access to the Web that exists across the United States today. For a new program that's had as much advertising as the Affordable Care Act, building a Web site for just 60,000 people at a time "is weird. The math just doesn't add up," he said.

No, it doesn't.

It's increasingly difficult to believe that overwhelming traffic is the primary problem with the federally run exchange system. Federal officials said that HealthCare.gov got 4.7 million visitors last Tuesday, the first day it was open, and just over 8 million by the end of last week. But New York state's exchange reportedly got 10 million visits on its first day. The state-run exchange went offline several times, and performance is still sluggish. But even still, the state now says that about 40,000 residents have submitted applications and been judged eligible for plans (they may not have actually enrolled yet). That's what an unexpectedly high volume rollout looks like.

The federal exchange system, meanwhile, was taken offline for repairs twice over the weekend, and again last night. The users who have already created accounts are also being told they have to reset their passwords. And even today, administration officials are still refusing to provide an estimate about when the system might be glitch-free. Health and Human Services Secretary Kathleen Sebelius claims she doesn't even know how many people have signed up in the federal exchange system—even though California, Washington state, Maryland, New York, and Kentucky have all released application data. It's not clear exactly what's wrong with the federal exchange system, but it's hard to trust the administration's assurances that it has the problem under control. 

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  1. Buttplug alert.

    1. half an hour and no sign of it, I think this is a false alarm.

  2. Kathleen Sebelius: HealthCare.gov simple, user-friendly

    After about 40 attempts over a week resulted in absolute FAIL, I think Kathleen Sebelius is giving Baghdad Bob serious competition as history’s most blatantly mendacious government official.

    1. Recent history or all of human history? I think they’re both pikers in the grand scheme of thing.

      You know who else was a blatantly mendacious government official.

      1. Chancellor Palpatine?

  3. So the fairy prince sprinkles some magic dust on the computers, and everything is groovy.

  4. “It’s not clear exactly what’s wrong with the federal exchange system,”

    um, BOOOSH?

  5. Prior to the rollout of Obamacare’s health insurance exchanges this month, there were a lot of comparisons to the launch of Medicare Part D, the prescription drug benefit for seniors that started up in 2006.

    Yeah, there’s a really big, big, super big difference between the Obamacare regulatory scheme overseen by the IRS, and Dubya writing the drug industry a blank check.

    1. Actually, there is.

      1. I know.

        1. I’ve been reading patents for two days. My sarcasm meter is stored safely away in a shock-proof container.

    2. Medicare Part D ended up costing less than its CBO score (but was correctly scored as a big deficit increaser), whereas Obamacare is going to increase the deficit more than its CBO score?

      1. But it(part D) wasn’t paid for like the stimulus was and Medicare was and Medicaid was!!! Oh, wait, um, nevermind.

  6. For a new program that’s had as much advertising as the Affordable Care Act, building a Web site for just 60,000 people at a time “is weird. The math just doesn’t add up,” he said.

    Drone strike in 3…2…

    1. With any luck they’ll program the drones to DDoS themselves.

  7. I was in HHS for Part D and worked on the enrollment for a bit. We set up shop with laptops all over the place and enrolled people.

    I was long gone before ACA rolled around.

  8. There was no way something this big and technical wasn’t going to be massively clusterfucked from day one if done by the government. This shouldn’t be even remotely surprising to anyone.

    1. Honestly, something this big would have had problems even with a competent organization behind it. The Obama administration and government bureaucrats? Good luck with that.

    2. But it wasn’t done by the government…it was outsourced to the Canucks. I’m sure the reason for the delay has to do with the metric system.

  9. Wait until we try online voting out. This epic failure will be considered mild.

    1. Why? Online voting doesn’t require id, and ID is racist.

      1. Just a list of candidates and a button next to the D. Make up the numbers later. Easy.

  10. How many people visited the website and tried several times to log in and log on? If everyone tried 10 times then that would reduce the number of “people” counted as visiting the site, which I think is the case.

    1. The computer system doesn’t know or care if it’s 10 people once or one person ten times… in fact one person ten times is much easier for any system to handle.

      PROBLEM IS: note the post above, pointing out the difference between seniors who, by and large, are NOT as web-savvy as the uninsured youngsters of today, so the loading for Part D would necessarily be lower and easier to handle.

      On the other hand, if there were any competent systems design people working on ObamaCare’s system, they would have rented tons more capacity for the startup and then throttled back along with demand as things “settled down.”

      Lousy Management, and it’s all over the place. This is just one more lousy example.

      ps.. the issues of people having trouble navigating the system merely says that there was a love-in of programmers and user-interface people who didn’t do enough real-human testing to see how humans interacted with their precious baby.

      But that’s true all over the place, too, so nobody should be surprised.

      I’ve been playing or working with computers since about 1967. This is nothing new nor surprising, nor should it be.

      Then the mainscream media steps in….

      1. The problem is that the Federal government has so little money to spend and it’s not like they just borrow or print what they need.

  11. Yes, Obama loves me
    Yes, Obama loves me
    Yes, Obama loves me
    My professors said so

  12. It seems that you are so bent on eliminating the ACA that you’re willing to deal on any negative aspects of the program or its implementation to pursue your organizational goal.

  13. Obamacare, you tease, you!

  14. What a mess!

  15. “she doesn’t even know how many people have signed up in the federal exchange system”
    Which can only be explained by the numbers being highly embarrassing.

    Has no one tried using the site off hours, just to test the theory that volume is the issue?

    There isn’t really any way I can see that high volume could result in a scenarios where users had to reset passwords, unless there were multi-threading/race condition issues in the code. It appears to me the site was not stress tested much, if at all.

    And I agree with the article that they did a lousy job of anticipating traffic.

    Quote from another article: “We are spending 24 hours a day, seven days a week working with our client”. This is not a good sign. I’ve been in this situation. The results of this kind of work are not going to be good.

    And to those who say that this kind of (flawed) roll out is typical and is only making headlines because of MSM and politics, I say not necessarily so. It does happen and if I were a betting man, I’d bet it would happen in this case, but there are plenty of roll outs that don’t go this way. It appears CGI made three critical mistakes: 1) under estimated volume 2) not enough stress testing (and testing in general) 3) did not do some kind of incremental roll-out.

    And, of course, the system cost orders of magnitude more than other web site startups such as esurance, ebay, facebook, etc.

  16. my friend’s mother-in-law makes $88/hr on the laptop. She has been fired from work for ten months but last month her payment was $15328 just working on the laptop for a few hours. official website



  17. Like so many Federal program it seems, it appears the idea was to push the actual work onto the states. If Obamacare failed, the blame would fall on the states. If it suceeded, the Feds would take the credit. Much of the problem is that not all states rolled over.

  18. When the Koreans were pissed that their Olympians were robbed of gold medals, they crashed the IOC website with heavy traffic. To do so, several million of them visited that site almost at the designated time – if I recall correctly.

    The exchange has been open for almost a week now, and there’s still two months left until the penaltax kicks in. Am I to believe that millions of Americans were visiting healthcare.gov at any given time? They’re not the notorious procrastinators I thought them to be?

    Chad Henderson said he signed up around 3 a.m. So millions of Americans were apparently skipping on their beauty sleep to wait for their chance to get enrolled. It’s hard to believe.

    I never had any trouble watching the “Gangnam Style” video at Youtube, that was drawing like a gazillion viewers.

  19. my friend’s step-sister makes $84/hr on the computer. She has been laid off for nine months but last month her check was $21144 just working on the computer for a few hours. Continue Reading


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