Opinion

The Edgy Optimist

Healthcare.gov is just the beginning

By Zachary Karabell
November 1, 2013

The Obamacare blame game is in full swing, and without other news to fill pages and airtime, it’s likely to continue for some time. Attention is shifting from the myriad problems with the official website Healthcare.gov, and toward the health plans that are being canceled, even though President Obama promised that they would not be.

But the longer-term story isn’t the rollout and its many severe glitches. No one recalls whether the first batch of Social Security checks was sent on time in the late 1930s. The story that will matter, and linger, is that the Affordable Care Act was the first major law implemented almost entirely online. It’s the template for the future, and rather than using its launch as an excuse to renew attacks on the law, we need to learn what we can because, like this bill or not, it is part of the next wave of government.

The past two weeks have been filled with various individuals testifying to Congress about the design and implementation of Healthcare.gov, the web portal that allows individuals to access the new health plans and exchanges. The tenor of these hearings, convened by the Republican-controlled House, is that the design of the website exposed the fundamental failings of the law and government incompetence. But what’s actually been exposed is that the U.S. government has not yet made the transition to a digital age. While the administration could have and should have done far better, the reasons for its failure are less about a flawed process than a system currently ill-designed for this type of legislation.

It’s safe to say that Congress has never before passed a federal law whose primary mode of delivery is a web portal that will be used by tens of millions of people. And not just one portal, but a portal that serves as a gateway to numerous state healthcare exchanges along with the federal exchanges; a portal that must link up newly designed web pages and interfaces with legacy systems stretching from the Internal Revenue Service to the Veterans Administration to the Medicare and Medicaid systems, none of which are easily compatible or speak the same language.

Many in the tech community have tried to analyze what went wrong with the web launch. Some think the government shouldn’t have hired low-bid contractors, choosing agile development teams instead. There was also a lack of sufficient testing of the site before launch, but the site went live anyway because of political considerations. That the site’s code is not public has limited the ability of even savvy tech-heads to fully explain the many problems.

What is evident, however, is how inexperienced the federal government is when it comes to developing complicated technology systems unrelated to the defense department. Testing is certainly a major issue. Whenever a large or small tech company releases a new version of software, it is after months of assiduous testing of bugs and glitches in a beta version. Even then, the more complex the programs, the more problems there are. Microsoft for years has earned the reputation of releasing programs that are still flawed despite months of running the code through its paces. Some critics have faulted the administration for similar sloppiness, but in truth, the federal government didn’t have the option to do this kind of beta testing.

Imagine the political blowback if an early version of the site had been tested and then scrutinized by adversaries. They would have used the glitches as a compelling case to delay the implementation. Testing publicly only works when there is some consensus on what the outcome should be, which in almost all cases is the actual release of the product. If everyone agreed that the healthcare law was a good thing and required a first tier website, then you could have beta tested it extensively in order to make it better. But when a fair number of people would use the flaws revealed during testing as a way to torpedo the project, optimal testing just can’t be done. Given that, it would have been extraordinary if the site had been launched without major issues.

So, how can government deliver in a digital world? The British government recently revamped not just its websites but its approach to creating them, adopting the software development methods that are more reminiscent of Silicon Valley: open sourcing, collaboration and smallish teams. The failures of Healthcare.gov should spark similar changes in the U.S., but the problem with a partisan system of highly atomized political parties is that what works best for implementing policies is frequently trumped by the partisans wanting to prevent that implementation. Right now that means Republicans are determined to halt Obamacare, but it likely will mean Democrats adopting similar tactics when it suits them.

Very little of the public debate over the launch of Healthcare.gov, including who was responsible for what, is about what will matter going forward. How government adopts its procedures to meet the needs of digital governance will, because governance is going digital no matter what happens with Healthcare.gov. (Just ask the NSA, whose spying program is nearly all digital in nature.)

And yet the United States has a current political system that is ill-suited to make best use of these new tools. Adversarial politics and the lack of government coalitions lead to too toxic of an environment to develop robust technology. But the U.S. also has a surplus of groups and individuals who created this digital sphere in the first place, and they’re highly adept at innovating and creating new systems for both the public and private spheres. We certainly have the capability. It’s yet to be seen if we have the will.

Comments
20 comments so far | RSS Comments RSS

Great article.
Government still operates in a 1960s style top down civil service structure. They do not have the concept of matrixing together a team to do anything. It must be a tree style organization only. Fifteen levels of managers and five workers at the very bottom. And in many cases unions are added further exacerbating the problems.
Yes, government must change, but it is the government workers that will fight against doing it.

Posted by tmc | Report as abusive
 

Obviously not all people are equal when picking ones to design complex things that require learning and various advanced mental skills. The overwhelming requirement the a high level position in the administration of something like Obama-care is demonstration of the main skills need in setting up and running large computer systems and ability to communicate and understand health and legal experts on call.

They got it reverse they hired political experts with health background. The day to day operations will also be optimizing the computer system. It will require search engines to direct customer questions to a limited number of suitable canned responses then agents.

It is almost 100% things most people do not do unless they work in the computer network field and trained in it.

Posted by Samrch | Report as abusive
 

Obamacare is already failed by design. Millions are losing ins.coverage and millions more next year when the employer mandate kicks in. The tragedy is hard working people are going to suffer. Many observers have seen how little the present regime cares. They are clueless bureaucrats.It’s amazing they can spy on the world and have absolute power but no common sense. We are doomed.The people morn when our leaders are not righteous…

Posted by oilyolin | Report as abusive
 
 

maybe healthcare.gov should be run by the NSA…….afterall it’s all about collecting information on individuals.

there might be some irritating questions….minor inconveniences, they already know most of the answers.

Posted by Robertla | Report as abusive
 

Necessity will prevail. America’s health care system is an oligarchic dream. Therefore it won’t work in a digital world. Much of the country’s debt is worsened by a grossly inefficient, if not heartless, medical insurance system. It is unbecoming (to say the least) that a country that non-stop trumpets its exceptionalism would stand by while its people suffer and die at the hands of a grotesque conspiracy between doctors and corporate CEO’s.

Posted by Newsrocket | Report as abusive
 

Does anyone really think politicians can change the government (both state and federal) from 1960s style top down civil service unionized structures to a more flexible corporate style flat management with matrixed teams? Not a chance.

Posted by tmc | Report as abusive
 

Insightful article, but absolutely wrong in defending not using beta testing for Healthcare.gov. It has been the Obama administration’s paranoid secrecy and technical ignorance that exacerbated the roll-out problems. The issues were government manager incompetence and an unwillingness to be open about the failure that any experienced software developer or integrator could see in five minutes.

Having done battle as a contractor with federal civil service managers(?) for many years in developing and rolling out major systems, this article is spot-on. Neither the structure nor the entrenched inefficiency of the current system is geared for progress. It was the contractors that liberals love to malign who did all of the work, fought for clarity in requirements, worked incredible hours on nights and weekends testing and fixing while civil servants went on their many vacations, and took it in the shorts with schedules created to please the ignorant and disconnected higher-ups in the government, and who got little of the credit when the government managers took their bows. The government managers are incredibly insensitive people who deliberately release requests for proposal just before the holidays, with a due date of January 2nd. I went ten years without a Christmas holiday because of proposal work.

Federal civil service is top-heavy, lethargic, lazy, and appallingly ignorant of technology. They are of the “design me a submarine that flies, keep the price down, and work out the technical details on your own” mentality, who then whine when the contractors reasonably assign a high price and schedule to their fairy tale requirements.

A good start at improvement would be to forcibly retire all GS-15 and above and recruit executives and key managers from outside (no concern for political affiliation) with track records of successful accomplishments.

Posted by EdRies | Report as abusive
 

Flawed premise from the start. ACA is much more than a website portal.

Posted by seamus321 | Report as abusive
 

. Again like many posts I have read here
.

The Author has no idea what they are talking about.
.
,

Sounds Good, but the TRUTH is far removed from the FAcTS.

.

.
.
. Proof …..

.

Most of U.S. Is Wired, but Millions Aren’t Plugged In
New York Times

By EDWARD WYATT

Published: August 18, 2013

” roughly 20 percent of American adults who do not use the Internet at home, work and school, or by mobile device, a figure essentially unchanged since Barack Obama took office as president in 2009 and initiated a $7 billion effort to expand access, chiefly through grants to build wired and wireless systems in neglected areas of the country.

Administration officials and policy experts say they are increasingly concerned that a significant portion of the population, around 60 million people, is shut off from jobs, government services, health care and education, and that the social and economic effects of that gap are looming larger. ”

——————————————

—————— So the VERY people they intend to assist via the internet, do not participate in the internet. =================================

It really seems a bit silly. Really.

Where do I go wrong ?

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Posted by Alexaisback | Report as abusive
 

. Again like many posts I have read here
.

The Author has no idea what they are talking about.
.
,

Sounds Good, but the TRUTH is far removed from the FAcTS.

.

.
.
. Proof …..

.

Most of U.S. Is Wired, but Millions Aren’t Plugged In
New York Times

By EDWARD WYATT

Published: August 18, 2013

” roughly 20 percent of American adults who do not use the Internet at home, work and school, or by mobile device, a figure essentially unchanged since Barack Obama took office as president in 2009 and initiated a $7 billion effort to expand access, chiefly through grants to build wired and wireless systems in neglected areas of the country.

Administration officials and policy experts say they are increasingly concerned that a significant portion of the population, around 60 million people, is shut off from jobs, government services, health care and education, and that the social and economic effects of that gap are looming larger. ”

——————————————

—————— So the VERY people they intend to assist via the internet, do not participate in the internet. =================================

It really seems a bit silly. Really.

Where do I go wrong ?

.
.
.
.
.

Posted by Alexaisback | Report as abusive
 

.
.
.
.
.”"”"”"”"”"”"”"”"”"” Administration officials and policy experts say they are increasingly concerned that a significant portion of the population, around 60 million people, is shut off from jobs, government services, health care and education, and that the social and economic effects of that gap are looming larger. ””"”"”"”"”"”"”"”"”"”"

“”"”"”"”"”"”"”"” around 60 million people, is shut off from jobs, government services, health care and education,”"”"”"”"”"”"”"”"”"”

————————————

Are not these the very people they say they intend to help ????????????????????????????

——————————————-

The author appears very naïve.

Very naïve.

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Posted by Alexaisback | Report as abusive
 

“Healthcare.gov is just the beginning”

I hope that’s not supposed to make me cheery or feel better; because it absolutely does not.

This one is the “best” so far:

http://blog.heritage.org/2013/11/02/excl usive-healthcare-gov-users-warn-of-secur ity-risk-breach-of-privacy/

I guess – if you put your information in on the Healthcare site – it’s like a raffle… as to who might get YOUR information back.

Posted by Overcast451 | Report as abusive
 

Can anybody honestly say that Obamacare should even be taken seriously? Our congressmen erroneously passed the legislation without undertaking their responsibility to us by fulling understanding the impact of this law and that in a nutshell is the real failure. Putting lipstick on a pig means we still have a pig and that therein lies the problem – no amount of lipstick will make the transform the pig into a beauty queen. Healthcare.gov was broken before it even started.

Posted by SeeAllEvil | Report as abusive
 

Sir, I believe that health care in the US needs to change. I believe that Obamacare is a necessary (though certainly not sufficient or even adequate) first step.

However, you are attempting to defend pure incompetence. Please stop it. Those contracting, designing, implementing, testing, and integrating this software have failed miserably. In industry, people would lose their jobs over this, yet that clearly has not happened. The leadership is clearly lacking.

Are you really wondering why the American public is turning against Obamacare? It has little to do with the law, and everything to do with those we have trusted to implement the law.

Posted by Curmudgeon | Report as abusive
 

This article is the metaphorical equivalent of a cheerleader trying to pump up fans whose team is losing 65-0 late in the 4th quarter.

Posted by RJWagner | Report as abusive
 

I was wondering when someone in the media would bring this up… In order to manage my health care, I need a computer and it needs to be the network – Its a right in order to secure my Health Care right. This is the ACA II. Affordable Computer Act part II.

Posted by Stephen1231 | Report as abusive
 

WOW – many of the posts are right on. Anyone who has been in the software development industry knows that this failure has political incompetence written all over it. Now outsourcing has been politically corrupted – with party relationships, it does look dire. People need to be held accountable – and that is not really part of politics. You see the conundrum – our political system cannot execute/create the systems required to support their policies – and their policies don’t take into consideration the poor systems. The answer is to take the purchasing of goods and services away from the interference of politics. Gee – it really looks dire now…

Posted by xit007 | Report as abusive
 

the government handling “health care” is a catastrophic. anyone who has served in the military can testify to that.
However, we did get an apology and he probably got another Lobby check.

Posted by rikfre | Report as abusive
 

“the next wave of government.” Good grief. I’m still choking and sputtering from the FIRST wave!

“Very little of the public debate over the launch of Healthcare.gov, including who was responsible for what, is about what will matter going forward.” That’s because it is all chatter meant to deflect attention from fundamental conceptual, structural and financial problems. Anyone who acceped the premise that this program “had to be passed before it could be understood” is a complete idiot.

@tmc,

“Fifteen levels of managers and five workers at the very bottom. And in many cases unions are added further exacerbating the problems.” Clear, concise thinking. How true, how true.

The so-called “workers” that comprise much of the indolent, unresponsive and bloated monstrosity we call the federal government are a problem that, by their very culture and associated personal goals and interests CAN NOT be part of any genuine solution. And few of us today are yet seriously contemplating the incredible cost to taxpayers of bringing millions and millions of the mentally ill or defective into a health care system already financially unsustainable?

We’re in for a VERY rough ride, people.

Posted by OneOfTheSheep | Report as abusive
 

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