THE BLOG
10/28/2013 04:27 pm ET Updated Dec 28, 2013

The Other Reason for Health Website Chaos

Advocates of a single-payer health system have long touted what they see as its cost-saving advantages. In light of the recent Obamacare rollout, they would be justified in citing another benefit as well: simplified sign-up.

An easy shorthand for single-payer is Medicare for All. The concept is to take a health coverage system that is highly popular and generally works well and just expand it. Without reinventing the wheel, simply lift the age restriction for Medicare eligibility.

Instead of covering only seniors, single-payer champions urge allowing everyone to be covered by a federal system -- the way health care is provided in basically every other industrialized nation.

For example, in Canada's single-payer system, you select your own doctor (and if unsatisfied, you pick a new one). There are some limitations on what services a patient can get when, but they're apparently not seen as too drastic: Canadians are reportedly far more satisfied with their health care system than Americans.

And for Americans, of course, there are limits to coverage from private insurers as well. Just ask anyone who has recently braved healthcare.gov and studied the fine print of competing private policies offered on the new exchanges. Or anyone who has had the unpleasant experience of being denied medical care by an American insurer.

I'm not sure which is more incomprehensible: the ham-handed launch of registration for the Affordable Care Act (ACA) or the system's mind-numbing complexity. But the two are related.

Failing to beta-test a national site with this many moving parts til two weeks before the liftoff date would strike most IT professionals I know as webmaster malpractice or at least dereliction of management at HHS.

But that doesn't clarify why so many moving parts were needed in the first place. What explains the system's convolution is the numerous powerful health care industry lobbies. Their behind-the-scenes influence before the ACA was passed by Congress in 2010 produced one of the least healthy foods on the planet: legislative sausage.

With about 50 million Americans, including many children, uninsured at the time of President Obama's first election, the time had come to do something to foster greater fairness in health care. But the awkward compromise reached, dubbed the Affordable Care Act, left no one fully satisfied.

As the legislative machinery kicked into gear in the spring of 2009, Senate finance committee chair Max Baucus, who led the deliberations, famously declared that single-payer coverage was "off the table."

On two occasions in March of that year, Baucus even ejected single-payer activists from Senate hearings. Yet single-payer was widely popular. A New York Times poll published the previous month found that "59 percent [of Americans] say the government should provide national health insurance, including 49 percent who say such insurance should cover all medical problems."

But there is powerful opposition to single-payer from a corporate sector that stands to lose billions -- the health insurance industry. Last year health insurers invested $243 million in lobbying.

The ACA, with its individual mandate to buy coverage, was passed by Congress partly because health insurers went along with it. After all, they were eying tens of millions of new customers. And competition for those customers, projected to yield billions in profits, has brought us the new health care exchanges, which are so complicated that the federal ACA website has been unable to put the pieces together, at least thus far.

Imagine what the rollout this month would have looked like if single-payer had carried the day in Washington instead. Undoubtedly, there'd be some computer glitches as happen with all website launches. And Congressional opponents of the law probably would still be griping loudly.

But rather than sorting through a bewildering maze of plans, the burden on health care consumers would likely be a far simpler registration for guaranteed health care. And by many calculations, the economies of scale from including more patients would slash the nation's per capita health costs, a boon to federal deficit reduction.

Says Marcia Angell, former editor of the New England Journal of Medicine, "The underlying problem with our health care system, the thing that makes it such a mess, is that it is based on seeking profits and not on providing health care."