Heathcare.gov to Go Down for Maintenance in Middle of Obamacare Enrollment

You can, but you couldn't be further from the truth.

> Anyway, you're are making general platitudes about "government systems" without regard for the level, department, or any other factor that would influence the quality.

I guess, but that's not really relevant to my point, which is to refute the statement "There's no excuse for doing slow, blocking maintenance operations on a live user-facing database.". There is an excuse in government systems for this. You may not like it, and you may think it's an excuse that they should avoid, but that's one reason, and these sorts of issues are pretty common in government systems.

You're correct that healthcare.gov is actually one of the better-functioning sites in that regard, but even if some aspects of it mitigate the shortcomings, that doesn't mean it's not subject to some of the other same limitations.

> It would be a genuine shock to anyone knowledgeable about these sort of things if this were truly technically necessary.

I'm emphasizing that what people on HN think of as "necessary" is different from what the government thinks of as "necessary". The example that I gave was that, if you don't have anyone on-call after hours (which is incredibly common), it makes sense to keep an important system offline during those hours, rather than risk a silent failure.

Medicare Advantage doesn't dictate prices. And indirectly, this is the entire reason that it it's popular (the service is substantially better).

Perhaps, but at that point, you usually have a system where providers see their only way of making a profit as cutting costs - except those cuts are never passed onto the taxpayer. It's the worst of both worlds. NHS England has been forced into selling off parts of its operation in a similar manner to what you're suggesting for ideological reasons, and it's only cost us more money for worse service.

Perhaps it works where there's actually competition - e.g. where there's a choice of half a dozen providers owned by entirely separate entities that you could reasonably go to, which might be the case in some cities - but it doesn't work where there's few options for service users.

1) Medicare isn't single-payer; it's a multipayer system

2) The government-run portion of Medicare underperforms the private payers in cost, medical outcomes, and patient satisfaction (the three primary axes on which success is measured).

If you want to point to data that suggests that a single-payer system would be successful in the US, Medicare is the last example you want to pick, because it suggests the exact opposite.