Don't Blame States for Healthcare.gov's Suckage

Healthcare.gov's rotten launch and poor performance has been blamed on a great many people, places, and things. I don't know for certain who deserves that blame, but I do know who doesn't: states which chose to rely on healthcare.gov instead of setting up their own marketplace sites. Luminaries such as former presidential candidate Howard Dean have blamed the 36 states which rely on healthcare.gov for somehow overburdening the system.

That argument is extremely silly. The idea that state-by-state sites would somehow be a better solution, instead of wastefully duplicated effort, is extremely silly. Even the idea that one single government website cannot serve the vast insurance needs of millions and millions of Americans is silly.

How do I know? Because the Feds have already created a sophisticated insurance marketplace site which serves many millions of Americans. It's called Medicare.gov—specifically, the Medicare Plan Finder. It works really, really well. And it is designed to serve a population of approximately 50 million Americans—which, coincidentally, is also about the number of uninsured Americans.

(According to data compiled by the Kaiser Family Foundation, there are over 49 million Medicare beneficiaries. Meanwhile, the ACA is trying to enroll what the Department of Health and Human Services has determined are 49 million uninsured Americans. So, the size of the market does not seem to be the problem here.)

I've seen Medicare.gov in action, many times. It manages to elegantly pull data from both federal and private-sector sources, including low-income subsidy eligibility. It also offers extensive functionality to guests. It automatically calculates the best available Part D plan based on user-defined constraints, including drugs which may be purchased on different schedules, and preferred pharmacies. (Imagine if healthcare.gov let you price out the best plan for you based on the number of urgent care visits, MRIs, and physical therapy trips you expect to have in a given year.)

And it cleanly takes people through the Part D enrollment process with private insurers. Yes, it can be a little clunky during peak enrollment times, but it works.

In fairness, I do not know how rocky the Medicare.gov site may have been after the launch of the Part D program last decade, but its successes today should have served as a blueprint for a masterful, comprehensive, 50-state version of Healthcare.gov. I am at a loss to understand why that didn't happen. Regardless, Medicare.gov's capabilities clearly prove that a single, nationwide marketplace site is not only viable, but very effective and desirable.