< Healthcare dot UGH


Friday, October 18, 2013

BOB GARFIELD:  There was at least one juicy irony in the debt ceiling standoff, that the fuss made over manufactured problems with the Affordable Care Act distracted press and the public from the real and documented cluster fail in the rollout of the program. According to CNBC, as many as 99 out of every 100 applications weren't able to be processed. One healthcare.gov user was asked politely to wait, 40 times. In a recent piece in Bloomberg BusinessWeek, Writer and Programmer Paul Ford laid out the root and the nature of healthcare.gov’s bungled launch.

PAUL FORD:  It’s a little bit like a restaurant, where you go into the dining room and you place your order:  I want to get some health care, I want you to show me a web page. Give me a picture. And a waiter runs back to the kitchen and says, hey, this is what I want, except the kitchen caught fire, the waiters had no idea what was going on, everybody was running around screaming. And the people were out there in the dining room waiting for their health care to show up, and nothing happened. And so, you just keep multiplying that by hundreds of thousands of people, and you have a real debacle.

BOB GARFIELD:  That is a splendid metaphor, and I give you my word of honor I will not attempt to flog [LAUGHS] it any further. I do want to ask you though the same question some congressional Republicans asked Kathleen Sibelius, the Secretary of Health and Human Services:  What exactly are the design and software problems?

PAUL FORD:  Pieces weren't talking to other pieces. What we’re looking at is a process that was closed off, involving a lot of contractors, under a lot of political pressure, and had to move relatively quickly. And clearly, they were not able to understand or simulate the situation that launching, that actually reaching real people who wanted real health care, would entail.

BOB GARFIELD:  And you think the solution would have been to be far more transparent, with open source software. Are you pretty certain that had the government been more transparent in the development of healthcare.gov, in the writing of the code, that it would have avoided the problems that cropped up on October 1st?

PAUL FORD:  The short answer is yes. When you went to the first version of healthcare.gov in June,that actually was open source code. That was available for anyone to download, and it was created by a, a company called Development Seed. They used a ton of other software that was already open source. They saved an enormous amount of time and money, by using that first and just taking what was available. And then when it was all done, they  put it online. Very, very strangely and without any clear explanation, the code has been pulled off of the Internet.

BOB GARFIELD:  Well, it’s probably secreted somewhere in Area 51.


Now, Paul, the reason we’re having this conversation is we saw your post on Bloomberg BusinessWeek. When I read the piece, I’m, like, yeah, yeah, open source, right. And then, Paul, I read the comments thread -


BOB GARFIELD:  - and saw a number of objections to your thesis, such as, this is not just a website, it is a full-blown platform that is dealing with all sorts of government databases, that there are all sorts of government regulations and laws about data, many hinging on privacy, and that generally the open-source approach was simply unavailable to Kathleen Sibelius to build this enormous system.

PAUL FORD:  It works for the Department of Defense. They've come out in favor of using open source on some of their projects and have been very, very clear; if you take away open source, we will have a less secure Department of Defense.

And, you know, the second issue, it doesn't feel that if everyone can look at code, it could be secure. It feels like, oh wow, some hacker’s gonna figure what's going on. But it doesn't actually work that way, which goes back to Department of Defense being okay with open source code. It's vulnerable, in the same way that any code is vulnerable. Nothing’s ever perfect. But lots of eyes on it can really make things better.

BOB GARFIELD:  We’re speaking on Thursday, 17 days into the life of healthcare.gov as a Federal insurance exchange. Are things beginning to go a little more smoothly?

PAUL FORD:  You know, the reports are that 70 percent of the bugs have been solved, or something along those lines. I'm assuming that when the President really wants you to fix a website, it gets fixed. They're going to get a good website out the door that actually works, because it really looks bad if they didn't. But we won't know what went wrong. If the process had been different, we’d have more insight.

BOB GARFIELD:  Paul, I have one final thought. In sharing it, I have to actually break a previous vow. There’s this saying, if people knew what went on in the kitchen, they wouldn't eat in the restaurant?

PAUL FORD:  It's sort of like these modern restaurants where you get to watch the chefs at work, or maybe it's like Benihana. The thing about open source is that you can walk back into the kitchen and, at some level, you’re not just seeing what's going on. You also can put on the chef’s hat and start cooking, if you want. You can take that code and make it your own and start to improve it. I really do want to know what's going on in the kitchen, and I think that, at some level, America deserves to know how our computer software is being prepared.

BOB GARFIELD:  Dude, I think you may have coined a new term. Ready?

PAUL FORD:  Mm-hmm.

BOB GARFIELD:   Benihana-care.


PAUL FORD:  Whooh!

BOB GARFIELD:  [LAUGHING] Paul, thank you. That’s – that’s the greatest response I’ve had in 13 years of doing this show.

PAUL FORD:  That’s why I’m here.

BOB GARFIELD:  Paul Ford writes about technology for Bloomberg BusinessWeek.


Paul Ford

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Bob Garfield