The Political Failure Behind the Healthcare.gov Debacle

You haven't heard much about healthcare.gov lately, and that's because it's working pretty well. So this is a good moment to think back on both what went wrong and how it got fixed, which we get in a timely article from Steven Brill. The fixing story is an interesting one, but before it's too late, I want to do a little more blame-placing.

It goes without saying that much of the responsibility lies with the contractors who did such a terrible job of creating the site. Another way to think about the problems is that there was a missing middle: you had people who understood the technology but didn't grasp the politics, and people whose job was politics who didn't understand the technological challenges. That's intuitively appealing, but I think it lets the political people off the hook. Their screw-up wasn't a result of their unfamiliarity with technology. It was a political failure, full stop.

What I mean by that is that the people who are supposed to understand politics should have known from the beginning that smooth operation of the web site was critical to the success of the program. They should have anticipated the fallout if things didn't work properly. The possibility of a web site failure should have terrified them. If it had, they would have been riding the technology people every day for months leading up to October, and they would have become aware of the problems much farther in advance. But they weren't, and it isn't because they lacked some complex understanding of web site design. It isn't because they didn't have the knowledge to do someone else's job, it's because they failed at their own jobs.

It's the job of those political people to anticipate political challenges and understand what factors might affect them, then create the conditions that minimize those challenges and maximize the chances of political success. And if they had been on the ball, they would have gamed out the rollout of the exchanges on October 1. Since those exchanges were online, and since many states had refused to create their own, anything other than flawless operation of the federal web site carried the potential for disaster. After all, you'd have hundreds of thousands of Americans logging in and trying to navigate through, along with lots and lots of reporters doing stories about that very web site.

In fact, healthcare.gov was (and is) the most important web site in the history of the United States government. Never before would so many people be sent to a single government site at the same time, and never had the success of a major policy initiative been so dependent on the smooth operation of a site. You didn't have to be able to code in order to understand that. Instead, we got this:

[White House Chief of Staff Denis] McDonough, in telling associates that the Obamacare launch was consuming an hour or two of his every day, similarly focused on the communications and outreach planning rather than the technology.

The press, too, concentrated on the purported marketing and enrollment hurdles. One favorite theme was that the White House had brought back its 2012 Obama-campaign whiz kids for an encore data-crunching, polling and messaging blitz, which is why Simas, a campaign pollster, data analyst and message maven, had assumed center stage.

It turns out that when it came to Civis' skills, McDonough, Simas and the others were working the wrong side of the house. Civis is great at analytics, but behind that world-class data crunching is a world-class technology team run by Gabriel Burt. Indeed, the key mistake made by President Obama and his team—who never publicized the arrival of Burt and other campaign coders in October the way they touted the role of the data-analytics marketing team last summer—is that they had turned only to the campaign's marketing whiz kids instead of the technologists who enabled them.

What saved them was that once the disaster began to unfold, Todd Park, the White House's Chief Technology Officer, and Jeff Zients, whom President Obama had tasked with overseeing the salvage operation, quickly assembled a team of Silicon Valley tech ninjas who worked like mad until the thing was fixed. But by then, so much damage had been done.

I know what you're thinking: OK, smart guy, how come you weren't writing one post after another saying, "Boy, they'd better have the web site working perfectly, or they are going to be in a heap of trouble"? I'll take responsibility for that one. I assumed, as did everyone else, that they had people on it who would get it working fine. And I didn't do enough thinking about it to appreciate the complexities of the technological challenge until after it started to unravel. But in my defense, the success or failure of the Affordable Care Act didn't rest on my shoulders.

Near the end of Brill's piece, there's this interesting paragraph:

McDonough says that in meetings with the President prior to the launch, Obama always would end each session "by saying, 'I want to remind the team that this only works if the technology works.'" The problem, of course, was that no one in the meetings had any idea whether the technology worked, nor did the President and his chief of staff have the inclination to dig in and find out. The President may have had the right instinct when he repeatedly reminded his team about the technology. But in the end he was as aloof from the people and facts he needed to avoid this catastrophe as he was from the people who ended up fixing it.

It's possible that McDonough is just trying to shift blame away from his boss, and Obama wasn't really issuing these warnings. But if he was, I think Brill is too hard on the President here. If he was repeatedly urging his staff to make sure the technology was working right, then he wasn't "aloof." The staff was. It was their job to take his instructions and act on them. It was their job, as the supposed political experts, to anticipate problems and do whatever was necessary to head them off. They were the ones who failed.

Comments

"...(Political people) would have been riding the technology people every day for months leading up to October..."

Having worked in IT for government for a decade, I'd like to introduce you to Brooks' Law (aka The Mythical Man-Month) and how it operates in the public sector.

http://en.wikipedia.org/wiki/Brooks%27s_law
http://en.wikipedia.org/wiki/The_Mythical_Man-Month

Whenever political people stick their heads into a technological project, the headaches of the technical people multiply exponentially. You end up carving out more and more of your day to explain what you're doing to people who haven't studied anything on your subject (in this case, writing code)... which leaves you less and less time to do your job (actually writing code).

The political people will sense that you're stressed out, but usually are not self-aware enough to realize that their presence is the cause of much of that stress... and will offer/insist on adding more people to "help" you. Now you've got to get those people up to speed on where the project is... which takes you away from your main task (writing code) even more. Those newbies invariably end up doing their job less well than how you would do it... so you've got to go back and make lots of corrections to their work and/or errors slide by. Rinse, wash, repeat... until the project is a total mess and the political people still insist on unveiling it by the political deadline.

In short: Political people need to hire technical people who can do the job, give them enough time to do it... and then build in enough flexibility into their deadlines that they can afford to push it back by a few months if unforeseen problems emerge amongst the technical people. That is what healthcare.gov lacked... a mechanism to push back the Oct 1 deadline when it became clear that it wasn't going to work well by that date.

Yes waldman healthcare.gov is the most important web site in American history. It will bring America to its knees. This will be a mill stone around our necks. The federal government destroys everything it touches. 17,000,000,000,000$ and still no meaningful plan to stop or even slow the spending. Politicians with captain Obama at the helm are like drunken sailors steering the USS America straight for the ice berg . Corruption is the word of the day in Washington. It's not changing. Both parties are ripe with it. They can't self limit. People like waldman refuse to see it. This government is our greatest liability. We need a purging, clean them all out then further limit the evil minds of men to seek and hold power. It destroys men and they are going to sink America. Wake up people grab your life jacket the USS America is already taking on water and obamacare will only make the hole bigger. Not a chance in hell we'll survive this with these leaders.

After a career spanning 35 years in software development, including both civilian and military US Government work as well as running software-development groups in half a dozen countries, it's always been obvious to me that the root cause was a failure of communications. I'm with Paul; communication is the political people's job, both as politicos and as the customer. It's your boss' credibility (and job success overall) on the line.

Two questions that have been repeatedly glossed over that I think need clear answers: How much of this massive communication failure was due to language/cultural disconnects, as is nearly universal with offshored or H1B-heavy projects? And how much of what needed doing was based on statutory/regulatory requirements that had successfully been implemented in other systems, and how much was hand-waving and pixie dust?

(OK, a third question: Given that, in the real world, every single software project successfully delivered has changed from its original requirements, why was the process used apparently designed to prevent that from happening?)

Those are the bits of the "technical picture" that the politicos needed to understand but clearly didn't, and it's something that every successful project deals with, explicitly or otherwise. And, for the most part, they're not technical per se; it's about communication and management and engagement and organizational discipline and all the other things that Team Obama is famously supposed to be very good at. So why weren't they?

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