# So how are those health care exchanges coming along? **URL:** \ **Category:** Great Debates\ **Created:** [October 21, 2013, 5:53pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841 "2013-10-21T17:53:17Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [October 22, 2013, 8:56pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/61 "2013-10-22T20:56:46Z")
Of course it’s relevant, because 5,000 people going to the states for medical procedures is 5,000 less that are going to be on waiting lists in Canada. So any measure of how Canada’s health care is doing has to factor in the number of people who had to go elsewhere because they couldn’t get what they needed in Canada. Here’s a [Comprehensive Report](https://secure.cihi.ca/free_products/HCIC2012-FullReport-ENweb.pdf) on wait times in Canada from the Canadian Institute on Health Information. Let me quote from the executive summary: > [@](#): > > Although access to primary care is important for preventing and managing most conditions, Canada fares poorly when compared with other countries. For example, a 2010 comparison of 11 countries showed that Canada ranked lowest for wait times to see a doctor or nurse when sick . Canadians also reported the longest waits for a specialist appointment, with 41% reporting waits of two or more months . Emergency room wait times: > [@](#): > > The report next presents information on waits in emergency departments (EDs) and acute care settings. > > Waits in Canadian EDs are longer compared with those in other countries, and compared with ideal response times recommended by the Canadian Association of Emergency Physicians. Among 11 international comparators, Canada has the largest proportion of adults waiting in the ED for 4 hours or more before being treated (19% higher than the international average). Overall lengths of stay in the ED are just over 4 hours, with 90% of visits completed within 8 hours The report has an interesting case study of “Hani”, a typical health care consumer. It’s worth reading as it strikes me as being a very accurate portrayal of the Canadian health care experience. > [@](#): > > Hani is 55 years old. He is a new Canadian, recently making his home on Vancouver Island. Like the majority of Canadians, Hani was able to find and make an appointment with a family physician. In addition to needing a general check-up, Hani wanted his doctor to have a look at his increasingly sore knee. > > Based on Hani’s age, his doctor recommended several routine screening tests—including an electrocardiogram, and blood and urine tests—to understand Hani’s current health status. Noting a family history of osteoarthritis, Hani’s doctor referred him for testing to confirm the source of his knee pain. His doctor also requested a routine X-ray, as well as an MRI (magnetic resonance imaging) test to assess the condition of the soft tissues around his knee. > > Although Hani now has an appointment scheduled for his MRI, he must wait for that appointment—as of December 2011, the Vancouver Island Health Authority (VIHA) reported that 66% of patients received their MRIs within 91 days of referral—and then Hani’s doctor must wait for the test results to make a confirmed diagnosis of the source of his knee pain. Even so, there are options to help manage the pain he is currently experiencing, including prescribing analgesics > > After waiting three months for his MRI and two months to see the orthopedic surgeon, Hani has now been diagnosed with osteoarthritis. The surgeon recommends that Hani have a total knee replacement to address his joint pain and to ensure he can resume the active lifestyle he had previously enjoyed. Hani is told to expect to wait at least six months for this elective surgery. The surgeon has told Hani that 67% of people in British Columbia who need this procedure receive it within 182 days, the evidenced-based benchmark time frame. Once the procedure has been scheduled, Hani can expect to be admitted to the hospital on the day of his knee replacement. > > Hani’s knee replacement procedure was a success. Because Hani lives alone and needs to walk up several flights of stairs to get to his apartment, his care team has recommended inpatient rehabilitation. > > Although physically ready for and eager to begin rehabilitation, Hani remains in his hospital bed and will likely have to wait about two days before starting this phase of recovery. > He has heard of other patients having to wait up to eight days for their inpatient rehabilitation to begin and hopes his wait will not be that long. Hani’s wait to be discharged is fairly typical of the 5% of patients in British Columbia who experience alternate level of care stays. > > In 2010–2011, 9% of the 50,000-plus knee replacement patients were subsequently admitted to inpatient rehabilitation. Due to his special circumstances (as noted in Chapter 3), Hani has been referred for inpatient care. He should not have to wait long; orthopedic patients wait approximately 1. 5 days on average for admission to inpatient rehabilitation. Based on the median length of stay for orthopedic patients, Hani can expect to spend two weeks in the hospital receiving rehabilitation. ---
**Author:** ![Cyros](https://avatars.discourse-cdn.com/v4/letter/c/a698b9/32.png) [@Cyros](https://boards.straightdope.com/u/Cyros)\ **Post date:** [October 22, 2013, 8:58pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/62 "2013-10-22T20:58:16Z")
> [@elucidator](#): > > Missing something here, **Sam**. That number, “5,000” does not seem to appear anywhere within the cited report. Nor can I see anything that supports “…this is only that subset of the population that has a medical condition that needs treatment AND that treatment is either not available in Canada or the waiting list is too long…” > > Can you clarify? I think that the 5000 number comes from the 7% Canadian share of the 60,000 to 85,000 travellers per year to the US for medical reasons. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [October 22, 2013, 9:01pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/63 "2013-10-22T21:01:20Z")
> [@elucidator](#): > > Missing something here, **Sam**. That number, “5,000” does not seem to appear anywhere within the cited report. Nor can I see anything that supports “…this is only that subset of the population that has a medical condition that needs treatment AND that treatment is either not available in Canada or the waiting list is too long…” > > Can you clarify? Yeah, I did some very complex math. From the article, 60,000 to 85,000 people travel to the U.S. for treatment. 7% of them come from Canada. So, that’s between 4200 and 5950 Canadians per year. That’s an average of 5075 people per year, which I rounded down to 5,000 and used the qualifier ‘about’ to indicate it wasn’t a precise number. As for the other statement… I guess I left out that they might have gone to the U.S. simply because they think the treatment is better. Unless you can think of another reason someone might travel a long distance and pay out of pocket for medical treatments that are available for ‘free’ at home, I think that about covers it. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [October 22, 2013, 9:09pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/64 "2013-10-22T21:09:48Z")
Ok, so Canada, with 35 million people has 5,000 per year going to the US for treatment The US, with 300 Million people has [according to this cite](http://en.wikipedia.org/wiki/Medical_tourism#United_States) 750,000 people going overseas for treatment. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [October 22, 2013, 9:13pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/65 "2013-10-22T21:13:36Z")
Don’t get me wrong with all this. I don’t think Canada’s system is horrible. I think it’s actually fairly good. But it’s not great, and we have a lot of natural advantages the U.S. doesn’t have. Our population tends to be healthier, for one thing. We also free ride on the U.S.'s robust R&D, and we offload some of the most difficult and expensive procedures to the U.S. Also, an equivalent system in the U.S. would not be federally-managed single payer - it would be state managed single payer. The Canada Health Act is 6 pages long. Obamacare is over 2,000. That’s because in Canada all the details are left up to the individual Provinces, and they have wide latitude in how they administer their own programs. That’s one of the reasons the system works as well as it does - the wealthy provinces can afford more health care than the poor ones, and adjust their service delivery accordingly. In addition, we have a competitive market of sorts in that the individual provinces learn from each other what works and what doesn’t, and people can vote with their feet if they don’t like the care they get at home. Within the provinces, authority is often delegated to regional health authorities. So our management of health care is very distributed. I don’t think liberals in the U.S. pictures a ‘states rights’ health care system. They want the feds to manage it. That will be a disaster whether or not it’s Obamacare or a new single-payer system with the feds paying for it all. And like I said, we have a very robust private health care system that exists alongside the single payer system and Canadians are on the hook for a significant percentage of our overall health care. I have job-related health insurance just like Americans do. It’s cheaper, because it only covers non-government costs like prescription drugs, dental, optical, orthotics, that sort of thing. But if I didn’t have that insurance, I’d be responsible for paying all that on my own. ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [October 22, 2013, 9:23pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/66 "2013-10-22T21:23:22Z")
> [@Cheesesteak](#): > > Ok, so Canada, with 35 million people has 5,000 per year going to the US for treatment > > The US, with 300 Million people has [according to this cite](http://en.wikipedia.org/wiki/Medical_tourism#United_States) 750,000 people going overseas for treatment. Sure. I never said they didn’t. They to it to save money, or because some treatments just aren’t available in the U.S. because of regulations. But note that you’re talking about Americans who go to all other countries, while the figure for Canada is just those Canadians who go to the U.S. It’s hard to find numbers on the total amount of Canadians who travel outside of the country for health care procedures, but [This CTV article](http://www.ctvnews.ca/canadians-warming-up-to-idea-of-medical-tourism-1.647176) says, > [@](#): > > Medical tourism is a growing industry, said Mark Fam, a senior manager with Deloitte’s National Health Services. The industry is divided into two sectors: inbound, the number of patients travelling into a country to receive treatment; and outbound, those travelling outside the country. > > In terms of outbound, “over two per cent of Canadians right now are already travelling outside the country to receive services,” Fam told CTV News Channel. > … > The issue made headlines last year when former Newfoundland and Labrador premier Danny Williams travelled to a Florida hospital for heart surgery – proof, according to critics of public health care, that a private system is better. > … > According to a 2009 Deloitte report, the outbound medical tourism industry could reach up to 1.6 million patients by 2012. Many patients travel to countries such as India, Thailand and Costa Rica where governments are aggressively vying for a bigger share of the estimated $40 billion industry. > … > Opponents of medical tourism are concerned the industry promotes a two-tiered system that favours the wealthy. > > Farm said however, that it’s not just the rich who are seeking outside services. “Regardless of income level, we see a range of 15 to 25 per cent of Canadians willing to travel.” If the two percent number is correct, that would be 600,000 Canadians per year traveling outside of the country for health services. That would be close to 10X the rate of Americans traveling outside their country. That’s pretty astounding when Canada’s home health care is ‘free’. The article opens by saying that surveys show that if health insurance covered out-of-country health services, up to 60% of Canadians would be willing to travel to get health care. ---
**Author:** ![Martin\_Hyde](https://avatars.discourse-cdn.com/v4/letter/m/47e85d/32.png) [@Martin\_Hyde](https://boards.straightdope.com/u/Martin_Hyde)\ **Post date:** [October 22, 2013, 9:32pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/67 "2013-10-22T21:32:43Z")
> [@BobLibDem](#): > > So the website was built by perhaps a contractor who overpromised and underdelivered. That can be corrected. If we have to delay the mandate for a few months because of it, fine. Republicans who carp about the system being a failure because it can’t handle the demand sound like Yogi Berra’s restaurant review (“Nobody goes there, it’s too crowded”). The number of people going to [HealthCare.gov](http://HealthCare.gov) is honestly not that big, especially considering the Obama Administration knew that this site would attract immense amounts of attention and I think they were forecasting something like 7m enrollments in year one. Lots of websites have vastly more traffic than that. Further, I’m not seeing a lot of evidence the problems are really “traffic” related. When the website first went live I tried to create an account in order to just get an idea how much health insurance would be. I have my own insurance and I have no intentions to enroll, I was just curious to finally see what the “real” premiums were going to be in this system for someone like myself (older male, income too high for any subsidies.) So the first problem I ran into was something very simple in web design relating to “forms validation.” Validation is basically when a web application validates user entry into a free text field to validate that what the user entered is acceptable to the system based on its technical rules for what that field can contain. An example is a website that wants you to use your email address as your username, a simple validation would check to make sure that whatever the user entered as their username contained the “@” character in it. If it didn’t contain the “@” character, then we can be quite certain the user was not entering their username address. Another common example is if you want a user to enter a password for their account, and you want them to use both a capital and lowercase letter, and at least one number or special character. You would use a regex to make sure an appropriate string was entered. Two important things can then be done with validation, you can block the form from sending that data anywhere else and halt the process, and you then convey to the user in some form of message why their form can’t be processed any further and what they need to do in order to correct it. Well, the first problem you might run into when [HealthCare.gov](http://HealthCare.gov) launched was that some of these forms had requirements (which is fine), but no messages to inform the user when the field had been filled with an invalid string. So what happens is you’d try to advance the form and nothing happened, with no indication as to why. Only by word of mouth did people find out what they needed to put in some of these fields to advance their enrollment. Okay, so once I got my account created, I had to select three security questions and type answers. Instead, I was presented with three drop down lists (basically a rectangular box on a web page that you click and it contains a list of options), that had no list items. Three empty drop down lists. You couldn’t advance to the next step because you couldn’t advance without choosing three questions. But since the three drop down boxes weren’t populated, you physically could not choose questions. That’s when my attempt at getting a price estimate from [Healthcare.gov](http://Healthcare.gov) ended. Now, I’m hoping stuff like that was cleared up on day one, but those problems have nothing at all to do with traffic to the site. Those are extremely simple, should have been seen the first time they did a user test sort of problems with the web application. An undergraduate student building a webapp as a capstone project would be expected to get that stuff down rock solid, and would be severely penalized for failing at such simple elements in their application. I’ve read that integration testing for [Healthcare.gov](http://Healthcare.gov) didn’t happen until like a week before go-live (I’ll search the internet for a more exact timing, but it was very, very late in the process.) That’s insane, and is simply incompatible with even the most shitty form of good software project practices. To be honest a good project manager if they saw that such a huge project was about to go live and had yet to even have integration testing done would communicate up the chain of command that they had missed the deadline. There would then be consequences, but if you’re doing integration testing that late in the game then you’ve missed your deadline. If you go forward with your deadline you are going to release a horrible, bug ridden piece of shit software, and that very often is far more damaging than missing some deadline. Some software companies do it quite frequently, release shit because they ran out of time and just had to ship and deliver NOW. They get bad reputations for producing bad software, and while they might patch it later, it is very difficult to fix the perception that the steaming pile of shit you released to the public created for your product. ---
**Author:** ![The\_Lurker\_Above](https://avatars.discourse-cdn.com/v4/letter/t/dc4da7/32.png) [@The\_Lurker\_Above](https://boards.straightdope.com/u/The_Lurker_Above)\ **Post date:** [October 22, 2013, 9:56pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/68 "2013-10-22T21:56:42Z")
> [@Sam\_Stone](#): > > If the two percent number is correct, that would be 600,000 Canadians per year traveling outside of the country for health services. That would be close to 10X the rate of Americans traveling outside their country. That’s pretty astounding when Canada’s home health care is ‘free’. It’s also astounding that the US, at 5,000 people a year, is capturing less than 1% of Canadians travelling for health care. I’m suspicious that either the 5,000 number is too low, or the 600,000 is too high. I would expect the US to get a much higher percent of Canadian’s business just from sheer proximity. ---
**Author:** ![VinylTurnip](https://avatars.discourse-cdn.com/v4/letter/v/b2d939/32.png) [@VinylTurnip](https://boards.straightdope.com/u/VinylTurnip)\ **Post date:** [October 22, 2013, 10:08pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/69 "2013-10-22T22:08:38Z")
> [@Martin\_Hyde](#): > > Some software companies do it quite frequently, release shit because they ran out of time and just had to ship and deliver NOW. They get bad reputations for producing bad software, and while they might patch it later, it is very difficult to fix the perception that the steaming pile of shit you released to the public created for your product. GTA Online had a painful launch, but Rockstar got their act together and is giving every user $500,000 for the inconvenience. And who knows, the same thing may happen here! ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [October 22, 2013, 10:16pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/70 "2013-10-22T22:16:56Z")
It’s been alleged that some of the problems were the result of a decision to shield people from seeing the underlying cost of the plans, by not showing any prices until the subsidized prices could be shown. To accomplish this they had to disallow upfront browsing and force people to submit and have verified a lot of personal information in advance, which involved a lot of systems and slowed things down. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [October 22, 2013, 10:51pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/71 "2013-10-22T22:51:23Z")
> [@Fotheringay-Phipps](#): > > I can think of several reasons. > > 1. The cost of government programs is not as apparent as the cost of private plans. People know in a general sense that their taxes pay for government programs, but the tie-in is not as direct as it is for fee-for-service exchanges, and many people tend to regard government services as “free” or “the government” paying for it. People complain about taxes, but tend to view these as unconnected to the services, which they want more of. The idea that you might have to pay for things that you’ve been getting “for free” is always going to engender a certain amount of fear and loathing. The Canadian taxpayer, like the taxpayers of nearly every developed nation, pays less for government healthcare than the US taxpayer does. From a certain US viewpoint, healthcare in Canada is actually free, as the US taxpayer pays even more for government healthcare but sees nothing in return. > [@Bryan\_Ekers](#): > > Heh, well… in all seriousness, some Canadians (a significant number, probably) do travel to the U.S. (or elsewhere) for medical treatments that are either not available in Canada or have prohibitive waiting lists, and there are any number of Canadians willing to move to the U.S. (and forego the single-payer system) because they can or feel they can make more money and pay lower taxes. There have been serious studies on that. They show that the number of Canadians getting healthcare in the US is minute, and mostly made up of snowbirds who take ill while in the US. [Canadians Use of Healthcare Services in the United States -Health Affairs](http://content.healthaffairs.org/content/21/3/19.full) It is certainly far smaller than the number going the other way for healthcare. Ref. “Americans filching free healthcare in Canada”, Ontario Ministry report. I don’t think it is online but there are [reports](http://www.nytimes.com/1993/12/20/world/americans-filching-free-health-care-in-canada.html?pagewanted=all&src=pm) on it. > [@Sam\_Stone](#): > > From [here](http://www.forbes.com/2008/05/25/health-hospitals-care-forbeslife-cx_avd_outsourcing08_0529healthoutsourcing.html), about 5,000 Canadians per year travel to the U.S. for health care procedures. That’s a pretty big number considering that we’re talking about a population of 30 million, and this is only that subset of the population that has a medical condition that needs treatment AND that treatment is either not available in Canada or the waiting list is too long. I think that number must be a fairly significant percentage of all the people looking for whatever those procedures are. That is based on a report that should be disregarded. McKinsey is normally quite good, I don’t know what happened with that report, but it should not be taken seriously. It puts the number of medical tourists in the world at between 65 000 - 85 000. Now, few countries keep records of how many people leave the country for medical treatment, most developed ones and many developing ones keep stats on arrivals. That year, a lot of countries had more medical tourists each than the McKinsey report claimed was the world total. (I have a vague memory thats some _hospitals_ in India and the Philliphines had more medical tourists than that, but I wont swear to it) The report also claimed most medical tourists go to the US. Given that between 10 and 20 times than number _leave_ the US for meidcal treatment, I think the report should be considered a work of wishful thinking. > [@Sam\_Stone](#): > > Let me quote from the executive summary: > Although access to primary care is important for preventing and managing most conditions, Canada fares poorly when compared with other countries. For example, a 2010 comparison of 11 countries showed that Canada ranked lowest for wait times to see a doctor or nurse when sick . Canadians also reported the longest waits for a specialist appointment, with 41% reporting waits of two or more months Every healthcare system has its strong and weak points. Canada does particularily badly on waiting times. Note that beating Canada on waiting times is a _very low bar_. And it does not add any cred to the US system to beat the worst performer in class. Given US spending, the US ought to compare performace with the top countries. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [October 22, 2013, 11:29pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/72 "2013-10-22T23:29:27Z")
> [@Fotheringay-Phipps](#): > > It’s been alleged that some of the problems were the result of a decision to shield people from seeing the underlying cost of the plans, by not showing any prices until the subsidized prices could be shown. To accomplish this they had to disallow upfront browsing and force people to submit and have verified a lot of personal information in advance, which involved a lot of systems and slowed things down. “It has been alleged”? By _whom_ has it been “alleged”? By someone who’s intelligence and insight you trust, or the smelly guy on the bus talking to himself? ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [October 22, 2013, 11:36pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/73 "2013-10-22T23:36:54Z")
I don’t know. Decide for yourself. [Obamacare's Website Is Crashing Because It Doesn't Want You To Know How Costly Its Plans Are](http://www.forbes.com/sites/theapothecary/2013/10/14/obamacares-website-is-crashing-because-it-doesnt-want-you-to-know-health-plans-true-costs/) ---
**Author:** ![iamthewalrus\_3](https://avatars.discourse-cdn.com/v4/letter/i/258eb7/32.png) [@iamthewalrus\_3](https://boards.straightdope.com/u/iamthewalrus_3)\ **Post date:** [October 22, 2013, 11:40pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/74 "2013-10-22T23:40:03Z")
> [@The\_Lurker\_Above](#): > > I’m suspicious that either the 5,000 number is too low, or the 600,000 is too high. I would expect the US to get a much higher percent of Canadian’s business just from sheer proximity. Traveling for expensive elective medical care is something of a special case, though. It doesn’t take much of a percentage difference to pay for a plane ticket somewhere else. American medical care is quite expensive. I’d guess there are few procedures where the net savings isn’t way better to buy a plane ticket and go somewhere where the doctors make 1/5th as much. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [October 22, 2013, 11:42pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/75 "2013-10-22T23:42:36Z")
> [@Fotheringay-Phipps](#): > > I don’t know. Decide for yourself. [Obamacare's Website Is Crashing Because It Doesn't Want You To Know How Costly Its Plans Are](http://www.forbes.com/sites/theapothecary/2013/10/14/obamacares-website-is-crashing-because-it-doesnt-want-you-to-know-health-plans-true-costs/) “it struck several of the people I spoke with as plausible” is not good enough for a reliable source, it is good enough for FUD purposes I guess. ---
**Author:** ![Cyros](https://avatars.discourse-cdn.com/v4/letter/c/a698b9/32.png) [@Cyros](https://boards.straightdope.com/u/Cyros)\ **Post date:** [October 23, 2013, 9:32am UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/76 "2013-10-23T09:32:27Z")
> [@The\_Lurker\_Above](#): > > It’s also astounding that the US, at 5,000 people a year, is capturing less than 1% of Canadians travelling for health care. > > I’m suspicious that either the 5,000 number is too low, or the 600,000 is too high. I would expect the US to get a much higher percent of Canadian’s business just from sheer proximity. Another possibility is that the two cites are comparing two different things. The first cite that speaks of 5000 Canadians is speaking specifically of in-patient procedures where the second cite seems to speak more generally by using the phrase ‘health services’. I suggest that this term is more inclusive and may include things such as travel for dental or day surgeries. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [October 23, 2013, 2:35pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/77 "2013-10-23T14:35:22Z")
> [@GIGObuster](#): > > “it struck several of the people I spoke with as plausible” is not good enough for a reliable source, it is good enough for FUD purposes I guess. He cites the WSJ as saying “An HHS spokeswoman said the agency wanted to ensure that users were aware of their eligibility for subsidies that could help pay for coverage, before they started seeing the prices of policies.””. So that part is reliable. The question then is to what extent that structure impacted the website’s performance. I’m sure it didn’t _help_, but I don’t know. ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [October 23, 2013, 2:56pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/78 "2013-10-23T14:56:28Z")
> [@ITR\_champion](#): > > I started the thread to discuss how well the exchanges are working. No you didn’t. You started the thread to snark and point fingers at Obamacare. But to answer your question: There were doubtless major software mistakes, caused by over-ambitious schedule and by requirements that government must observe (or thinks it must observe) that private firms need not. However there are three other problems: [ul][li] Delay waiting for constitutionality question to make its way through Federal courts.[/li][li] Delay waiting for the 2012 (Romney would cancel Obamacare) general election.[/li][li] Extra load caused by _refusal of Republican-controlled states to implement their parts even though this causes financial loss to those states_.[/li][/ul] HTH. ---
**Author:** ![Gyrate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gyrate/32/3588_2.png) [@Gyrate](https://boards.straightdope.com/u/Gyrate)\ **Post date:** [October 23, 2013, 3:50pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/79 "2013-10-23T15:50:33Z")
I posted this in another thread, but if I can throw an anecdote into the mix: [“I was an Obamacare guinea pig”](http://www.foxnews.com/opinion/2013/10/21/was-obamacare-guinea-pig/) ---
**Author:** ![ITR\_champion](https://avatars.discourse-cdn.com/v4/letter/i/c67d28/32.png) [@ITR\_champion](https://boards.straightdope.com/u/ITR_champion)\ **Post date:** [October 23, 2013, 3:59pm UTC](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841/80 "2013-10-23T15:59:06Z")
> [@septimus](#): > > No you didn’t. You started the thread to snark and point fingers at Obamacare. Well, being the one who has personal access to my own motivations, I can testify that I did. I wanted to know whether the reports coming in were accurate or not; there appears to be agreement that they were. > [@](#): > > But to answer your question: There were doubtless major software mistakes, caused by over-ambitious schedule and by requirements that government must observe (or thinks it must observe) that private firms need not. However there are three other problems: > [ul][li] Delay waiting for constitutionality question to make its way through Federal courts.[/li][li] Delay waiting for the 2012 (Romney would cancel Obamacare) general election.[/li][li] Extra load caused by _refusal of Republican-controlled states to implement their parts even though this causes financial loss to those states_.[/li][/ul] Wherever there is democracy, there will be elections, courts, and politicians. It can’t be avoided. Wherever the government decides to construct a major piece of technology, it will take a long time to build, and during that time there will be a possibility of an election, a court ruling, or an uncooperative politician that doesn’t support the government’s use of that piece of technology. It can’t be avoided. [Previous page](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841.md?page=3) [Next page](https://boards.straightdope.com/t/so-how-are-those-health-care-exchanges-coming-along/671841.md?page=5)