(Image by Michelle Jia)
Reaction to the roll-out of healthcare.gov has taken many predictable forms, among them the false equation whereby Grand Tech Failure = Evidence of the Unconstitutionality of the Affordable Care Act itself. The desperate illogic of that equation aims to insure (pun intended) that Obamacare’s effort to distribute health care more equitably in the United States will fail. And that it will fail so spectacularly as to seem to justify continued denial of access to health care to poor, unemployed, previously ill, and chronically ill people. Rather than parsing the improvements—incremental, not ideal—mandated by the Affordable Care Act, this post intends to start thinking about the grand tech distraction of media coverage of healthcare.gov in relation to three admittedly disparate things: a consumer product, the Quantified Self movement, and (in a later post) the letters of a poet.
How, everyone from ProPublica to the Heritage Foundation seems to be asking, did they not test the whole website? How did they not anticipate the traffic? How did this become such a mess? And so forth. But tech failures are familiar: think unstoppable pinwheel or the series of old-school computer meltdowns that, as reliably as tired motherhood clichés, propel director Alfonso Cuarón’s visually mesmerizing film Gravity. It’s not the failure itself of healthcare.gov that’s unusual, it’s the scale and publicity of the failure.
As against that very familiarity of tech fail as daily annoyance or narrative plot point, much of the coverage of the healthcare.gov episode (perhaps especially in the left-leaning news outlets on which I rely) bespeaks an implicit confidence in how communications technology and digital marketplaces might streamline health care reform. “If the design, construction, and testing of the website had just been better” the thinking seems to go, “everything would’ve been fine!” Such “if… then…” optimism about technology and optimal health only gains ground, or bandwidth, in what is now routinely called the digital age.
Witness the logic of “If I measure myself more effectively, I will optimize my health.” This is the logic of such consumer technology products as the Fitbit. At its root, there’s nothing new about such logic, as anyone who has ever counted calories or logged exercise or monitored sleep patterns will tell you. Gadgets like the Fitbit simply enhance or exacerbate, depending on your point of view, their users’ tendencies to quantify health, to associate wellbeing with acts of measurement, and to apply both language and behaviors of consumerism to the monitoring of health—or, less holistically and perhaps more frequently in the United States, to the monitoring of one’s weight. According to its website, Fitbit makes sleek devices that track “your steps, distance, calories burned, and stairs climbed.” The popular Fitbit One “never rests,” even while you do: “come nightfall, it measures your sleep quality, helps you learn how to sleep better, and wakes you in the morning.” If knowledge is power, then data, it seems, is empowerment in the name of personal health. You just have to buy it, in the fullest sense of the phrase “buy it.” You have to buy the logic and the product.
The Fitbit offers an apt metonym for a much larger movement, based in the Bay Area, called Quantified Self (QS). (QS tagline: “Self knowledge through numbers.”) The most recent QS Global Conference, held in San Francisco last month, included talks with titles like “What I Learned from 30 Days of Continuous ECG,” “Data Cartography: The Journey to Existence Mapping,” and “How Six Months of Tracking Everything Increased My Awareness.” (You can view the full conference program here.) Incidentally, the bio for Ernesto Ramirez, the Program Director at Quantified Self Labs, tells us that he “has recorded more than 9 million steps on his Fitbit.” Beat that!
Both the gadgetry associated with QS and the habits of mind that QS endorses and enables would make a fascinating study. I’m intrigued, for example, by QS interest in what we might think of as the analog prehistory of digital self-tracking, as evidenced in the video “Grandma was a Lifelogger,” and in how QS work might help patients manage chronic pain or illness. Nonetheless, the recent context of the healthcare.gov debacle, and of protracted Republic resistance to the Affordable Care Act, highlights the fundamentally private and market-driven character of QS, a character that lines up uncomfortably well with resistance to any change in a private, market-driven health care system. You buy these products. You collect this data. You optimize your health. What public health or social change progress might result from such individual, purchased empowerment remains to be seen. Much less measured.