Designing with care: Personal and professional ethics in a world full of unseen technology

“Software engineers continue to treat safety and ethics as specialties, rather than the foundations of all design; young engineers believe they just need to learn to code, change the world, disrupt something. Business leaders focus on getting a product out fast, confident that they will not be held to account if that product fails catastrophically. Simultaneously imagining their products as changing the world and not being important enough to require safety precautions…”

– Yonatan Zunger

As I make my way through my current program at Tufts University on human-computer interaction, I think about the ways in which I hope it will influence my own work and the ways I think it could benefit other students and aspiring professionals. As with many fields of research, the work can be highly specialized – the origins of the field still shine through as one reviews the large existing body of research on aviation safety, or models of operator psychology framed around anecdotes about radar screens. But of course, we now live in a world where advanced technology is so ubiquitous it’s become banal. That pervasiveness means we are constantly interacting with technology in ways that can go unseen, and thus the potential risks my also go unseen. The news is full of examples of unprecedented risks, be it self-driving cars or Cambridge Analytica.

Engineering psychology, as the study of human-machine systems, is a much more complex discipline impacting far more of our lives than ever before. We view this as a unified system that includes the human operator, but our academic language often shrouds the role the system designer plays in the functioning of the system. As we evaluate the psychological quirks, biases, and limitations that constrain an operator of a machine or system, we need to take care to account for the same quirks, biases, and limitations of the designer of that system.

Physical safety and ease of use may be evaluated in advance, and tools or techniques subsequently modified over time to achieve greater degrees of success. But this entails a certain comfort with a minimum viable product that is unfinished and not fully predictable upon release, that can be reevaluated in hindsight. The more complex the systems become, the more intertwined and interdependent, the greater the risk of failure, it becomes ever more important to try and predict those pitfalls in advance.

That is perhaps where we as professionals can have the greatest impact: looking forward rather than backwards. The field can and does provide guidance on system design and usage, but that framework can and should have an ethical component directed at the system designer themselves. Specifically, I would advocate that engineering psychology has guidance to offer software developers regarding personal and professional ethics, and advocate for the development and enforcement of an ethical standard on the profession.

Engineering psychology has a long history of providing such value to fields like mechanical engineering, aviation, and ground transportation. A key factor connecting these fields is their public nature. Key to enforcing certain standards of care in design on the products engineered under each discipline are the public users of planes trains or bridges providing the political and cultural capital. Related technology may be regulated after the fact by government agencies due to public outcry once tragedy has already struck. Our textbook, The Atomic Chef by Steven Casey, documents several related case studies along these lines.

Yet in many ways, modern software development is categorically different. Products are privately designed, often for private audiences. Unlike those older fields, there is no standard for licensure or certification, as the underlying programming languages and applications change so frequently and specific applications are highly customized and decentralized. This makes it hard to weave ethical concerns into the daily routine of many developers, and unsurprisingly the culture reflects this. Most stereotypically embodied in the former Facebook mantra, “move fast and break things”, individual developers rarely see themselves as trained professionals providing service to the public. Of course, however we view ourselves, the work we do has consequences for the general public.

There are older examples of software development and design failures. Six people died due to design oversights in the cancer therapy device known as Therac-25 (Ha, 2017). Casey (2006) describes the 1995 deaths of several members of the Middleton family in Los Angeles, due in no small part to operator error but also the lack of GPS technology to help locate the caller and communicate that to the switchboard operator, a problem that persists today with 911 systems around the nation. These risks to bodily harm due to computer technology, in domains where we have a general expectation that the experts are taking care of us, map fairly easily onto the regulatory framework of those older and more established subfields of engineering mentioned previously. Public outcry meets an industrial ethos that embraces that responsibility, and addresses issues accordingly. Where a divide begins to form is when the technology is perceived as a private good, and not a public service, and where the risk is not exclusively physical.

Going further, new technologies on the cusp of being fully realized offer even more potential for harm. The manipulation and deception possible with AI, VR, and AR technologies, if used in unethical ways, is frightening. With Twitter full of “bots” and deceptive news articles of unknown providence already crowding our feeds, we risk something subtler and potentially more destructive than we yet have the language or frameworks to combat.

Blog Picture 1

What is lost when we fail to consider our work in software design a public service, and constrain our thinking to only the narrow technical specifications and profit motives? When should we feel an obligation to foresee problems not only from a functional or technical perspective, but from a human factors perspective? What would it mean for individual designers and engineers to see themselves as responsible for the ways their products are used in the same way that doctors see themselves as responsible for the health outcomes of their patients? What would it mean for the industry to adopt standards of training, licensure, and oversight that mimicked other fields? Who could even be that authority for an industry with so many subfields of study, unconnected public or private organizations, and individual actors?

Despite the many unanswered questions, the industry has not been unaware of this growing problem. Several leading groups, including the IEEE ( and the ACM (, have developed ethical guidelines in collaboration professionals and experts, and expressly consider the social consequences of system design. The ISO offers design guidance on a detailed level for some specific applications, like medical devices. The unresolved element has been the enforcement of such generally agreed upon terms. I believe it could be possible to utilize state law in the way a bar association or medical specialty might, even if only in certain contexts. Independent contractors offering their services publicly, or developers working with public entities like school districts or hospitals, may be cases for early adoption.

Realistically, much of the effort would have to be a form of self-policing by developers , informed by an inter-disciplinary understanding of their work and reinforced by pressure on their private employers by an ever more technologically educated and aware public.



Reference list and further reading

Bogost, Ian (November 2015). Programmers: Stop Calling Yourselves Engineers [Article]. Retrieved from

Brown, Jennings (December 2017). Uber’s Big Claim That It’s Not Really a Cab Company Is Bogus, EU Court Rules [Article]. Retrieved from

Casey, Steven. The Atomic Chef and other true tales of design, technology, and human error. Aegean Publishing Company, Santa Barbara, CA. 2006

Ha, Qinghua (November 2017). Excess social media use in normal populations is associated with amygdala-striatal but not with prefrontal morphology [Article]. Retrieved from

July 2014. Facebook’s Manipulation Studies – A Critical Look [Blog]. Retrieved from

Lim, Joanne (October 1998). An Engineering Disaster: Therac-25 [PDF]. Retrieved from

Zunger, Yonatan (March 2018). Computer science faces an ethics crisis. The Cambridge Analytica scandal proves it [Article]. Retrieved from


Thoughts on a chain email: is Trump Wallace or Goldwater’s heir?

J.D. Crowe - Mobile Register - Trump and George Wallace - English -

Of course I don’t usually read chain emails, but this one was forwarded by someone close to me with a request to “let me know what you think”, which might as well be a trigger word for me. Ask and you shall receive, probably more thoughts than you actually wanted but oh well! And so I come back to the blog.

The thrust of the chain was a political cartoon about today’s primaries, with winner-take-all Florida as the grand prize of delegates:

So tonight we find out if the GOP gets a stay of execution or the nation may be witnessing what amounts to a wake of the GOP

Take a look at George Wallace 1968, Barry Goldwater 1964, and Lincolns 1st and 2nd runs for office, the second victory kinda didn’t last too long for poor old Abe, (too bad they didn’t have Netflix back then he could’ve stayed home that night) The similarities of these four campaigns are in some instances amazingly similar to the shitstorm of this current tsunami of nonsense we bear witness to daily without pause for reason

Aint politics great…..

I think the comparison to Lincoln is lacking any substance (sure it was a divisive election, but that GOP was nearly nothing like the modern version) but the tenor of Wallace and Goldwater’s campaigns (populist, bombastic, nativist/xenophobic, outsider/non-politician) have some resonance. The scary thing is that those campaigns were always much farther from the presidency. Trump has exposed a real rift in the party between elites who focus policy on the wealthy, and the white working class and poor who actually vote, against their self interest, for those elites based on mostly false or failed promises.

Marco Rubio recently joined a chorus of talking heads claiming that a Trump nomination could meaningfully split the GOP. I’m of a mind with that opinion, because the party of “tax cuts and Liberty” isn’t really doing that for the last few decades, except for a small privileged class. If the party wants to remain more universally popular I do think it needs to rethink how to speak to the disaffected people supporting Trump out of fear and frustration, with both the economic and social climate.

See this article from Slate for more in depth thoughts on how the GOP could come home to its voting base and re-imagine itself as the party of small government and liberty for all, not just wealthy elites.

If the Fed can’t help the long-term unemployed, no one will

via The Brookings Institute
via The Brookings Institute

Via Jordan Weissman at Slate:

There are 3.8 million Americans who have been out of work for 27 weeks or more. These are the country’s long-term unemployed, as defined by the Department of Labor. And right now, they’re the subject of the most important ongoing argument about the state of the job market.

In recent months, a growing chorus of economists and writers have concluded that “the long-term jobless don’t matter to the economy,” as Wonkblog’s Ylan Mui put it in a recent headline. At least, they don’t when it comes to issues such as inflation and pay growth. (I’m guessing most everyone agrees that their personal suffering matters a great deal, and that the world would generally be better off if they were working). The idea is that these unlucky millions are so far from employers’ radars, and so unlikely to ever hold a steady job again, that their presence no longer influences rest of the labor market. Should the economy heat up, businesses will start paying out higher wages to keep or poach workers who already have jobs before they dip into the pool of people who have been out of the game for more than six months. And if wages escalate, so too could inflation…

In other words: The Federal Reserve probably can’t help the long-term unemployed to begin with, nor should it risk trying.

Yesterday, however, the hawks received a big intellectual boost, courtesy of a new paper debuted at Brookings by Princeton economist and Obama advisor Alan Krueger. It is a grim document, to say the least. Krueger and his co-authors, Princeton’s Judd Kramer and David Cho, suggest that many of the long-term unemployed may never work again and “tentatively conclude” that, as a group, they “exert relatively little pressure on the economy.” Wonkblog’s Mui has already written a solid summary, andThe New York Times’ Binyamin Applebaum has a very useful take. But here are three of the key points:

1. The overall unemployment rate doesn’t seem to affect inflation. That depends on the short-term unemployment rateSome economists have argued that the traditional relationship between unemployment and inflation, known as the Phillips Curve, fell apart after the recession. But Krueger and his coauthors find that once you pull the long-term unemployed out of the equation and focus only on the short-term unemployed, it works again like new. The same goes for the relationship between wages and unemployment. But why? That brings us to…

2. The long-term unemployed rarely return to work. Between 2008 and 2012, the authors found that, after 15 months, only 11 percent of the long-term unemployed were back in a full-time, steady job (as shown in the Brookings graphic below). This is in keeping with research that has found employers ignore job applicants who have been out of work for an extended period. But the problem may go deeper. The long-term unemployed, the authors write, seem to be on the margins of the labor market, and have difficulty sustaining employment once they find it. Many ultimately lose interest in work altogether.

3. Worse yet, even a stronger economy might not help their predicament.The paper finds that the long-term unemployed don’t fare much better in states with low overall joblessness than they do in states with high overall joblessness. Regardless of the health of the local economy, they’re about equally likely to find a new job as they are to leave the labor force entirely.

…for now, it’s worth remembering why the stakes of the debate are so high. We can all probably agree that Congress is not going to step in and do something dramatic to help the unemployed find work. That makes the Fed is more or less their last hope. If it can’t help, or decides not to try, nobody will.

Raise the Gas Tax! The Best, Least Popular Idea in Politics

Photo by Alex Wong/Getty Images

Sometimes, a politician makes waves by proposing a sound, reasonable policy initiative based on relevant research and informed by historical fact. And quite often that idea has a snowball’s chance in hell of going anyway because it is politically toxic. Raising the gas tax is one of those ideas.

Via Matthew Yglesias at Slate:

Back in 1994, the cheapest Mac laptop on the market cost more than $1,600. On the other hand, a dozen eggs were less than $1, a gallon of milk was $2.88, and a gallon of gas could be yours for just $1.11. Of that, 18.4 cents were the federal tax on gasoline. Today, of course, everything’s different. You can get a Mac laptop for under a grand, but that milk will cost you about $3.40, and gasoline has almost tripled in price to $3.28 a gallon. But one thing hasn’t changed. The federal gas tax is still right where she was at 18.4 cents per gallon. Legislators haven’t raised it since 1993, and because they neglected to index it to inflation, the tax has lost more than a third of its real value in the ensuing two decades.

Matthew Yglesias is Slate‘s business and economics correspondent. He is the author of The Rent Is Too Damn High Rep. Earl Blumenauer, Democrat of Oregon—who represents the Portland area and is best known as Capitol Hill’s leading bicycling advocate—wants to change that. Last week, he introduced a bill to phase-in a 15-cent hike in the gas tax, followed by an indexing of the tax to inflation.

The idea is a total nonstarter in Congress and politically toxic to boot. Even bothering to discuss it is somewhere between pointless and insane. It’s manna from heaven for Republicans who’ve been on the defensive over taxing the rich and would love to shift the conversation to Blumenauer’s plot to make the middle class pay more at the pump.

It also happens to be a great idea.

Gasoline, you see, is very useful as a fuel for automobiles, but it also causes quite a bit of pollution when you burn it. Some of this, of course, is the carbon dioxide pollution that contributes to the greenhouse effect and the global threat of climate change. But a lot of it relates to other kinds of dirty particulate matter, nitrogen dioxide, and ozone that lead to drastically higher rates of asthma for kids who grow up near highways, for example. Burning gasoline by driving your car also imposes nonecological external costs. Bored kids cruising around in circles just to get out of the house and people taking extra trips to the grocery store rather than planning in advance take up space on the road, thus slowing everyone else down. And every additional vehicle-mile driven increases the chances that you’ll collide with somebody else, killing or injuring him. In a useful 2007 paper, Ian Parry, Margaret Walls, and Winston Harrington concluded that the full social cost of burning a gallon of gasoline is a staggering $2.10—far, far higher than what even Blumenauer would charge.

Most strikingly, they calculated that the local pollution cost alone—that is, the cost if you completely ignore climate change, traffic congestion, and road deaths—is 42 cents. 

Those costs are one of the reasons conservative economist Gregory Mankiw has proposed a gas tax hike of up to a dollar. But Mankiw also offers another important reason, relating to what’s called “tax incidence.” Formally speaking, the gas tax is paid for by gasoline buyers. But any time you tax anything, some of the real cost is borne by producers, who sell less stuff now that the price is higher. Except nobody really produces oil—it’s just sitting around in the ground. So slowing the pace of oil extraction doesn’t reduce long-term national wealth in the way that inhibiting other economic activities do—the oil is still around for later use.

But what makes Blumenauer’s legislation even better than your typical wonk policy dream is that it’s pretty clear we have to do something about the gas tax situation. Gas tax revenue, you see, has been falling pretty sharply in recent years. Americans are driving less than they used to, and the miles we do drive are increasingly likely to be in a fuel-efficient hybrid or diesel vehicle. Electric vehicles’ market share is tiny but seems overwhelmingly likely to increase in years to come. And even conventional vehicles are getting more efficient as the fine points of engine design and sturdy lightweight materials steadily improve. Increased fuel efficiency is mostly good news. The problem is that the government funds transportation infrastructure largely out of fuel taxes, so falling gasoline consumption creates a problem for the budget. That’s led various politicians to propose such things as a tax on hybrid and electric cars or a brand-new tax on vehicle miles traveled.

These aren’t absolutely horrible ideas judged in isolation. But if you’re going to raise a driving-related tax, why not raise the one kind of tax that also reduces pollution and makes lucky oil barons share in the burden? Gasoline taxes’ unpopularity with the voters is one reason, of course, but there’s no reason to think people would like a vehicle miles traveled tax or hybrid car tax any better. Given a necessarily thorny political situation, sometimes the best option is just to do the right thing.

TED Talks: Invest in social change

Here’s a stat worth knowing: In the UK, 63% of men who finish short-term prison sentences are back inside within a year for another crime. Helping them stay outside involves job training, classes, therapy. And it would pay off handsomely — but the government can’t find the funds. Toby Eccles shares an imaginative idea for how to change that: the Social Impact Bond. It’s an unusual bond that helps fund initiatives with a social goal through private money — with the government paying back the investors (with interest) if the initiatives work.

Toby Eccles has created a radical financial instrument that helps private investors contribute to solving thorny public problems.


China’s Massive Pollution Problem


The current environmental situation in China represents what America may have become without the environmental protections enacted by Congress starting in the 70’s and refreshed in the 90’s. In it mad dash to grow economically, China has relied far to heavily on dirty coal as source of fuel for power production, only weakly regulated fuel economy for vehicles, and obfuscated the growing health and social implications until quite recently, and even now only vowing to cut coal consumption 2%.

The effects of ignoring environmental concerns are serious, material, and widely expensive to solve. China’s policy decisions and their horribly obvious detrimental effects should be clear warning to American policy makers who may consider such legislation trivial or worse.

Via Keith Wagstaff at The Week:

How bad is China’s smog?
Sixteen of the world’s 20 most polluted cities are in China. The air in some cities there is so bad that, at times, visibility drops to 30 feet, traffic slows to a crawl, and nearly everyone wears masks over their noses and mouths. In Harbin, a city of 11 million people, government officials recently shut down roads, schools, and the airport when air pollution levels hit 40 times the safe limit set by the World Health Organization (WHO). During the “airpocalypse” in Beijing earlier this year, the density of small, lung-penetrating particles reached 993 micrograms per cubic meter — a concentration normally not seen outside of forest fires. The U.S. Environmental Protection Agency (EPA) considers anything above 300 dangerous, and maxes out its scale at 500. The smog was so thick in Beijing — which English-speaking residents call “Greyjing” — that a factory building burned for three hours before anyone even noticed that it was in flames.

Why is China’s air so polluted?
It’s the result of two decades of runaway economic development unrestrained by strong air-pollution laws, a dramatic increase in car ownership, and China’s overwhelming reliance on coal. China’s cities were filled with bicycles as recently as the 1990s, but thanks to the explosive growth of the middle class, the Chinese now own more than 120 million cars and another 120 million motor vehicles of other kinds. Fuel standards, set by a government committee stacked with oil industry members, have not kept pace. Auto emissions, however, account for only about 25 percent of the problem. Most of the blame rests on coal. China burns almost as much coal as the rest of the world combined. Despite making large investments in renewable energy, China still depends on coal to meet nearly 70 percent of its power needs. While air pollution is almost always bad in northern China, it really soars after cities turn on their coal-fired collective heating systems for the winter “heating season.” Temperature inversions often trap bad air for days or weeks.

What are the health effects?
They’re widespread and severe. In 2010, air pollution contributed to 1.2 million premature deaths in China, according to a study. Hospitals in Harbin reported a 30 percent increase in patients with respiratory problems after air pollution spiked in the city. Lung cancer rates in China have climbed by 465 percent over the last three decades, despite there being no significant increase in smoking rates. Scientists say the pollution in northern cities is so severe that 500 million people’s lives will be shortened by an average of 5.5 years.

How else is smog hurting China?
It’s damaging the country’s economy. In 2012, smog-related economic losses in four major Chinese cities totaled $1.08 billion, according to a study by Greenpeace and Peking University’s School of Public Health. Largely in response to the “airpocalypse,” tourism in Beijing has dropped by 50 percent this year, the Beijing Youth Daily reported last week. The pollution has also hurt efforts by Beijing-based businesses to recruit top foreign talent. More potential employees are demanding hardship pay for having to deal with the city’s awful air quality. With studies connecting prenatal exposure to air pollutants with autism, depression, and long-term lung damage, many foreign and local parents are “second-guessing their living in Beijing,” said family physician Richard Saint Cyr, who is based there.

Are Chinese citizens angry?
Yes, and they are increasingly willing to show it. Chinese netizens this year defied a government ban and began sharing hourly air quality measurements from the U.S. Embassy in downtown Beijing. Microblogging sites like Sina Weibo have served as forums for citizens to express their frustrations with China’s air quality. “Our requirements aren’t high,” posted radio reporter Guo Yazhou. “We just want clean food, clean water, and clean air.” The dissatisfaction has given rise to a growing environmental movement, with 30,000 to 50,000 “mass incidents” of protest every year, according to former Communist Party official Chen Jiping.

Is the Chinese government listening?
The grumbling has become too loud to ignore. This year, Chinese Premier Li Keqiang claimed that the country’s smog made him “quite upset,” while the state-run China Daily bluntly referred to major cities like Beijing as “barely suitable for living.” That is a big change from 2011, when the state media referred to China’s choking air pollution with the euphemism “heavy fog.” Now, China says it will spend $817 billion on a plan to drastically cut pollution by 2017. While that might sound like real progress, provincial officials and state-owned businesses in China have a history of ignoring policies handed down from the central government. Critics also note that the new air-pollution plan calls for only a 2 percent reduction in coal consumption — the result of the Chinese coal industry’s powerful influence. Tong Zhu, an air pollution specialist who travels between Princeton University and Beijing, sees political infighting in China’s giant bureaucracy as the biggest impediment to progress. “There is technology available” to fix the problem, he told NPR. “I think as long as there is political willingness, the environmental situation can be drastically improved.”

Fashion-forward protection
Not everybody hates the smog. Companies that make protective face masks are selling millions of them, surpassing records set after the SARS outbreak in 2003. On the streets of Beijing, it’s strange to see someone not wearing a mask, designer Chen Dawei told the South China Morning Post. The result has been a boom in fashion-forward face masks adorned with everything from animal prints to counterfeit designer logos. Wealthy businessmen and government officials are also shelling out for indoor air purifiers, which sometimes sell in upscale showrooms for as much as $3,000. In the first half of 2013, IQAir, a Swiss company, saw sales of its luxury air purifiers triple in China. The trend, however, has bred some resentment from average Chinese families. Their annual income? About $2,100 a year.


Five myths about the Affordable Care Act

Karen Bleier/AFP/Getty Images
Karen Bleier/AFP/Getty Images


The rollout of the Affordable Care Act has been a “debacle” even according to the administration, but there is more to the confusion than just poorly written code. Take a deeper dive with this quick list from the Washington Post:

“Frustrating.” A “debacle.” That is how President Obama’s own secretary of health and human services, Kathleen Sebelius, has described the rocky launch Americans were supposed to begin shopping for insurance coverage on Oct. 1, but millions have been unable to log into the federal online exchange . Congress, meanwhile, shut down the government for 16 days in a dispute over whether to fund the health-care law. As the debate continues, let’s look at some of the most persistent myths about the law — and some new ones that have cropped up.

1. Americans will be forced to buy health insurance.

The health-care law’s individual mandate, despite its name, isn’t meant to force Americans into health plans. Instead, it is supposed to encourage people to purchase coverage by giving them two options: Buy insurance or pay a fine. In 2014, that fine is $95 or 1 percent of an individual’s income, whichever is higher.

The Internal Revenue Service is responsible for collecting this penalty from individuals who indicate on their annual tax filings that they have not purchased coverage. The agency can take the penalty out of a filer’s refund, but beyond that, its ability to recoup those dollars is extremely limited. The IRS cannot, for example, send agents to people’s homes or put liens on their houses. In the health-care law, Congress specifically curtailed the ability to enforce this penalty, giving the IRS fewer ways to collect it than there are for other tax fines.

2. If you like your health plan, you can keep it.

Obama has repeatedly made this key promise about his signature legislation. “If you’re one of the more than 250 million Americans who already have health insurance, you will keep your health insurance,” he said in June 2012, shortly after the Supreme Court upheld the law.

In truth, the health-care law makes a number of changes to the insurance industry that will affect the nearly 165 million Americans covered by private plans. For one, it requires all health plans to include a wider set of benefits, among them maternity care and mental health services. Employers have responded by increasing premiums by less than 3 percent, on average, to make up for the cost of these new benefits.

The individual market, where 15 million Americans buy their own coverage, will see even bigger changes. Experts estimate that insurers will discontinue at least half of these plans in 2014 because they do not cover the benefits that the Affordable Care Act requires. Some say the number could be even higher, around 75 to 80 percent.

CBS News has reported that more than 2 million people have already received word from their insurers that the health plans they have now won’t be available next year. Customers who receive a cancellation notice will need to shop for new coverage. Those plans could have a higher price tag because they offer more benefits, although many people will receive financial help from the government to buy a new policy.

3. The exchange’s big problem is that it ’s overwhelmed by traffic.

The federal exchange did get a lot of web traffic at first; the White House estimates that 8 million people visited the site in its first four days. To put that in perspective, as one Web developer recently did, that’s more users in’s first 24 hours than Twitter had in its first 24 months.

Traffic has decreased since then, and some people have successfully purchased insurance through the online marketplace. That’s led insurance companies to discover an even more serious problem with the exchange: It’s sending inaccurate enrollment data to insurers. Companies are supposed to get a file from the exchange each time someone enrolls in one of their plans. These files include important information such as where the new subscriber lives and how many people are in her family. But insurers say these files are sometimes wrong, listing children as spouses, for instance, or including an address that doesn’t exist.

Some companies have assigned employees to hand-check each file for errors. This works now because few people are enrolling through the exchange. But at some point, insurers expect that they’ll receive thousands of files each week and won’t have the manpower to check each one. If lots of people start signing up before the problem is fixed, insurers worry that they won’t know who actually bought their plans. And without knowing who has subscribed, insurance companies won’t be able to send out membership cards, for example, or begin paying claims for trips to the doctor.

4. The exchanges will transform the insurance industry.

While the federal exchange has gotten much attention in recent weeks, only a small fraction of Americans are expected to use the new marketplace to buy health insurance. The Congressional Budget Office estimates that, by 2023, 24 million people will buy insurance through the state and federal exchanges; that’s about 7 percent of the population. It’s telling that many of the large insurance companies, such as Cigna and UnitedHealthcare, have decided to participate in only a handful of the states’ marketplaces. So far, they don’t see this segment of the market as key to their growth.

The vast majority of Americans will still get their health insurance the way they did before the Affordable Care Act: through their employers or through a public program, mainly Medicare and Medicaid.

5. The health-care law will increase the deficit.

The Congressional Budget Office estimates that, over the next decade, the health-care law will reduce the deficit by $109 billion. That’s because the Affordable Care Act includes new spending cuts and tax increases, which more than offset the cost of expanding health insurance to millions of Americans.

The law’s new revenue sources fall into three main categories. First are cuts to Medicare providers, such as hospitals and doctors. Under the Affordable Care Act, the federal government will pay slightly lower rates.

Second are cuts to private health insurance plans, known as Medicare Advantage plans, that cover Medicare patients. The federal government has, in recent years, paid these private plans more to cover Medicare beneficiaries than it has spent on seniors who sign up for the traditional public program. The health law aims to reduce those differences by cutting Medicare Advantage payments.

Lastly, the law includes new taxes on a number of health-care industries, including hospitals, medical-device makers, insurers and pharmaceutical companies.

Wealth Inequality in America is Much Worse than We Think

Infographics on the distribution of wealth in America, highlighting both the inequality and the difference between our perception of inequality and the actual numbers. The reality is often not what we think it is.