This all comes back around to technology and why we contract Medicare to insurance carriers as the HHS over the years never built their own.  We have conflicts of interest too with contractors with all the recent mergers and acquisitions.  Lack of participation and knowledge of technology has really hurt all of us via our non participant leaders.  Actually when Obama took office Health IT in this area should have been a priority, but not putting some one in charge with an IT background it didn't get started soon enough.  2 years ago I said this was going to be a problem without a hybrid personality in place with both tech and people skills and we have it big time now.  It was a mistake to put someone at the top who has not written code.  See Bill Gates and Steve Jobs for those who wrote code and can predict, it works. 

http://ducknetweb.blogspot.com/2011/03/lawmakers-finally-asking-about-medicare.html