To be fair, a "transaction" here is probably a lot more complex than people give credit. Healthcare is a very sophisticated beast... it's a huge many to many problem, and though people keep trying to "standardize" details always prevail.
Most sites are more complicated than they seem from the outside. Complexity is fractal -- the closer you get to something, the more complex it is.
One of my past employers was Salesforce.com. Seems pretty simple at first glance (and the early implementations were very simple), but then you learn more. Ignoring all of the platform-related stuff, just doing a multi-tenant database at scale turns out to be plenty hard.
The fact remains, they're a couple orders of magnitude away from extreme load.
I know it's just a throw away joke, but this persistent idea that government is incompetent, no matter what is really damaging.
When it comes to health care systems there is no evidence whatsoever that less government means more efficiency, if anything the US is a huge example to the contrary.
Im not really joking, their ability to do anything efficiently or correctly for a reasonable sum of money is embarrassing. I know it's a joke as well, but it's funny because it's true.
My experience is the opposite. Private companies seem completely inefficient compared to government, and I've worked as engineers in both.
Really it is only a right-wing profit-driven talking point to say government is inefficient, mostly to protect against their profits that government takes away.
The numbers support my case. You can send a mail with the USPS for 50 cents anywhere in the country, but it costs $5-$10 to do the same with UPS or FedEx.
Literally 10x-20x costlier.
Government just doesn't have to waste money on things like profit or marketing that private companies need to do.
Uhh, the US has had extreme government regulations regarding healthcare for as far back as I remember. Every state has it's own insurance administrator and purchasing insurance across state lines isn't allowed. What we have right now is the worse of both systems actually. It's a heavily regulated false free market where the customer has basis for comparing prices and has no direct control over providers. Instead they must choose between a government chosen option or an employer chosen one. It's just terrible all around.
With a single payer system, at least it would be fair to lay all blame on the single payer. It'd still be beuqacratic and political, but at least there'd be direct responsibility.
Removing the regulations, at least the customer would be able to choose a provider themselves and people could sue over pricing disagreements. There would be issues with pre-existing conditions and low income that would still need to be addressed, though.
Either option is better than where we are today, which is, well I'm not sure. There's not really a term to define the mess we've created. It's not socialist, it's not capitalist, it's just a mess of special interests, political concessions, and reactionary legislation. I guess the one thing we can definitely call it is bureaucratic.
And is Healthcare.gov developed by the government or just bough to an external company? It just an observation, I don't know if Healthcare.gov is a good or bad technology.
Not quite. It was designed by a contractor, developed by several others, and once it was released to the public and shown to be dreadful, another contractor was put in charge of fixing it. It's still primarily developed by contract to this day.
The first head of the USDS was involved in coordinating the fixing of Healthcare.gov, though.