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Maybe this is facile, maybe it is illustrative, but I find it interesting to compare HealthCare.gov and Twitter. Twitter has raised over a billion in funding so

Maybe this is facile, maybe it is illustrative, but I find it interesting to compare HealthCare.gov and Twitter. Twitter has raised over a billion in funding so far, has been going 8 years and has over 3,000 employees. Healthcare.gov is at about 3 years, $840M, and I can't find a number for how many people were involved, but it's likely also in the thousands. Healthcare.gov has delivered life-altering value to about 6 million people and cost about $150 per user (soon amortizable over at least two years). Twitter has about 200 million active users getting everything from minor titillation to revolutionary aid and has cost about $6 per user. Neither of those "prices" seems shocking to me, and I'd pay $6 to use twitter and $150 to use Healthcare.gov. If anything, healthcare.gov seems cheap in that context. In terms of scale of effort; if I took a cursory look at twitter's functionality, and even taking scale into account [1], I'd spitball it as taking maybe 3 or 4 small dev teams for the website and API, and another dev team per app; maybe 100 engineers total. I'm sure they have more than that though; because a cursory spitball guess is an insult and there's likely a lot of hidden complexity and business logic discovered only you if try to do something like twitter very well. I'm also sure there's a huge mass of employees dedicated to wet, human, problems too like sales acquisition and support and what direction the shading should be on the twitter eggs and why the logo should just be a bird. And so it likely is with Healthcare.gov, interfacing with hundreds of different healthcare providers, handling different administrations and so on; probably a real deep mess. I'm impressed they got it working at all; especially as when they set out it was never intended to be used much (as I understand it the idea was that the state exchanges would handle the larger burden). The frontend seems to have been shoddy, but how much of the expense was that? [1] I have built and operate services at the same scale as twitter.

waps 12y ago
This does not seem to be a fair assessment. The "life-altering value" is not provided by the cost of the IT project, but by the total cost of healthcare in the US. That's 3.8 trillion dollars, or 11900 USD per person per year (first figure divided by 300 million). Wikipedia lists the per capita expenditure as 8500 USD per person per year for 2011, not sure why there is such a large discrepancy. Total amount of people on healthcare in the US is listed as 11.7 million jobs.
- colmmacc 12y ago
  Another reason I find the comparison to twitter interesting is that both Healthcare.gov and Twitter have no intrinsic value; their innovation and value is that they facilitate and mediate in ways that couldn't have gone before. The real value is provided by the parties with whom the connection is made; healthcare professionals and medicines in the case of h.g, other users and communicators in the case of t.c. Something else I should have mentioned before; it is also very tempting to look at the outward functionality of something and not see the mistaken paths that led to nowhere, the research and measurements and experimentation it took to arrive at a working destination. That's another area where I'd guess the two sites have costs.
chatmasta 12y ago
You're neglecting to consider an important difference between Twitter and Healthcare.gov, which is that they have completely different usage patterns. Even if we assume Twitter and Healthcare.gov serve the same number of users, the engineering and scalability challenges of Twitter far outweigh those of Healthcare.gov. Active Twitter users engage with the platform daily, often simultaneously with millions of other users, and expect state changes to propagate across the platform immediately. Healthcare.gov, on the other hand, barely even has a concept of "active" users. For the most part, each user only engages with the website once at sign up, and then periodically thereafter. Users do not have an expectation of immediate propagation of state change. As long as the site works, nobody cares how long it takes for the accounting system to update. My point is that you're comparing apples and oranges. Equating raw user numbers alone is not a fair comparison, because that's not what causes the engineering problems that make Twitter hard to scale. It's the usage patterns of those users that create the challenges. Healthcare.gov is one step up from a static website, and customers rarely engage with it throughout their lifecycle. It's absurd to suggest that developing it should cost anywhere near the same as developing Twitter.
- colmmacc 12y ago
  > Even if we assume Twitter and Healthcare.gov serve the same number of users, the engineering and scalability challenges of Twitter far outweigh those of Healthcare.gov. I may have a bias because of my background, but I absolutely don't agree. Twitter is a very busy service, a planet-scale multi-way messaging bus isn't trivial by any means, but that part is still a relatively well defined, small in scope, engineering problem and something a small team of talented engineers could tackle. That's probably the easiest part to account for. Healthcare.gov on the other hand is gigantic in scope and faces many ill-defined problems; "integrate" with 50 states and various other administrations and insurance providers and so on to deal with, all of which are a moving target. In my experience the cost of having things poorly defined is something like 100x having something well-defined, and increasing scope is a lot more costly than increasing scale.
  - chatmasta 12y ago
    Ah, I understand your point better now. You're comparing scope vs. scale as an engineering bottleneck. That does make sense, simply because number of engineers need to increase linearly with scope, but not necessarily with scale. Put another way, scalability problems are a subset of scope problems. Still, I get the sense that the government threw way more money and engineers at this than necessary. The fact that a few relatively small "repair teams" could join the project after development and fix all the problems, makes me wonder if those problems really needed to exist in the first place. Perhaps it would have been better to group these 1000's of engineers into smaller groups of ~100, and have them compete with each other to implement specs in the fastest/best way. Pay each engineer a base salary, and then allocate the remaining money to a bonus system that incentivizes fast and quality development. All that said, I'm talking out of my ass. :)

waps 12y ago

This does not seem to be a fair assessment. The "life-altering value" is not provided by the cost of the IT project, but by the total cost of healthcare in the US. That's 3.8 trillion dollars, or 11900 USD per person per year (first figure divided by 300 million). Wikipedia lists the per capita expenditure as 8500 USD per person per year for 2011, not sure why there is such a large discrepancy. Total amount of people on healthcare in the US is listed as 11.7 million jobs.

colmmacc 12y ago
Another reason I find the comparison to twitter interesting is that both Healthcare.gov and Twitter have no intrinsic value; their innovation and value is that they facilitate and mediate in ways that couldn't have gone before. The real value is provided by the parties with whom the connection is made; healthcare professionals and medicines in the case of h.g, other users and communicators in the case of t.c. Something else I should have mentioned before; it is also very tempting to look at the outward functionality of something and not see the mistaken paths that led to nowhere, the research and measurements and experimentation it took to arrive at a working destination. That's another area where I'd guess the two sites have costs.

chatmasta 12y ago

You're neglecting to consider an important difference between Twitter and Healthcare.gov, which is that they have completely different usage patterns. Even if we assume Twitter and Healthcare.gov serve the same number of users, the engineering and scalability challenges of Twitter far outweigh those of Healthcare.gov. Active Twitter users engage with the platform daily, often simultaneously with millions of other users, and expect state changes to propagate across the platform immediately. Healthcare.gov, on the other hand, barely even has a concept of "active" users. For the most part, each user only engages with the website once at sign up, and then periodically thereafter. Users do not have an expectation of immediate propagation of state change. As long as the site works, nobody cares how long it takes for the accounting system to update. My point is that you're comparing apples and oranges. Equating raw user numbers alone is not a fair comparison, because that's not what causes the engineering problems that make Twitter hard to scale. It's the usage patterns of those users that create the challenges. Healthcare.gov is one step up from a static website, and customers rarely engage with it throughout their lifecycle. It's absurd to suggest that developing it should cost anywhere near the same as developing Twitter.

colmmacc 12y ago
> Even if we assume Twitter and Healthcare.gov serve the same number of users, the engineering and scalability challenges of Twitter far outweigh those of Healthcare.gov. I may have a bias because of my background, but I absolutely don't agree. Twitter is a very busy service, a planet-scale multi-way messaging bus isn't trivial by any means, but that part is still a relatively well defined, small in scope, engineering problem and something a small team of talented engineers could tackle. That's probably the easiest part to account for. Healthcare.gov on the other hand is gigantic in scope and faces many ill-defined problems; "integrate" with 50 states and various other administrations and insurance providers and so on to deal with, all of which are a moving target. In my experience the cost of having things poorly defined is something like 100x having something well-defined, and increasing scope is a lot more costly than increasing scale.
- chatmasta 12y ago
  Ah, I understand your point better now. You're comparing scope vs. scale as an engineering bottleneck. That does make sense, simply because number of engineers need to increase linearly with scope, but not necessarily with scale. Put another way, scalability problems are a subset of scope problems. Still, I get the sense that the government threw way more money and engineers at this than necessary. The fact that a few relatively small "repair teams" could join the project after development and fix all the problems, makes me wonder if those problems really needed to exist in the first place. Perhaps it would have been better to group these 1000's of engineers into smaller groups of ~100, and have them compete with each other to implement specs in the fastest/best way. Pay each engineer a base salary, and then allocate the remaining money to a bonus system that incentivizes fast and quality development. All that said, I'm talking out of my ass. :)