Full disclosure: my wife works at CMS (and this post is entirely my views, not hers), I worked on the president's re-election campaign, and politically, I wish to see the PPACA law in general and the new marketplaces specifically succeed.

This has been an important week in the history of health care in the United States and for technology professionals working in government and on related services. Here are some thoughts on healthcare.gov and the state-based marketplace websites from my perspective as someone who was been developing and deploying web-based software applications for many years and who has experience with large systems and high-traffic sites.

As I write this there is a weird mixture of angst, elation, anticipation, control-freakery, sympathetic embarrassment, hope, and generalized anxiety about healthcare.gov and the state-based marketplace sites among supporters of Obamacare and also among left-leaning technologists. On the one hand, affordable health insurance is now available to any American; on the other, availability doesn't necessarily mean you can get it, due to errors during the sign-up process on healthcare.gov and the state-based marketplace sites which have been widely reported. There is a sense that, while this is primarily a technology problem to be fixed, the political problem is larger and may risk the implementation and success of the overall law–if enough people perceive the marketplace sites to be broken, support for the law–already tenuous according to some polls–will erode, and the law's opponents' argument that implementation needs to be delayed or even defunded will be persuasive.

It is natural for technologists to go into crisis mode and immediately start triaging problems and brainstorming solutions. They are smart and want to help and believe they can fix things. This is a totally appropriate attitude, and their nervous feelings are valid. The people implementing the marketplace sites have all the problems of developing large-scale, integrated, enterprise software, plus delivering a high-quality consumer experience. I think we should also have some perspective on what's happening, and I would caution against panic. There are a number of things to bear in mind:

Architecture. Caveat: I don't have direct experience with the marketplace sites, only second-hand knowledge about how they're implemented. That said, I know some details. The main thing to understand is there is no one, single Obamacare site–there is healthcare.gov, which is home to the federal marketplace and a portal to the state-based marketplaces, and there are the 20+ state-based sites. The federal marketplace is for all Americans for whom their states either chose not to implement their own marketplace or their site isn't ready yet.

The user interface, or frontend, of healthcare.gov is quite interesting. It's design has been compared favorably with top commercial sites. It was implemented using modern web development techniques, working well across browsers and on mobile devices. We used similar techniques on the president's campaign: generate static files from templates with Jekyll, serve them from behind a CDN (Akamai, in the case of healthcare.gov). This gives you a very fast, low-latency user experience that's very durable in the face of high-traffic loads. Dave Cole has written about the process by which the frontend was developed, it's fascinating to read if you have any experience with how government sites have typically been built. And you'll notice, no one has complained about being able to access the site itself. healthcare.gov itself has been up continuously since October 1st. It's submitting forms back to the server that's been the issue.

About the backend server: having a great frontend experience means little if you can't complete a transaction with the service. (Although, not nothing–many important informational consumer resources reside on the frontend and have been wholly unaffected by the reported outages.) People may not realize that a major part of Patient Protection and Affordable Care Act was the streamlining the rules surrounding Medicaid eligibility. healthcare.gov serves then as a portal, routing people to the appropriate resource they need to help them get covered. This means not only sending you to your state-based marketplace site if your state has one, but directing you to Medicaid instead of the marketplaces, if you are eligible, or determining that you meet requirements for a subsidy on the marketplace. In order to do these things, the system verifies your identity, income, and other personal data with new and existing government databases. In other words, so that it may route you to the correct entity that will be offering or providing you health insurance, healthcare.gov looks up your information online (i.e., during the course of a request-response cycle with the site). The architecture of healthcare.gov is an example of both the challenges of integration–different software services working together–and distributed systems–independent systems that may or may not be available or meeting certain service-level agreements or standards.

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