The ACA Foul-Up: The Difference Between “We Can Do That” Versus “We Could Do That”

I’ve stayed away from commenting on the actual details of how Healthcare.gov got so screwed up, largely because details–as opposed to guesses–have been scarce. But a recent NY Times article on the subject is very revealing (boldface mine):

The prime contractor, CGI Federal, had long before concluded that the administration was blindly enamored of an unrealistic goal: creating a cutting-edge website that would use the latest technologies to dazzle consumers with its many features. Knowing how long it would take to complete and test the software, the company’s officials and other vendors believed that it was impossible to open a fully functioning exchange on Oct. 1.

Government officials, on the other hand, insisted that Oct. 1 was not negotiable….

CGI and other contractors complained of endlessly shifting requirements and a government decision-making process so cumbersome that it took weeks to resolve elementary questions, such as determining whether users should be required to provide Social Security numbers. Some CGI software engineers ultimately walked out, saying it was impossible to produce good work under such conditions.

over the past three years five different lower-level managers held posts overseeing the development of HealthCare.gov, none of whom had the kind of authority to reach across the administration to ensure the project stayed on schedule.

As a result, the president’s signature initiative was effectively left under the day-to-day management of Henry Chao, a 19-year veteran of the Medicare agency with little clout and little formal background in computer science.

Mr. Chao had to consult with senior department officials and the White House, and was unable to make many decisions on his own. “Nothing was decided without a conversation there,” said one agency official involved in the project, referring to the constant White House demands for oversight. On behalf of Mr. Chao, the Medicare agency declined to comment…

Mr. Chao seemed to colleagues to be at his wit’s end. One evening last summer, he called Wallace Fung, who retired in 2008 as the Medicare agency’s chief technology officer. Mr. Fung said in an interview that he told Mr. Chao to greatly simplify the site’s functions. “Henry, this is not going to work. You cannot build this kind of system overnight,” Mr. Fung said he told him.

“I know,” Mr. Chao answered, according to Mr. Fung. “But I cannot talk them out of it.”

I’ve witnessed similar woes outside of government in some projects I’ve been involved in (thankfully, only a few, but they were more than enough). As far as I can tell, there were several key mistakes:

1) An inability to scale back or alter the objectives. In something this complex and original (i.e., we’re not just allowing any adult to enroll in Medicare instead of limiting it to 65+), things will never work out as planned.

2) Giving someone responsibility is not the same as giving them authority. You can’t undercut the authority of the person responsible for leading the project.

3) Revolving project contacts. No matter how much documentation and declarations of intent there is, there is a lot of informal knowledge and understandings. You can’t have five project heads in three years. That’s too much instability. It also makes it easy for scammers and halfwits to flourish by making oversight that much more difficult.

There’s also the other question, which probably won’t be resolved for years by historians, of what the hell was Obama thinking:

Yet that same White House also let Obama swan around the country making ludicrous statements like this, four days before launch:

“[OBAMA:] This is real simple. It’s a website where you can compare and purchase affordable health insurance plans side by side the same way you shop for a plane ticket on Kayak, same way you shop for a TV on Amazon. You just go on, and you start looking, and here are all the options.”

That’s complete management dysfunction.*

As we asked earlier, how was this even possible? At the best, Obama’s staff — who were constantly demanding oversight — can’t pass bad news on to him; at the worse, Obama’s just telling outright lies that are going to be exposed in days.

Or, even worse, I suppose, we have a political class — like the ruling class in the FIRE sector, in its own way — that’s completely disconnected from all basic reality. It’s not merely that the political class can’t distinguish between campaigning and governing: They cannot distinguish between what can be done and what can’t; they don’t see any difference between bullshit and lies; they cannot be honest with each other, or with us, because they literally do not know what it means to be honest…

Like I mentioned, I’ve seen this outside of government as well, so I think there’s something else going on here: magical, Peter Pan thinking. Having been Cassandra–seeing the coming train wreck and having no ability to stop it–it usually stems from leadership, both the top and the next couple of rungs down, who can’t differentiate between we can do something and we could do something. Can means you have actually done that before (or something very similar). Could means, in theory, it shouldn’t be hard (cough, hack, cough) to do it. Note I wrote in theory. Theory rarely survives contact with reality, and is often dragged a couple of hundred yards to boot.

What the Obama Administration wanted to do could be done, but it wasn’t like anything that had been done. As those two statements begin to diverge, upper echelons become more and more frustrated and, most of the time, rather than paying attention to reality, will attempt to ignore it. Out of sight, out of mind.

Unfortunately, bullshit is not a load-bearing structure.

Seems to me that might have been what happened here.

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6 Responses to The ACA Foul-Up: The Difference Between “We Can Do That” Versus “We Could Do That”

  1. mtomasson says:

    I had dinner last night with a business school colleague who does a lot of government consultation, and said that the Obama administration consistently ignores pragmatic operational lessons and structures in favor of the political and botches things as a result. Seems consistent with your assessment, and I must agree.

    At the same time, I wonder…this has been a PR disaster, and egg on the face of the administration, but the law is still moving forward. I wonder if all of these difficulties will eventually fade as the law gets up and running and, bottom line, changes the face of American healthcare. I thought the Supreme Court case was bungled and Obama should have done more to support the ACA, until he won. People are focused on the short term, that’s natural. This was clearly a huge fumble. But it is very very early in the game.

  2. albanaeon says:

    My experience with contracts gone bad were either the situations you described or contractors that would bid the sun and moon for birdseed and fail to deliver.

    The best were when both combined into epic FUBARs. Part of me wonders if that happened here.

  3. Lymie says:

    “bullshit is not a load-bearing structure”

    This is a great phrase that I will steal immediately!

  4. All these idiots should be forced to read “The Mythical Man Month,” among other things.

    http://en.wikipedia.org/wiki/The_Mythical_Man-Month

  5. J E McCombs says:

    Although the roll-out of ACA is enormously important politically for the Obama administration, the longer-term success of the program itself is far more important for the country, and that still seems highly promising.

    Private enterprises probably never have to deal with anything quite this massive and complex — and if they do, they don’t have un-fireable members of their management team who are willing to do anything to make the program fail. They don’t have to begin with a design they know is far from ideal, chosen only because those internal opponents would block a better program completely.

    Private enterprises rolling out a major new product don’t also have to deal simultaneously with extricating the country from doomed wars, economic doldrums, powerful parties trying to start at least one more doomed war, and the thousand other critically important crises the Obama administration has been handling.

    And if they did, they would probably not be judged on their success on each of those myriad issues as if it was the only thing they were doing.

    Just sayin’.

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