When I was in grad school (before the glaciers descended and dinosaurs ruled the earth) the importance of volume, of scale, in processes was brought home to me when it was pointed out that the beautiful, simple, elegant, and provably correct process that I had designed would take an incredibly long time to fulfill if load requirements increased. The process wasn’t scaleable. I had a similar experience years later when a process I designed (also simple and elegant) demonstrably had the same problem: it took an enormous amount of time to complete under load.
That’s why I’m skeptical of the claim that success in the states implies that Healthcare.gov can be made to work:
With all the waves of bad news about the Obamacare website and the canceled policies, it would be easy to conclude that nothing in this law will ever work — that it’s just too big and complicated and messy.
But that’s not the complete picture of the Affordable Care Act rollout. There are a few bright spots — just enough to suggest that, for all the early disasters, the law’s fate isn’t final yet.
There are states that are running their own websites and enrolling a lot of people, way more than the amateur-hour federal website that serves most of the states. Medicaid enrollment, another part of the law, is going significantly better than the signups for private insurance — nearly 400,000 people were determined to be eligible in October.
The problem with that analysis is that the task that Healthcare.gov must perform is on the order of 100 times more complicated that the task to be completed for any single state. If the process does not scale with linear complexity, i.e. that twice as large means twice as complicated, three times as large means three times as complicated, but in geometric complexity or worse, it could well be impossible, not merely impractical, for Healthcare.gov to work.
I’m prepared to believe that the healthcare insurance exchange concept can work at the state level. Beyond that? I’m from Missouri. You’ve got to show me.
I’d like to wish each and every one of you the best Thanksgiving wishes. Despite the faux persona I adopt here its just to get the competitive juices flowing. For whatever reason, people tend to come clean when they are riled up. I value all of the perspectives I’ve gotten over the past five years and sincerely appreciate them all. I really do.
A special thanks to our host, Dave. It must be a heavy load to constantly come up with content that keeps people coming here. I know I certainly couldn’t do it. Thanks for doing what you do when you actually have a real job.
Best to all and your families……..including the dogs.
Thank you, RB. Very gracious of you.
As I’ve said before, this blog is therapy for me. Without it to keep my mental faculties working even at its reduced level I think I’d’ve lapsed into nearly a vegetative state.
Oddly, although I still experience dry spells in my ability to come up with new ideas and new posts, they’re fewer than they were a year ago.
Let me second Drew’s sentiments. I learn from everyone here, even when (maybe especially) when I disagree. Thanks to Dave for content and occasional refereeing. Here’s to family, friends, too much Turkey and almost too much fine scotch.
Steve
Well said Drew and thank you Dave!
Agree with all of the above, including appreciation towards Dave’s efforts in making this blog fruitful and interesting.
It kind of puts things into perspective, when you see the ‘soft’ side of people emerge during either a national crisis or holidays, such as Thanksgiving. It rekindles an awareness of our ties with each other, more of a ‘united’ spirit, rather than the spirited differences expressed in the average day-to-day Glittering Eye threads.
Anyway, I hope you all have a long Thanksgiving holiday filled with meaningful and memorable times with those you care about.