In the famous story of the Tower of Babel, God is said to have uttered these words" Look, if they can accomplish this, just think what they will do later. Nothing will be impossible for them!"
Of course, the Tower failed, and the corrupt nature of man caused the people of Babel to loose their unity, disperse to all points of the compass and never work together again.
In the Bible story, the advent of new technology in brick-making gave humans the belief that they could build a tower to the sky. Given our ability to raise 200-storey skyscrapers all over the world, it's possible that the technology could have worked. But the cause of this failure was confusion caused by multiple languages. When men could not understand one another, they could not work together. Today, we are on course to witness another failure of another gigantic project caused by another failure of language. This time, the attempt is being made by a huge bureaucracy of men, perhaps as many as half-a-million, and the catastrophe that will ensue will dwarf the Tower of Babel in the histories of project management.
The project is the implementation of national health care in the United States, often called Obamacare. Although there is much political controversy surrounding Obamacare, it will not fail because of politics even though it appears to be quite unpopular. It will fail because of technology, in this case the language of large-scale computers.
Obamacare might survive multi-billion dollar cost over-runs, but it cannot weather a Trillion-dollar over-run. And the implementation of nation-wide Electronic Medical Record-keeping will result in numbers approaching that chasm within 10 years. Why? Because the technological reach of today's IT professionals is exceeded by the grasp of today's bureaucrats. A very large part of the economic benefits of a national health care system, as envisoned by the Progressive politicians who wrote the legal requirements for it, necessarily require global access to patient records, hospital records, pharmacy records, etc. Only when these records are organized and evaluated can individual health care decisions be made by national supervisors, which is essential for any cost savings to be realized. The Affordable Health Care Act mandates the implementation of such a global system, beginning right away.
But building a system like this is beyond anything ever contemplated in business or government. The closest we've come is the Air Traffic Control System, which helps manage 15-20,000 flights per day into and out of 450 airports in the United States alone. It's an amazing system, which has provided a very high level of safety for decades. In fact, much of the system was designed, programmed, implemented and currently runs on 1970's technology! Yet it is straining to maintain its effectiveness; new systems are desperately needed to manage the growth of air travel around the world. It's not broken, yet. But the complexity of an ATC system is nothing compared to a nation-wide health-care records system. No known database can begin to manage the amount of data that will be required for 330 million individuals, even if the record-keeping is distributed to end-points of major population centers.
On paper, such systems can be conceived. But none have ever been built that would meet the requirements for a country our size. Even the Europeans, where nation-wide systems correspond more closely to the size of our states, have only had limited success. Today, our ability to create fictional systems for science fiction movies and congressional staff presentations has fooled many otherwise well-educated people into believing that we actually know how to implement real-time high performance systems for gigantic populations.
Yet the financial objectives of Obamacare cannot be met without a dramatic new systems approach. Of course, this is obvious. Obamacare increases the population served by our healthcare system by 15-20% with no increase in medical personnel or hospitals. The core assumption in Obamacare is the belief that if all practicioners can have access to all patient information, there will be huge savings in diagnosis and testing. Insurance companies (if they continue to offer coverage at all) must price their offerings based on these assumptions. If the assumptions appear to be wrong, the companies will stop writing policies.
How will this unfold? For the next two years, the government will generate hundreds, even thousands of regulations to govern the implementation of Obamacare. Many of these new regulations will require new information collection, storage, distribution, and protection activities in hospitals, pharmacies, clinics, laboratories, and doctor's offices. There will be no compensation for these efforts, so the cost associated with them must be passed on to patients or insurers. The first squealing will be heard next summer as the government unleashes a torrent of specifications for the so-called insurace Exchanges, which will include state-run programs in many states, Federal programs in all others. By law, the Exchanges have to be up and running by 2014. Currently, no state or federal department or contractor is known to be building the IT system for any exchange, even though testing will have to commence within 12 months.
Large-scale systems of this type are comparable to the systems supporting the space program. It took 12 years to build the system used for the Apollo missions, and uncounted hundreds of millions of (1970) dollars were spent on it. The involvement of major contractors, such as IBM, McDonald Douglas and Martin-Marietta was critical. But today, those resources are no longer in place, and it's doubtful they could be brought to bear in a timely fashion, even if there were a single point of decision-making ready to spend the money.
In recent years, the federal government has commissioned several large-scale software implementations. Air Traffic Control is still in design phase. The IRS re-programming was a billion dollar bust. The players are literally going back to the drawing board. In fact, the feds have a long history of failed, expensive program implementations. Obamacare will join the parade.
But the implications are more serious, given the scope of Obamacare. As many as 400,000 employees in the Department of Health and Human Services are on their way to give us National Healthcare, whether we are ready for it or not. Enforcement of Obamacare is delegated to the Internal Revenue Service, where a division of 16,000 agents will be dedicated to the effort.
When the desire the control every aspect of individual health care in a nation of 330 million runs into the reality of unworkable IT systems, Obamacare will start to come apart at the seams. What we will wind up with is a gigantic, unwieldy Medicaid system for about 50 million, with long waits and high overhead, and a private healthcare system for the rest with catastrophic insurance coverage only. Everything else will be pay-as-you-go. In other words, it will look like the U.S. healthcare system of 1950. The bad news is that it will probably take 40-50 years for Obamacare to collapse of its own weight.
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