Opinion

Lawrence Summers

The lessons from Obamacare’s flawed Web launch

By Lawrence Summers
November 11, 2013

As the president has recognized, the failure of his administration to deliver a functioning website that Americans can use to enroll in Obamacare represents an inexcusable error. Having succeeded after more than a century of failed efforts in achieving the progressive dream goal of legislating universal health insurance in America, it is tragic to be falling short on the mundane task of allowing Americans to actually enroll in the healthcare exchanges. Even if the goal of getting the health insurance exchanges working by November 30 is achieved, and this cannot be regarded by objective observers as a certainty, a shadow has been cast on the core competence of the federal government.

What should be learned from this episode? It is too soon to know with confidence, but worth reaching some preliminary judgments while the issue is front of mind.

At a basic level the implications go to public management. The dismal track record of the implementation of large-scale information technology initiatives, even in rigorous and focused corporate environments, points up their difficulty. Unexpected obstacles always arise, deadlines are usually missed, and budgets are usually overrun. Maximizing the prospect of success requires providing for slack in the schedule and the budget, structuring projects with very clear accountabilities and frequent checkpoints, and assigning oversight responsibility to people with extensive IT experience, rather than general managers with programmatic commitments.

Success also requires some trusting by more verifying. A homeowner who hires a general contractor to build an extension to his house, discusses the specifications, and then goes away for 6 months is usually unhappy with the result. The same is true for public managers who hire contractors to perform essential tasks and then trust them and fail to rigorously oversee every step.

An additional requisite for success is steadiness and realism in the face of difficulty. Once a project gets off track, there is an overwhelming temptation for everyone involved to circle the wagons and promise rapid repair so as to hold critics at bay. Yet the right response to failure is to surface problems as rapidly as possible and to move more deliberately and carefully, not more quickly. The best football teams stick to their playbooks even when they fall behind. So, too, when projects fall behind, it is important to mobilize new resources and management but not to overpromise with respect to how soon and how good a fix is possible. Overoptimism once will ultimately be forgotten and or forgiven. Repeated overoptimism should not and will not be excused.

These are old truths that those responsible for implementing Obamacare should surely have heeded. Yet, fairness requires recognizing that there is an equally important and in some ways more fundamental factor behind the problems in implementing Obamacare — the systematic effort of the president’s opponents to delegitimize and undermine the project.

Large-scale information technology projects in the private sector are hard enough with no organized constituency rooting for failure. It is no exaggeration to say that it has been the prophecy and the hope many of those responsible for funding the implementation of Obamacare, confirming the appointment of those who will do the job, and overseeing the results that the project will fail. They have been eager to seize on any problems, highlight any controversial judgments, and create an environment in which failure becomes the expectation.

It is disingenuous for those who stood ready to turn any regulatory detail into an attack ad to profess outrage when guidance was not provided during an election campaign. It is hypocritical for those who held up confirmations of key officials with responsibility for managing federal healthcare programs and whose behavior deterred many able people from coming into government to lash out at the incompetence of government management. And it is indefensible to refuse to appropriate money to carry out a program and then attack it for being under-resourced.

There is a danger here that goes far beyond delays in access to health insurance. The risk is of a vicious cycle developing in which poor government performance leads on the one hand to overly bold promises of repair, and on the other to reduced funding and support for those doing the work. This then leads to unmet expectations and disappointment, setting off the cycle again. In the end, government loses the ability to deliver for citizens and citizens lose respect for government. Our democracy is the loser.

PHOTO: A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this October 2, 2013 photo illustration.  REUTERS/Mike Segar 

Comments
13 comments so far | RSS Comments RSS

“As the president has recognized, the failure of his administration to deliver a functioning website that Americans can use to enroll in Obamacare represents an inexcusable error.” – I believe that presenting the problem this way only aggravates it…
I do think that the President needs people who would do much better job at “public management”, who could clearly and loudly decouple to the public the differences between the Affordable Healthcare Act law and the government healthcare insurance enrollment website. The Americans also need a distinct understanding that Obama is not a Chief Information Officer, but the President of the United States of America.

Posted by UauS | Report as abusive
 

Larry knows all about SNAFU…..he’s an expert.

Posted by rikfre | Report as abusive
 

Every business set to serve the masses if put to this much of early scrutiny, will be faced with such a grand fiasco with no exception.

Posted by Mott | Report as abusive
 

Interesting analysis. One factor that escapes you is that there was no bipartisan support. It is not because opposition parties wouldn’t play, it is because it had to be “his way or the highway.” This is the goal of the Administration–if you can’t get it done through legislation, do it on your own. Separation of powers and recognition of opposition positions, force leaders to use their powers of persuasion. These tactics were used by the Administration against it own party member–Nelson had to accept deals that his constituency didn’t want and wouldn’t take. No real affinity to negotiation. Some times we miss the trees from the forest. The ACA is all on “him.”

Posted by RobertK123 | Report as abusive
 

Read “A Note on Uberveillance” by M. D. Michael. Newport News Police and Virginia State Police had Dr. Lawrence Chang implant me w/o my knowledge and consent with a biochip. It enables torture. They use it as a sensor and pulse energy projectiles at you. I had a heart attack. It enables voice to skull communication. See LRAD white papers or audio spotlight by Holosonics. See Safeguards in a World of Ambient Intelligence by Springer page 9. See Mental Health and Terrorism by Amin Gadit. See Bio Initiative Report 2012. See Forbescom and search Brandon Raub. Law enforcement tases citizens into “excited delirium” (see at nijorg) to make them act in ways they normally would not. I believe they are directly responsible for the Virginia Tech massacre. There are 3 reasons to have it implanted 1) mental health, 2) criminal record, and 3) infectious disease. If you don’t meet any of those requirements like me, they’ll falsify your records. All the mass shootings are the work of law enforcement. They want to take away your right to bear arms and make America a police state. They torture people into a state of what the national institute of justice calls “excited delirium.” People aren’t suddenly going crazy, they’re being tortured. I also believe the biochip to be responsible for PTSD. Read Brian Castner’s book “A Long Walk”. I have the same ambiguous pains, twitches, heart attack, night mares, day mares, gurgling, etc. I never served in the war. What do we have in common? The biochip. Suicide is one way to get relief. Virginia’s suicide rate is higher than the national average and the military suicide rate is unacceptable!

Posted by SJmithB | Report as abusive
 

@SJmithB, I truly hope either you turn yourself into authorities or they track you down. You are a threat to society.

Posted by tmc | Report as abusive
 

SJmithB. To comfort your belief, go have a full body MRI done and you will not find a chip. Besides they don’t need a chip. You should seek help from the Mormon Church and their missionaries.

Posted by 2Borknot2B | Report as abusive
 

Mr. Summers, The health care industry has been in trouble for a long time. The problem is the insurance companies. So, to do more of the same is the problem. Neither insurance companies or web sites offer actual health care services. Direct single payer is the only way to offer cost effective, appropriate, efficient and fair care. The system is already in place and the only thing that would change is the unnecessary bloat of “administration.” Billions of dollars per year that could go toward the delivery of actual patient care, just imagine.

Posted by 2Borknot2B | Report as abusive
 

So Larry Summers would throw even more money at a problem and more no-bid contracts that always seem to cost at least twice as much as when first unveiled.

“Government oversight” tends to mean “government fraud” with kickbacks and bribes – we are now seeing it in military areas more than ever seen in the past.

It isn’t what you know, but who you know when it comes to spending government (TAXPAYER) money.

Posted by AZreb | Report as abusive
 

Nov 30 was initially stated as a promise, not a goal. That, in itself, was unwise at best.

“….assigning oversight responsibility to people with extensive IT experience, rather than general managers with programmatic commitments.” Good idea. But who was the person, or who were the people assigned this oversight? Even after watching the hearings this is not clear. If it was Sebelius that is astonishing. A project of this magnitude needed a czar or a group with no responsibility other than ensuring the roll out was as smooth as possible. Not someone with the wider responsibilty for HHS.

“It is hypocritical for those who held up confirmations of key officials with responsibility for managing federal healthcare programs…” Whose confirmation was held up?

Posted by Gracchus | Report as abusive
 

The history of large, outsourced public projects in this country is littered with vastly overblown budgets, missed deadlines, and incomplete or incompetent implementation of the original, promised product.

The main difference here is that there are so many people who wanted it to fail, and the media is trumpeting that failure.

About twenty years ago, governments and corporations started the process of outsourcing. Skilled programmers were let go, and the new generation of programmer/analysts were told pretty bluntly not to expect to stay at their job long term.

Business journals and managements schools were saying that managers of IT projects do not have to be IT people, and we saw huge projects being managed by budget analysts and bureaucrats.

They are technically incapable of assessing the situation when a vendor gives an explanation of why a deliverable is late, or not working. It could be that the original specs were ridiculous. It could be that the vendor has gone cheapo on its hiring, and hired a bunch of low-wage newbies (a common practice), and they are incapable of delivering what they promised, or it could be that, indeed, the vendor is right, it it will be ready in two weeks.

A technically competent person would be able to ask the questions and suss out what is going on. A bureaucrat will trying to come up with a way to not make this their problem.

What most people do not understand is how important not only technical knowledge is, but also how important institutional knowledge and business rules are, and also how much of a difference there is between a skilled programmer and a newly-graduated low-wage grunt.

Until we go back to having IT be a good, long-term career for serious-minded techies, and not a get-rich-quick scheme for well-connected snake-oil purveyeurs, this will continue to occur, over and over again.

Posted by MargaretBartley | Report as abusive
 

With all due respect, one more aspect you forgot to mention: the contrition that you, and most your associates in the press have with this administration. Your lack of any in depth investigation into this huge and expensive issue has now come back to haunt us all. You could have reported back in 2009 the clauses, and unanswered accusations by ‘the opposition’ that directly address the major flaws and misrepresentations in this legislation. But you did not. And just as the administration has had 3 years to make this work, the press has had 3 years to investigate it. Neither did their job. You’d mentioned we now distrust the government even more. Wake up call: you better believe we can’t trust the press to do their job either.

Posted by Tomohawk | Report as abusive
 

Sir, it is not “disingenuous” for those who vote against any measure in Congress to continue to speak out against it. It is not “hypocritical” of them to continue to use any parliamentary means are at their disposal to defeat that measure, and it is not “indefensible” for them to turn back funding for such a measure if such should be possible. Healthy opposition is the only hope for individual liberty. When a measure is broadly unpopular, it would be “disingenuous, hypocritical and indefensible” not to voice opposition. In the case of Obamacare, as it becomes clear that American households will save $2,500 a year, will be able to keep their doctors and their insurance plans, opposition will simply melt away. Have no fear. Till then there is a clear obligation, for you as well as me, to fight unwise laws and abuse by dishonest politicians. Anything else is “disingenuous, hypocritical and indefensible.”

Posted by billbradbrooke | Report as abusive
 

Post Your Comment

We welcome comments that advance the story through relevant opinion, anecdotes, links and data. If you see a comment that you believe is irrelevant or inappropriate, you can flag it to our editors by using the report abuse links. Views expressed in the comments do not represent those of Reuters. For more information on our comment policy, see http://blogs.reuters.com/fulldisclosure/2010/09/27/toward-a-more-thoughtful-conversation-on-stories/
  •