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Healthcare.gov’s Identity Problem

Some thoughts on the broken healthcare exchange website, and how proper identity management could have saved it a lot of trouble.

Identity management poses the most important and most striking problem for the new healthcare exchange site. Identity management remains one of the great, unsolved issues of our times and uniquely displays the anti-capitalist postures of some of the biggest technology businesses that exist.

That something as basic to any and every service as identity remains a closely guarded commodity shows that many major companies do not wish to compete on an even playing field. They would rather draw straws amongst themselves for the userbase pie, based on lock-in and turf wars, than to actually free their own markets. But while that general malignance runs rampant throughout virtually every industry, why in gods’ names should it infect government projects?

Indeed, inevitably the government will create a single sign-on or other universal identity mechanism for its Internet services. But in the meantime we all suffer. Everyone includes the government, with all of the bad press the new website received post-shutdown. Finger-pointing from the contractors, calls for resignations, and general what-the-fuckery from most of the attempted users of the site.

But a rough guess would get you the answer that at least half of the problems with the site center on identity when you include:

  • The initial sign-up process (username, password, e-mail verification)
  • The identity verification process (document submission, phone verification integration)
  • Family member and employee identification process

The site, like any government services site, relies on identity for so much of what it does. Handing off to other databases for things like subsidy requirement verification and other eligibility requirements.

A whole swath of inefficiency in government, much less in this one site, vanishes if the government merely gets its identity house in order.

But instead the government pays a high premium to build a monstrosity. Of course, that same argument bears against the Affordable Care Act itself with equal keenness (that a simpler system like single-payer would have saved far more money and woe both in the short term and long term).

What else could have eased the creation of the site? Some say that management of such a large-scale project requires a so-called quarterback. Others say you want a catcher. Some say you really need a good goalie, or a head chef, or even a Benevolent Dictator for Life (BDFL).

Nah. New projects suffer the most pain from the code they use for the first time. Like a new idea, fresh in your mind, or a fresh stone broken off a larger stone. Still sharp, cuts your hand, not yet smoothed by time and trial. Full of mealy worms wriggling waiting to grow into full-fledged bugs.

A QB will screw up a new play the first time through just like the rest of us. The most-needed piece of kit in software? Reuse. Use something that already gets used a ton, that does not have bugs because it gets used all the time.

The site broke because too much of the code and the way the code got used had not been proven. The databases had not been proven for their loads.

Testing a new project does help you sand the code smooth, but building from smooth code to begin with sounds smarter.

Gerrymandering: A Double-edged Sword

A look at how the gerrymandering of districts can and will backfire.

The shutdown ended, the debt ceiling hiked, and House Republicans found themselves bewildered by a backfiring strategy to retreat the Affordable Care Act.

With a follow-up due by 15 January 2014 for the funding issue, and the limit on borrowing to pay for debt requiring another tune-up by 7 February 2014, the question firing among the people: what will snap the American government out of their funk?

One of the major adverse interactions behind the GOP House attempt against the ACA comes from the nature of House seats and the reality of gerrymandering. State lawmakers try to draw their districts to empower their party-mates and suppress those outside of their party.

But the pretense of parties then rears its head. The reality that no such thing as parties can truly exist, so long as humans do not become automatons, shines through.

The party line, a fiction, only holds so long as it does not damage those holding it. But when select interests who identify with the party find themselves underrepresented, they will seek to magnify their attention within the party.

Whence primaried. Another way to say it: reverse-gerrymandered. The district, drawn too strictly and too strongly for your party position, swung around you. The center moved to your right. What now?

Now, the fiction of parties mainly serves special interests that hitch on to the party. But when the party sours, from party to Tea Party to Tea Pirates, either the interest groups will drift solo, or remain tethered to a listing ship.

If the former, they hope for short rescue, the latter for new hands to right the ship. Blood in the water attracts sharks. The opposition interests find new purchase, new avenues of attack, while the interests tethered to the soured party bail and pump the bilges and panic.

At some point one must question the sensibility of gerrymandering, a trap set too tight for the trapper’s own good. It caricatures the electorate, makes fools of good men, as they must take up increasingly contorted poses to fit the party mold.

But the party member sees himself as but an acolyte. As he twists half-way, so the politician must make a three-quarters twist. And so on. And then, one fine day: snap goes the neck, crunch goes the bone, squirt goes the blood, and out go the lights in the eyes of the extremist politicians trying to find standing ground in a world they turned upside down.

The aftermath of gerrymandering comes chaos. Some to any semi-sane third-party around, some to the formerly minority party. Some to the wind, out of Dodge, never to vote again or to speak of the strange rituals they partook on the Tea Pirate ship.

Rumors among the people of cannibalism sneak in between nervous laughter and a tired hope for a better government. Too much to ask.

Oh, do not call this bleak. The demise of the Tea Party (be it in 2014 or in years to come) will bring renewed hope. The center will normalize to a truer equilibrium, for example. The minority party strength will grow.

The memetic force of the Tea Party relies on the notion that the government fold up like a map, and that their politicians can fold that map. Neither bear out. They promised the world and delivered nothing. But at least the people still will another shot at the reform game, even if they chose such a lackluster option.

Scare Tactics and Mortality

A brief look at the use of scare tactics to try to influence behaviors.

Graphic warnings on cigarette and tobacco products, mere warning labels, skull and crossbones on cleaning products, and transvaginal ultrasounds all have the common theme of being emotional appeals meant to shape behavior.

When you don’t buckle your seat belt in the car, it merely chimes and lights a “buckle-up” icon. Why not change that into screams or an icon of roadkill? Which reminds me of the cigarette lighters in India that chant Raam Naam Satya Hai (a funeral chant) (YouTube: Chanting Lighter).

And how long until the gun control advocates propose that gun buyers have to review graphic photographs of gunshot wounds before buying guns and ammunition?

The question is how far should we take these sorts of emotional appeals meant to remind people of inherent dangers? Should military enlistees be required to view statistics regarding casualties and mental illness risks associated with service? Should law school students be warned of the difficulties of finding jobs with their degrees?

Currently the use of scare tactics is rather arbitrary. People buying a home with a pool or having one built may pay higher insurance premiums, but they aren’t faced with the risks in graphic form. With Thanksgiving coming, we are reminded that every year people harm themselves in deep fryer accidents or undercooked stuffing causes food borne illnesses.

Parents of newborns often retrofit their homes in a religious ritual known as childproofing. This involves such feats as putting the kitchen knives behind electric fencing and turning all food into mush to prevent babies from wanting to eat it. They buy sophisticated surveillance equipment to spy on the babies at night, in case the babies are plotting anything. They even clothe the proto-humans in special garments to avoid granting them access to sensitive household equipment such as the toilet.

The question remains, how much does this all save in injuries and loss of life?

The fifth leading cause of death is accidents. But the top causes include heart disease, cancer, pulmonary diseases, and stroke. A decent amount (say 30%) of these others are estimated to be from tobacco use.

But that’s simplistic. Most of the deaths per year are of people over 64. The leading cause for people below 45 is accidents. 45-64 is cancer.

So smoking and other carcinogenic sources have long-term negative effects. Same with poor eating habits and lack of exercise. Does it make sense to use the same sort of scare tactic (skull-and-crossbones poison labeling) on something that kills you today and something that kills you in the distant future?

Same question for the ultrasound crowd. Will a scare tactic prevent abortions, when it is closer to the chronic condition (being a parent) category than the you will die if you eat a poison category?

Indeed, sans seatbelt seems more like a poison (a fixed risk of imminent death or injury) than tobacco or overeating do.

Ages 1-44 all have homicide in the top five leading causes of death. 10-44 has suicide in the top four. Where are the warnings there? Most homicides are in poor areas, and telling people they shouldn’t go home doesn’t help them unless they have an alternative. For suicide, mental health care would be required, so a scare tactic doesn’t really do.

But accidents (also known as unintentional injuries), they bear another look. Cars come in the top two for everyone at least one year of age. Unintentional poisoning is up there for ages 25-64. Gravity (the force, not the film)(AKA “unintentional fall”) leads among the over-64 group.

I’m just not sure how you would warn people about gravity. Parachute signs down from the sky? Plumb bobs?

But I do think that scare tactics need revisiting, because those old driver’s education videos didn’t make a big dent. There are still too many smokers. Diets need improving. More exercise is needed. And the overall quality of the environment needs work to protect our bodies from other (non-tobacco) man-made carcinogens.