Give the Obamacare bug the correct treatment
As the president has recognised, the failure on the part of his administration to deliver a functioning website that Americans can use to enrol in “Obamacare”, the Affordable Care Act, 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 enrol 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 there are some preliminary judgments that we can make.
At a basic level the implications go to public management. The dismal track record of the implementing of large-scale information technology initiatives even in rigorous and focused corporate environments points to the difficulty. Unexpected obstacles always arise, deadlines are usually missed, and budgets usually over-run.
Maximising the prospect of success requires providing for slack in the schedule and in the budget, structuring projects with very clear accountability and frequent checkpoints, and assigning responsibility for oversight not simply to general managers but to people with extensive IT experience.
Success requires trust but also verifying. A homeowner who hires a general contractor to build an extension to his house, discusses the specifications and then goes away for six months is usually unhappy with the result. The same is true for public managers who trust contractors to perform essential tasks but 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 such failures is to bring problems to the surface as rapidly as possible and to move deliberately and carefully rather than more quickly. The best football teams stick to their playbooks even when they appear to be losing. So also when projects fall behind, it is important to mobilise new resources and management but not to overpromise with respect to how soon and how good a fix will be possible.
One case of over-optimism will ultimately be forgotten and, or, forgiven. Repeated over-optimism should not, and will not, be excused.
These are old truths that those responsible for implementing the Affordable Care Act should surely have heeded. Yet fairness requires recognising that there is an equally important and in some ways more fundamental factor behind the problems of implementing Obamacare – the systematic effort of President Barack Obama’s opponents to delegitimise and undermine the project.
Large-scale information technology projects in the private sector are hard enough even without an organised constituency for failure.
It is no exaggeration to say that it has been the prophecy and the hope of many of the opponents 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 hypocritical for those who held up the confirmations of key officials with responsibility for managing federal healthcare programmes and whose behaviour 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 programme and then attack it on the grounds that it is being under-resourced.
Many people regard it as an obligation when their country is at war – even a war they oppose – to support the troops. In the same way history will not judge kindly those who, having lost a political debate over policy, try to undermine programmes when they are being enacted.
There is a danger here that goes far beyond delays in access to health insurance. The risk is a vicious cycle develops 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 once again. In the end, government loses the ability to deliver for citizens and citizens lose respect for government. Our democracy is the loser.
The writer is Charles W. Eliot university professor at Harvard and a former US Treasury secretary