The recent IT blunder that is facing our nation spurs huge questions about information infrastructures in the healthcare arena. While people’s opinions vary on whether or not the Affordable Care Act is going to help or hurt us, most of us are wondering how, in this day and age, did the back end of this venture fall apart? After all, it’s just information that needs to be processed. News coverage of this debacle has found that the issues stem from its original design, calling it political incompetence and unawareness of actual website traffic volume. And can we mention why a non-American programming company was hired? Are these really the problems, though, or are they byproducts of something larger?

The Healthcare Insurance Marketplace system was built by 55 contractors, utilizing 112 different computer systems, and received 14.6 million unique visits in the first 10 days. The Washington Post recently published an article that explained their take on why the system broke and further speculated that it will not be up and running by the end of November. The Wall Street Journal reported that the cost of the exchange site was more than the development cost of the orginal iPhone.

The process to access and sign up for coverage entails information exchange through eight steps. First, users create an account, followed by a registration step that collects personal data. The third step verifies the user’s data while he or she waits for further instruction. After an applicant’s identity is verified, the system obtains proof of eligibility and the applicant can shop for a plan. After a plan is selected, the data is translated into a format insurance companies can accept. Finally, the system notifies the applicant of enrollment. During this entire process, information is handed off from one database to another.

This process peaked my curiosity, and I began to wonder how in the world did a government program work before computers and large-scale networks?  Social Security began to organize in 1936. The Social Security Board did not have field offices, so it contracted the U.S. Postal Service to help. Sound familiar? At the time, 45,000 post offices were in operation, and 1,074 of them were designated as typing centers. On November 16,1936, employers began to complete an SS-4 form. Employees completed an SS-5 form, which was the basis for assigning SS numbers. The forms made their way back to the Social Security headquarters in Baltimore, MD, where all master files were kept. Once at HQ, the cards went through a nine-step process that created a master record.  

The birth of Social Security had its obstacles too. Technically, no social security cards should have been issued before November 24, 1936, but post offices didn’t follow their instructions and there were reports that some cards were given out before this date. The first person officially issued a SS number was John David Sweeny, Jr. (SS# 055-09-0001) on December 1, 1936.  

If you think about large undertakings like Social Security and the Affordable Care Act, it is interesting to note that many of the problems stem from a lack of communication. Today, in-person communication is limited and problems arise from databases not communicating properly. In 1936, the entire system relied on communication from actual humans – and it was all done without computers.  

Communication is a vital component of anything we try to accomplish.  Stepping back from the micro details of any problem exposes that we, as society, don’t communicate well.