Reflections on Health Infrastructure

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Screen capture from NYT: http://www.nytimes.com/pages/health/index.html

The role of infrastructure in the current controversy about the Affordable Care Act.

As is well documented in national newspapers, America is finally trying to create a national health care insurance program. However, the bill is being hotly contested on the hill and some are even calling resistance to the program blackmail on a national level because every effort to fund the government for another year has been made contingent on defunding the national health care program that some call “Obama Care.”

The twin issues of policy battle and the introduction of national health insurance are further complicated by infrastructural concerns. They are two fold:

1. The race by tech companies and the government to use information technology infrastructure to support one of the bill’s primary objectives: offering citizens a platform for researching, selecting, and then purchasing health care insurance programs. The goal is to reduce cost and make program costs competitive, all of which will hypothetically benefit the citizen. However, support — in this case, the support of information technology infrastructure, not political support — has been slow to come into existence.

The Affordable Care Act has been contentious, confusing and abstract, but that might change on October 1 when states are required to launch websites where people can chose among different health plans.

In addition to the basic support of the program other technologies are being added to this melange of health technologies such as biometric bracelets to let your employer know how you’re doing at any given moment.

2. The prototype for the online support of the health exchange network mentioned in 1 is not friendly to non-English speakers. Apparently, the government is so worried about rolling-out the website on-time that they have not been able to offer the service in Spanish.

On Thursday, the Obama administration announced two new delays in the implementation of the Affordable Care Act, saying small business and Spanish-language online enrollment services in federally run exchanges would not begin on Oct. 1 as planned, Reuters reports (Morgan, Reuters, 9/26).

This has happened even though, as is even posted on the White House website:

Today, an op-ed from President Obama is running in major Spanish-language newspapers across the country. The op-ed discusses the benefits of the Affordable Care Act for Latinos and announces the release of a new Spanish-language version of HealthCare.gov – www.CuidadoDeSalud.gov.

The op-ed is running in ImpreMedia’s print publications (including La Opinión in Los Angeles and El Diario La Prensa in New York) and online properties, all of which have a monthly reach of 9.3 million adults and monthly distribution of nearly 11 million.

Obama’s op-ed is, in contrast, available en español.

These two issues remind students of infrastructure that Law and Latour were correct all those years ago in saying that technology is “politics by other means,” although in a slightly different light. Routinely, the implementation of political aims is contingent on technological infrastructure, its development, and maintenance over time.

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