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The Affordable Care Act needs an upgrade, not a rip and replace


Brian Eastwood, Senior Editor


Before joining Fierce Markets, I spent more than nine years covering enterprise information technology--sometimes related to healthcare, sometimes not.

My experience covering IT taught me that there are two basic approaches to changing a piece of tech: Starting over completely or bolting on features.

Seeing the news trickle from Capitol Hill last week, where a new Republican-led Congress hopes to alter the Affordable Care Act, reminded me that both ways of solving a technical problem have their merits and drawbacks. The ACA isn't a piece of software, mind you, but the way it has been written, implemented, updated and challenged reminds me a lot of the software development process.

In tech, starting over is commonly called a "rip and replace" job. This happens in two scenarios. One is when an otherwise functional product has outlived its usefulness. (Think of that old computer your parents had, complete with the dial-up modem and dot matrix printer.) The other is when a product completely fails. (Think of Windows Vista.)

The ACA, despite its flaws, has neither outlived its usefulness nor completely failed. Some Republicans would love to rip up the law and replace it, but the political environment in Washington is such that the courts and not Congress will ultimately make that decision.

Meanwhile, bolting on new features happens when so much time, effort and money has gone into an internal application development projects that the Powers That Be prefer to modify and upgrade the program again and again instead of investing in something else.

There are parallels with the ACA here, too. So much time, effort and money went into healthcare reform that, though some call the ACA a major political blunder, many proponents and even some opponents alike prefer to modify and "upgrade" the law rather than scrap it altogether.

There's an inherent danger here, though. When you continue to modify something, two things happen. One, though it may grow with the times, it remains grounded in its roots. This is why so many enterprise applications only run on Internet Explorer 6, Windows XP or that one server that no one is allowed to touch.

Two, as something grows, so, too, does the distance from those roots. Today's electronic health record systems, the multimillion-dollar backbone of the healthcare provider market, began as electronic billing systems.

As stated, the courts--specifically, the Supreme Court--will decide the fate of the ACA. I have no idea how the Court will rule. I do agree with Drew Altman, president and CEO of the Kaiser Family Foundation, who said that the King v. Burwell case will define healthcare politics in 2015.

I do know, too, that, as with many an application development project, the ACA could unravel over something trivial. In software, it's the bugs--the little glitches, typically lost amid thousands of lines of source code--that trip of projects and keep developers awake at night.

Meanwhile, the crux of King v. Burwell is but seven words in a lengthy document: "Through an exchange established by the State." The Supreme Court must decide whether the phrase applies to big-S "State" (the federal government) or little-s "state" (state governments).

I see one final similarity. Good software developers use their experience and expertise to make a product that's best for the needs of end users, even if they may not necessarily agree with a particular use case.

Here's to hoping the Justices of the Supreme Court approach King v. Burwell in a similar manner, putting personal and political differences aside to ultimately issue a ruling that's best for the needs of Americans within the letter and spirit of the law. -- Brian (@Brian_Eastwood and @HealthPayer)

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