I would imagine if CMS had even 1% the infrastructure Facebook or Google deploys, many issues would go away...except for the budget. I think Google has spent over $21B on data centers so far to service their users - $21/user? CBO said 7M predicted to enroll by 2014 so $142M on data center resources would be an equivalent spend..before any programming. There is no evidence in the spending that CMS was given anywhere near that budget..... Oh, and that $21B in data center spend? Thats just to build them, not actually operate them...add electricity, bandwidth, people.....

A universal data model for all health insurance policies - proposed and as-written, pricing and issuing? Thats been tried before in RDBMS's and hasn't gone that well (ChannelPoint had about 1,000 people working on this problem in 2000 and didn't succeed...) While the auto and property insurance has standardized on some processes between broker and issuer, health insurance has really lagged. This is a place where NoSQL has really sped development.