How healthcare.gov failed: the technical aspects

The Thinker by Rodin

(Also read parts 1, 2 and 3.)

A lot of how healthcare.gov works is opaque. This makes it hard to say authoritatively where all the problems lie and even harder to say how they can be solved. Clearly my knowledge is imperfect and thus my critiques are not perfect either. I am left to critique what the press has reported and what has come out in public statements and hearings. I can make reasonable inferences but my judgment will be somewhat off the mark because of the project’s opacity.

It didn’t have to be this way. The site was constructed with the typical approach used in Washington, which is to contract out the mess to a bunch of highly paid beltway bandit firms. Give them lots of money and hope with their impressive credentials that something will emerge that is usable. It was done this way because that’s how it’s always done. Although lots of major software projects follow an open source approach, this thinking hasn’t permeated the government yet, at least not much of it. Open source projects mean the software (code) is available to anyone to read, critique and suggest improvements. It’s posted on the web. It can be downloaded, compiled and installed if someone has the right tools and equipment.

It’s not a given that open sourcing this project was the right way to go. Open source projects work best for projects that are generic and used broadly. For every successful open source project like the Apache Web Server there are many more abandoned open source projects that are proposed but attract little attention. Sites like sourceforge.net are full of these.

In the case of healthcare.gov, an open source approach likely would have worked, and resulted in a system that would have cost magnitudes less and would have been much more usable. It would still have needed an architectural committee and some governance structure and programmers as well, principally to write a first draft of the code. Given its visibility and importance to the nation it would have naturally attracted many of our most talented programmers and software engineers, almost all of who would have donated their time. Contractors would have still been needed, but many of them would have been engaged in selecting and integrating suggested code changes submitted by the public.

If this model had been used, there probably would have been a code repository on github.com. Programmers would have submitted changes through its version control system. In general, the open source model works because the more eyes that can critique and suggest changes to code, the better the end result is likely to be. It would have given a sense of national ownership to the project. Programmers like to brag about their genius, and some of our best and brightest doubtless would have tooted their own horns at their contributions to the healthcare.gov code.

It has been suggested that it is not too late to open source the project. I signed a petition on whitehouse.gov asking the president to do just this. Unfortunately, the petition process takes time. Assuming it gets enough signers to get a response from the White House, it is likely to be moot by the time it is actively taken up.

I would have like to have seen the system’s architecture put out for public comment as well. As I noted in my last post, the architecture is the scaffolding on which the drywall (code) is hung. It too was largely opaque. We were asked to trust that overpaid beltway bandits had chosen the right solutions. It is possible that had these documents been posted early in the process then professionals like me would have added public comments, and maybe a better architecture would have resulted. It was constructed instead inside the comfort of a black box known as a contract.

After its deployment, we can look at what was rolled out and critique it. What programmers can critique is principally its user interface because we can inspect it in detail. The user interface is important, but its mistakes are also relatively easy to fix and have been fixed to some extent. For example, the user interface now allows you to browse insurance plans without first establishing an account. This is one of these mistakes that are obvious to most people. You don’t need to create an account on amazon.com to shop for a book. This was a poorly informed political decision instead. Ideally someone with user interface credentials would have pushed back on this decision.

What we saw with the system’s rollout was a nice looking screen that was full of many things that had to be fetched through separate calls back to the web server. For example, every image on a screen has to be fetched as a separate request. Each Javascript library and cascading style sheet (CSS) file also has to be fetched separately. In general, all of these have to complete before the page can be usable. So to speed up the page load time the idea is to minimize how many fetches are needed, and to fetch only what is needed and nothing else. Each image does not have to be fetched separately. Rather a composite image can be sent as one file and through the magic of CSS each image can be a snippet of a larger image and yet appear as a separate image. Javascript libraries can be collapsed into one file, and compressed using a process called minifying.

When the rollout first happened there was a lot of uproarious laughter from programmers because of all the obvious mistakes. For example, images can be sent with information that tells the browser “you can keep this in your local storage instead of fetching it every time the user reloads the page”. If you don’t expect the contents of a file to change, don’t keep sending it over and over again! There are all sorts of ways to speed up the presentation of a web page. Google has figured out some tricks, for example, and has even published a PageSpeed module for the Apache web server. Considering these pages will be seen by tens or hundreds of millions of Americans, you would expect a contractor would have thought through these things, but they either didn’t or didn’t have the time to complete them. (These techniques are not difficult, so that should not be an excuse.) It suggests that at least for the user interface portion of the project, a bunch of junior programmers were used. Tsk tsk.

Until the code for healthcare.gov is published, it’s really hard to assess the technical mistakes of the project, but clearly there were many. What professionals like myself can see though is pretty alarming, which may explain why the code has not been released. It probably will in time as all government software is in theory in the public domain. Most likely when all the sloppy code behind the system is revealed at last, programmers will be amazed that the system worked at all. So consider this post preliminary. Many of healthcare.gov’s dirty secrets are still to be revealed.

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