Two months after the disastrous launch of the website for Obamacare, the website’s performance appears to have been improved. It can handle more people creating accounts, entering data and signing up for health insurance.

But challenges remain — big challenges that nobody in the White House is talking about.

When it comes to the federal health exchange website, there has been progress. But warnings from insurance companies and even the Internal Revenue Service suggest there are major problems once prospective consumers get beyond the sign-up stage of the process. The so-called back-end of the process is reportedly just as flawed as the widely criticized front-end was in early October.

The coming back-end glitches are less visible to the public, but are also more serious.

The back-end requires connections between the website and insurance companies regarding personal data, coverage, payments and processing. There are also links to the IRS for income verification — to prevent fraud by people claiming lower than their true income to get bigger government subsidies. Insurance companies say they already are getting incomplete, duplicate and error-filled applications.

If the IRS cannnot verify eligibility for subsidies, the potential for fraud is massive. And administration officials admit the part of the software that lets the government pay insurance companies has not been completed.

The Baltimore Sun described HealthCare.gov as “an old Western town in which false fronts hide ramshackle buildings.”

But even if the front-end and back-end problems with the Obamacare web site are fixed, huge problems remain, including high health care costs.

The irony of the health care law’s official name — the Affordable Care Act — is glaring because the law does little to address out-of-control health care costs in the United States.

Granted, there are some pilot programs aimed at cost control and there are currently ACA-based efforts to push hospitals to reduce costly re-admissions. But U.S. health care spending is off the charts when compared with other countries.

Americans spend twice as much as citizens of other countries (on a per capita basis), yet the health outcomes are below those in other countries where spending is far less.

This week, the New York Times reviewed costs for some basic medical procedures — treating simple cuts with stitches — at hospitals around the country. The stories paint a troubling picture of U.S. health care.

Parents of a toddler who was treated with skin glue for cut on her forehead received a bill for $1,696. A 26-year-old California woman who cut her knee and required three stitches was billed $2,229. A New York City man was billed $3,355 for emergency room treatment after he cut his finger while working in his kitchen.

The article revealed irrational hospital charges that have no connection to actual costs. For a Tylenol-codeine pill, a California hospital network, California Pacific, charged $36.78. The estimated cost of the pill — 50 cents. An IV fluid bag generated a charge of $137 from California Pacific, while the actual cost is about $1. The charge for a simple neck brace was $154, despite a cost of $19.99. At a different hospital in San Francisco, the charges for these same items were much lower. There is no logic to prices.

The same irrational and out-of-control charges seen for treating small cuts with stitches are also found in more complex medical treatments. For example, a hip replacement costs $13,000 in Belgium while the same procedure in a U.S. hospital costs $100,000 and $130,000.

Hospitals use a system based on a “chargemaster” or price list with thousands of charges for everything: aspirin, gauze, physical therapy, heart surgery. Hospitals appear to charge whatever they want to — and they get away with it because few people see the bill. And if a patient does see a bill, they might question the costs, but don’t bother objecting because most of the costs will be paid by their insurance company. They think they are not paying the outrageous charges. But they are paying — we all are.

Obamacare was mostly about expanding access and providing health insurance to millions of Americans who lack access to regular health care. That’s important and a good thing to do. But it’s also the easy part. The hard part, and something few politicans in Washington talk about, is bringing the cost of U.S. health care in line with other advanced countries.

The poorly named Affordable Care Act only reminds Americans, at least those paying attention, that health care in the United States is a crazy, dysfuntional marketplace. The result is that health care is not affordable.

It’s time for Obama and Congress to talk about health care costs — and not just about flawed websites and broken promises.