DHHS Preparing 'Tech Surge' To Fix Remaining Healthcare.gov Issues

itwbennett writes "It's no secret that the healthcare.gov website has been plagued by problems since its launch 3 weeks ago. On Sunday, the Department of Health and Human Services said that it's now bringing in the big guns: 'Our team is bringing in some of the best and brightest from both inside and outside government to scrub in with the [HHS] team and help improve HealthCare.gov,' the blog post reads. 'We're also putting in place tools and processes to aggressively monitor and identify parts of HealthCare.gov where individuals are encountering errors or having difficulty using the site, so we can prioritize and fix them.' Other emergency measures being taken as part of what HHS calls a 'tech surge' include defining new test processes to prevent new problems and regularly patching bugs during off-peak hours. Still unclear is how long it will take to fix the site. As recently reported on Slashdot, that could be anywhere from 2 weeks to 2 months."

Comments

How about they just scrap it entirely?

[Anonymous Coward]

Single payer - have everyone buy into Medicare. Done.

Re:How about they just scrap it entirely?

[rubycodez]

you're confused. the whole reason we pay three times or more what more advanced countries do (yes kiddies, U.S. is not #1 for healthcare) is because of the big insurance and big healthcare full of fat cats lining their pockets. that system has to be destroyed. ACA just gives it more money. single payer might be viable solution but it will burn down some huge corporations. however, don't believe the lie that those big corporations are the main contributors or participants in our economy, people and small/medium business are the bulk of it.

Re:How about they just scrap it entirely?

[Unordained]

The ACA exchanges are specifically designed to (a) help people buy in larger pools for discounts and (b) induce competition between insurance companies, to reduce prices.
Where we don't have as much pressure is in healthcare, because people are not naturally inclined to go to a physician billing himself as the cheapest on the block. We as patients don't know how to evaluate the quality of the care we get, or its value, so we cannot effectively price the services we buy.

Re:How about they just scrap it entirely?

[Jeremiah Cornelius]

That's the exact opposite economically to produce affordable healthcare for the whole nation. Sure poor people will have little incentive not to come in for every cough but someone will pay for it. That will tax our whole economy, not including dead weight loss inefficiencies.

Cut the 3 billion sent to Israel's military every year. Why subsidize the Israeli social welfare system, when they have a booming economy and the US has bread lines?
 

Re:How about they just scrap it entirely?

[Salgak1]

Or even better, apply the O'Rourke Circumcision Principle. All budgets get cut, 10%, off the top.

Stop ALL foreign aid. Means-test ALL transfer payments to individuals. And prohibit the use of proprietary software: MANDATE open-source.

And most importantly, Limit ALL Congressmen to 6 terms max, lifetime, and all Senators to two terms max, lifetime. If it's good enough for the President, it's good enough for them. . .

Re:How about they just scrap it entirely?

[mc6809e]

you're confused. the whole reason we pay three times or more what more advanced countries do (yes kiddies, U.S. is not #1 for healthcare) is because of the big insurance and big healthcare full of fat cats lining their pockets.

Saying that they line their pockets with money may be a fact, but it's not a reason.

The reason we collectively spend so much is because we have government spending competing with private spending for a finite amount of healthcare services.

It's this competition for limited services that bids prices up for everything. And as prices rise, some people are priced out of the market, justifying more government spending to help them, which further increases prices.

Re:How about they just scrap it entirely?

[rubycodez]

hahaha, so all extra money goes into R&D? Guess again, I'll start you with a hint, 30% is "administrative" costs

Re:How about they just scrap it entirely?

[phantomfive]

Where we don't have as much pressure is in healthcare, because people are not naturally inclined to go to a physician billing himself as the cheapest on the block.

The way to make up for that is by allowing customers to know the outcomes for various surgeries in the hospital. Once customers know the price and the outcomes, they can make informed decisions.

Price and outcomes are not always related. For example, a hospital that does many heart surgeries could be very good at them, and also very efficient, so they can do them more cheaply. Whereas another hospital that doesn't do many heart surgeries will need to charge more as a result, and also will have worse outcomes.

Whether prices are published or not, outcomes should definitely be published, because making that information public will be an incentive for hospitals/doctors to improve treatment even if nothing else changes.

Re:How about they just scrap it entirely?

[johnlcallaway]

The reason we pay so much for health care is:

1. Availability BECAUSE of widespread insurance. This drives up demand and screws with pricing since the people using it don't have to pay based on the type of service received. You see the same thing in our college education system, as the availability of 'free' education has gone up via grants and student loans that delay the financial pain, the costs have risen for essentially no improvement in services. When the lie took over that 'everyone has to have a college education to get anywhere', and everyone bought into it, it became far more expensive. The same type of lie has invaded our medical system; that 'everyone has to have access to health care, no matter what the real costs are'.
2. Newer, more expensive treatments. My fibula was broken in a motorcycle crash. The billed costs to fix it were over $72K and included a three day hospital stay, a plate in my ankle, several follow-up visits with the surgeon, including one more surgery, and months of physical therapy. 50 years ago, they probably would have thrown a cast on it in the emergency room and I would have limped the rest of my life. The facts are that people are receiving more and better treatments and living longer and better than they ever have before, and it's costing a crap load more money than it used to.
3. Duplicate/litigious-avoidance medical testing because insurance pays for it. I found it interesting when I had a high-deductible plan and started to question tests how many the doctors really didn't need to do but did so 'because insurance covers it'.
4. Insurance companies are some of the lowest margin companies in the US that have driven down health care costs by forcing hospitals and doctors to accept lower payments. It's a double edged sword, while they have helped drive costs down, the increased demand has driven it back up.
5. Tax laws and accounting procedures used by healthcare providers. Ever wonder why your hospital bill is $40K, but the insurance only pays $12K?? The $12K is the 'negotiated rate', while the $40K is the full rate. Everyone who fails to pay results in a $40K write-off for the hospital, not a $12K. And if you are in a car crash in many states, the hospitals can go after the at-fault person for the $28K difference. A friend of mine, who had chosen to not buy insurance where she works, needed an expensive procedure. When the hospital was offered cash, they took 50% off the price. So don't tell me that the prices being charged are real.
6. Lack of transparency/competition coupled with government subsidies. Why is it auto repair facilities have to give a detailed estimate and are held to it, yet our hospitals don't have to?? My son, who doesn't have insurance, hurt his ankle and went to the hospital. He wanted to get it checked, and being a responsible person was going to pay for it. The hospital was unwilling to tell him how much it was going to cost, so he left. However, the next day they called him back and told him they were able to get the state insurance program to pay for it.

No one is entitled to affordable health care, there is no reason why everyone should be able to have liver transplants regardless of income level. We should have access to fairly priced health care that we can work out the details of paying for it. And choose whether or not it's worth the money to us as individuals. Not the government deciding.

Re:How about they just scrap it entirely?

[Bugler412]

(former HMO IT guy) That 30% administrative cost is driven primarily by the hideous complexity of health care billing brought on by the mutli-payor insurance setup we have today. Every single line item on a hospital bill must be evaluated for who pays for it. That takes a lot of skilled labor in classification of each individual item. Then throw various mixtures into the mix of who allows what to be done, various contractual pricing schemes not seen by the individual consumer, etc. etc. etc. It's a God awful mess in there. THAT is where the administrative costs come from. Not from corporate profits. and seriously, do you think a government operated bureaucracy would have LESS overhead in its' operation? What planet do you live on if you think that?

Re:How about they just scrap it entirely?

[iserlohn]

Hospitals in the UK don't even have a billing department. Administration costs in the NHS is orders of magnitude less than in the US.

Re:How about they just scrap it entirely?

[nine-times]

Which limited services are you referring to? What's the limit?

Re:How about they just scrap it entirely?

[shadow169]

Not say that is a bad idea, however you may not be aware that it has some very negative consequences within itself. Once the outcomes of all procedures are made publicly available, health care providers (such as surgeons) will start to refuse to perform procedures on patients who do not have a very high probability of success. In addition the general public will look for simple "pass/fail" information on the outcomes, when that is a completely unrealistic way of looking at it. The cold hard truth is that surgical outcomes have too many factors for the general public to be able to make a well informed decision on.

Re:How about they just scrap it entirely?

[Unordained]

in what way is the ACA designed to do so? by what method, and what's the loop?

yes, you're correct that we have a pricing problem. i don't think any of us disagree on that point. the problem is what to do about it. we didn't get to this point because of the ACA.

Re:How about they just scrap it entirely?

[mc6809e]

Which limited services are you referring to? What's the limit?

How about the time available to doctors and nurses to treat people? They can only treat so many people.

And there are psychological limits, too. Doctors and nurses may have time but not the will to devote 80 hours a week to watching people die.

There are also equipment limits. An MRI requires scarce materials and scarce skills to assemble.

There are countless things that limit the total amount of healthcare available.

Don't think like a mere consumer, where the perceived limit on what's available depends only on the money in your bank account. That's putting all the focus on the demand side of the equation. Try to see the big picture. To do that, you have to look at the supply side, too. The supply of most things is limited (ultimately by physics).

Re:How about they just scrap it entirely?

[dywolf]

1: Nope.
2: Nope.
3: Contributes, but nearly as much as people think.
4: Nope. In fact the opposite. Hospitals can get away with charging more because the insurers act a a shock absorber, insulator, between your wallet and the true cost of care. they dispute some, but not all excessive costs, because they act more as a match maker between patients and hospitals than a representative of the patient. in fact, it can be argued that hte true commodity is the patients, and the customers are the hospitals.
5: Nope. Red herring. It contributes, but negligibly so.
6: Finally got one right. Lack of competition and economic pressure. This single factor is responsible for the majority of high cost of healthcare in this country. Quite simply, healthcare costs so much because it can. Because they can get away with it. Because there is a middleman between our wallets and the caregivers, that sheilds us from direct costs. Because healthcare isnt like a car sale...you're not going to walk away from life saving surgery because it's too expensive.

It's as a simple as that. Number 6 is the single most important factor, all others are either false or negligible.

http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-introduction/
http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-red-herrings/

We should have access to fairly priced health care that we can work out the details of paying for it. And choose whether or not it's worth the money to us as individuals.

Again: no one actually does that. No one is ever going to do that. If I tell you you need to take these pills, that cost 100$ per pill, or you will die, you're not going to walk away and just accept death. People just dont do that. and since you care to mention government...the single most cost efficient sector of our healthcare system IS the government run single payer segments: Medicaire/Medicaide.

Re:How about they just scrap it entirely?

[nine-times]

How about the time available to doctors and nurses to treat people? They can only treat so many people.

I'm not sure that counts as a limited resource, since it doesn't explain why we can't scale up on doctors or nurses to meet the demand. After all, we do have unemployment. I'm not saying you don't have a point, but you're being very picky that we get down to the reason why things are so expensive, and your explanation doesn't quite seem adequate. Scarcity of materials for MRIs could be a real limit, but it would only explain why MRIs are expensive. Why is the aspirin in hospitals so expensive? Aspirin isn't meaningfully limited.

This isn't a simple supply and demand issue.

Re:How about they just scrap it entirely?

[Xyrus]

Why did you write a wall of text? Here's a brief summary: Poor people deserve to die.

That's really what you want, isn't it? The haves can have health care, the have-nots can die in a gutter someplace. And this will be better for everyone.

Unfortunately for you, other more socially advanced nations have provided strong counter-examples to your Rynd-esque sociopathic utopia.

Re:How about they just scrap it entirely?

[iserlohn]

I don't know where you get your numbers but UK healthcare spend is 8% of the economy while in the US it is over 15%. You can compare all of these stats and more at the Commonwealth Fund.

Hey, how about some graphs to illustrate the point?

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/PDF_1533_Anderson_multinational_comparisons_2010_OECD_pfd.pdf

Re:How about they just scrap it entirely?

[Unordained]

The income redistribution was already happening, except it happened in spurts (when people went to the ER, couldn't pay, and the hospital passed along the loss) or through the courts (when people went bankrupt, and we all paid for it when their creditors passed along the loss.)

Insurance, by its very nature, is always re-distributive. Those who don't need (today) pay for those who do (today). It evens out, eventually (there's no reason to expect those who are currently rich to be naturally healthier over their entire lifetime), but in the short term it's redistribution. We redistribute for basic needs -- food, shelter, and healthcare. We've had a mandate to that effect since 1986, under Reagan. It's not a particularly partisan issue to say that our fellow man doesn't deserve to die of some curable disease just because he can't currently pay for care. And it's not unreasonable to say we'd rather he go see a doctor while the problem is easy to fix, rather than wait until the last minute -- by doing so, he's doing us a favor (if we're footing the bill.) We may subsidize his care today, but if he recovers and thrives, he'll be paying back into that same insurance pool too.

We generally regulate what products people can buy. We do that with securities. With drugs. With food. Weaponry. Animals. ...

We have certification requirements for plumbers, lawyers, electricians, and yes, doctors. Does that increase the cost of the services? I'm pretty sure it does -- but the regulation wasn't done without reason. When you look at the history of deregulation of these industries, you see all sorts of calamities. A cheap self-described electrician can set fire to a whole neighborhood. A quack doctor could easily cause a pandemic. We're all affected.

Self-reliant today, but what about tomorrow? Will you willingly accept to be left in the gutter by the rest of society in your hour of need, because you deserve no better? Money is secondary to me. People come first.

The ACA does not prevent you from paying more, if you want to. So I'm not sure what that's about.

Not that interested in the teething problems

[Albanach]

Personally, I'm not that bothered by teething problems. Plenty of sites have experienced them. Yes, there are many ways they could have been avoided, but they weren't, and they will undoubtedl be fixed.

More interesting would be to know what penalty clauses are in the contracts? If they were absent, it's a whole lot clearer why these problems have hit. There was simply no financial incentive to design a site that could scale appropriately.

Re:Not that interested in the teething problems

[Dahan]

Yes, please, lets mention them. Or wait, we can't because they haven't been stopped. Anyone who had difficulty one day, has been able to get through later that day or the next day at worst. Remind me again what your dictionary has listed for "disaster"?

"Anyone"? It only takes a single counterexample to disprove that, and here I am. I signed up for an account on Oct 1--took me a couple of tries, but I was eventually able to do it. Got my confirmation email, confirmed it, and my account should be active. However, I have never been able to actually log in. When I try, I get a red error message under the username/password boxes saying, "The information you entered isn't valid. Review this information." If I use the "Forgot Password" link in an attempt to reset my password and enter my username, I get an email with a password reset link--so my username is obviously in the DB and associated with the right email address. But when I click that link, I get a page that tells me that "We weren't able to process your request because we couldn't find a Marketplace profile that matched the information that you provided." Wut.

And although it only takes a single counterexample to disprove a universal, I'm certainly not the only person having the exact same problem. Do a web search for those error messages and you'll find many others saying the same thing.

licensing

[AliasMarlowe]

Or bring it into compliance with the GPLv2 or BSD3 licenses.

Mythical Man-Month

[Anonymous Coward]

"Our team is bringing in some of the best and brightest from both inside and outside government"

Brooks

[DoofusOfDeath]

Part of me wants to send Obama a copy of, "The Mythical Man-Month". Another part of me wants to just sit back and watch.

Re:Brooks

[rubycodez]

then it is truly screwed, he is out of his depth on this. Those dreamy eyed fools who made the ACA did not realize the implications of it needing an massive IT infrastructure that cannot be crapped out in 3 years and tested for all of ONE FREAKIN DAY when it was completed this month (!!!!). pop up the popcorn kids, this train wreck will be worthy of a Fugative sequel

Bad Medicine

[drfred79]

How is taking over more of the economy an even better idea when the DHHS can't even take over half of medicine? Single-payer is dead in the water and immoral. There is no real way to kill the entirety of Obamacare but Congress should work to mitigate its impending harm.

Re:It's a lost cause

[larry bagina]

It's not about helping the poor; it's about feeling good for helping the poor. Whether the poor are helped or not is irrelevant.

Spot-checking healthcare.gov

[dkegel]

Just how broken is it? Let's find out.

I tried creating an account early Sunday morning and failed.
I tried again Sunday evening, and it worked... on Firefox, anyway. On Chrome, logging in took me to a blank screen.
( See https://plus.google.com/u/0/113779301404424240904/posts/2mxh2wPTein )

If you try creating an account on healthcare.gov, reply here with what happened. Let's see how broken it is.

Re:Spot-checking healthcare.gov

[khallow]

Apparently, the performance varies between states since some of the states have their own systems which work rather than the federal default one. I recall hearing that California and New York both had working systems.

Government Thinking

[sycodon]

Thirty Million out of 300+ million supposedly don't have health insurance.

So, lets write a plan that affects all 300+ million instead of one that addresses the 30 million.

Brilliant!

Re:Government Thinking

[AlphaWolf_HK]

Yes, because a law that dramatically alters the way your insurance company will do business is just not going to change things for you.

Seriously how naive can you get? I've yet to meet a single person who works in the health care industry who told me that this plan isn't a train wreck in the making, one of them even intends on getting out of the business entirely.

Re:Government Thinking

[GodfatherofSoul]

That's not insightful. The problem is lots of us who have insurance have been getting a raw deal. Including getting dropped when you get sick, having coverage capped, losing a job for being sick and being unable to afford a new plan after you get well (preconditions). The ACA isn't about just those 30 million, or they would've just expanded Medicaid.

Re:Government Thinking

[AlphaWolf_HK]

I like how if you complain about government overreach, it's now fashionable for somebody to suggest somalia, as if there's nothing in between this mess and that mess.

Really you have to be a total moron to not be able to understand the difference between anarchists and libertarians. Libertarians want a government, the difference is they want a government that protects you from others rather than you from yourself. Liberals want the later, such as banning trans fats and soft drinks.

And this change for the sake of change is stupid. Personally, when I look at the prices for services that people pay for out of pocket, I notice how cheap yet good they are. Two months ago I paid $40 to get a full dental exam, x-rays, cleaning, and scaling. Meanwhile that same place bills insurance companies $250 for the same service. Why is that? Because when people shop around, they save. Insurance gets rid of the shopping around part because you don't even need to concern yourself with the cost.

Look in other areas traditionally not insured as well - some places offer Lasik for less than it costs to get a new pair of eyeglasses in some cases. I'm not eligible for Lasik (due to keratoconus) but an eye exam usually runs me about $30, whereas insurance companies typically pay about $50.

This is why health care costs are so expensive in the US - and the solution, according to people like you, is more insurance?

Re:Government Thinking

[GodfatherofSoul]

Insurance IS redistribution!

I would never call this bill mere tweaks. I can't believe *anyone* would call this bill mere tweaks. Now, as for costs, there are some things that the ACA does. For one, it caps profiteering by the healthcare insurance industry by forcing at least 80% of expenditures to be used on actual healthcare. Second, it makes healthcare checkup plans far cheaper so that people don't ignore small health problems, then run to the ER when their pancreas explodes. I'd google for some of the other cost control measures.

Personally, I wanted a whole-hog UK healthcare system completely run and funded by the government and making doctors and nurses federal employees. What we've got is the best compromise that we could get through Congress. People are criticizing features of the ACA like they slept through the 2 years of rancorous public debate. It's a miracle that we got as much passed as we did.

In the future, when the idiots in this country crying about socialized healthcare understand what it actually means, I foresee a government-run public option being dropped into Obamacare. I also see other future changes like larger penalties for the John Waynes who declare they don't want insurance, but run to the ER when their pancreas explodes.

Re:Government Thinking

[Bloomy]

The bill did originate in the House, but as a bill concerning tax breaks for members of the military. After it passed the House, Senate Democrats added the healthcare provisions to it, and were able to pass it during the few months when they had a filibuster-proof majority. After they lost their supermajority in the Senate, Congressional Democrats decided the clearest path to law would be to drop the House's original legislation and try to pass the bill the Senate amended. To get enough House Democrats on board to pass it, it was agreed to pass a follow up bill removing some provisions and Obama reinforced the Hyde Amendment preventing federal funds from being used for abortions. The amended bill barely passed the House and was signed into law. The follow up bill originated in and passed the House, and since it was written to only cover budgetary items, it couldn't be filibustered in the Senate and passed there as well, though with an amendment that was re-passed by the House.

Re:How about this...

[Capt James McCarthy]

How about defund both and give me my money back. I don't want to pay to listen to phone calls and could care less about paying for someones birth control.

Re:Platform

[DoofusOfDeath]

Which platform did they use to implement this ?

Having worked for the government in the past, I can only assume it's a combination of Ada, and a proprietary language written by an intern at IBM in the 1980's, and Welsh.

Not unlike a big-bang private sector project...

[ErichTheRed]

I'm sure there's tons of people salivating at the chance to jump all over this topic and say things like "classic government inefficiency at work." But the reality is that these kinds of projects happen every day in private sector companies. You only hear about them when they make the news. I've seen many companies throw out millions in sunk costs because they couldn't get an ERP system massaged enough to fit their business processes. Often, the companies realize too late that they're getting bled dry by outsourcing "partners" and getting nothing in return, then make the hard decision to just dump everything and try again.

Some of it may be leadership incompetence (analogous to CIOs getting swindled by consulting salesmen over copious rounds of golf and strippers) but HHS doesn't have hundreds of web developers on staff, and there would be a monster backlash if they actually did go out and hire them as permanent employees. IN the real world, they're forced to outsource to be "good stewards of the taxpayer's dollar" and end up getting crap. I can't believe that no one over the last 30 years has come to the realization that outsourcing always costs more, and results are not guaranteed no matter how much money gets flushed. What probably happened is that the project got awarded to the lowest bidder of the big consultancy firms, who promptly replaced all the super-geniuses they promised with new grads, and just kept collecting money.

A lot of private firms get fed up and just insource the whole thing, but I don't think the government has that option right now. Given the political climate, I'm sure every paper clip purchased is tracked by certain right-wing groups, and hiring hundreds of Federal employees certainly won't go over well. So, we'll just see the same consultancies who screwed up get rewarded to "fix" the problem. Just like in the private sector...

Re:Not unlike a big-bang private sector project...

[DoofusOfDeath]

As a former government software developer, I can honestly say that it's just not a worthwhile place to work, hiring caps or not.

Well, let me correct that. If you're willing to have that be the last place you work in your career, and you're willing to find job satisfaction outside of work, and you can handle both the intense frustration of being prevented from doing your job properly, with being badmouthed by politicians for not doing your job properly, then it can actually be an okay place to work.

Government is moving digital

[EMG at MU]

I think this might be the first goverment case of a large organization trying to execute a publicly facing software project and failing. For decades the goverment didn't do public facing benefit projects. If this all happened in the 90s you would have to sign up using paper forms and although it may have been slow and inconvenient by today's standards that's what the goverment had experience in doing, it probably would have worked just fine.

I think software/web centric failures like this are going to keep happening. Few organizations, especially those whose primary business isn't software, are good at implementing huge software projects. Most management doesn't know how to run software projects, budget departments dont know how to account for software projects. If the Social Security administration has a huge backlog of applications they just add more people to the workforce until they work through it. Now everything is different, it doesn't matter how many people and how much money you throw at it, it's going to talk a while to fix. Very few people in goverment, and very few members of the electorate understand how a software project is run, hence a "surge" to fix the problem. People understand that concept, they imagine tons of nerdy looking guys flowing into some building and typing furiously at a keyboard until the problems go away. Good imagery, not really accurate.

I'm actually really amused by all this, it's my job playing out on a national stage. Terrible software estimates, contractors failing to live up to contracts, unrealistic timelines, poorly understood requirements, angry management demanding all hands on deck, and unhappy users. Maybe now software management will become an academic subject and mandatory study for MBAs and such.

deconstructing Healthcare.gov

[Presto Vivace]

Lambert Strether has a tremendous post-by-post analysis of what when wrong.

Re:Should not be a federal program

[SJHillman]

The Articles of Confederation have not been in use since 1789... so I think we can safely discard them in any discussion about modern states. One of my professors pointed out an interested change in linguistics after the Civil War. Prior to the war, "United States" was almost always a plural ("The United States are...") but after the war, it became a singular noun ("The United States is..."). The Civil War was basically the end of the question of state sovereignty in the US. It's also one of the reasons the Confederate States were a confederation (and not a federation)... confederate states are independently sovereign and can freely secede from the confederation, but in a federal government, they have shared sovereignty with the federal government at best.

Re:really?

[Idarubicin]

Why do Canadians often come to the States for treatment?

The number of Canadians who receive any health care in the United States for care is vanishingly small. In a country of 30 million people, it is relatively easy to find a few who do so, and who can offer a sound bite for a newscast or an anecdote for a blogger. The fraction of Canadians who receive medical care in U.S. hospitals and clinics appears to be around the 0.5% mark.--of whom roughly 4 out of 5 do so because they happened to fall ill while visiting the United States, and not because they travelled there to receive medical services.

For certain urgent care services, communities close to the Canada-U.S. border can and do make arrangements to share facilities. (If someone has an urgent need for specialized cardiac or neurological care, you want to go to the nearest major hospital, not just the nearest one on your side of the border. Patients flow in both directions under these agreements; there are regular transfers from northern Washington state to Vancouver hospitals.)

Why does the Elderly death rate in Britain start climbing, late in the summer, and start going down again after the new Fiscal Year starts ??

Because high temperatures combined with substantial swings in temperature - typical late-summer weather, and likely exacerbated by climate change - are physically stressful. The same pattern is observed in the United States.

For that matter, why are so many doctors from Single-payer countries practicing in the States, instead ???

I don't have all the data at my fingertips, but in every year since 2004, there has been a small net migration of doctors out of the United States and in to Canada. Further, doctors practicing in Canada (and in the UK) report being significantly more satisfied in their jobs that their colleagues in the United States.