As President Obama has recognized, his administration’s failure to deliver a functioning website that Americans can use to enroll in Obamacare represents an inexcusable error. The Affordable Care Act, which legislates near-universal health insurance, was passed after a more than a century of failed efforts to achieve this progressive dream in this country. It is tragic to be falling short on the mundane task of enrolling Americans in health-care exchanges. Even if the goal of getting the health insurance exchanges working by Nov. 30 is achieved — and objective observers cannot regard this as a certainty — a shadow has been cast on the federal government’s core competence.
What can be learned from this episode? It is too soon to know with confidence, but some preliminary judgments are possible.
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 missed and budgets are overrun. Maximizing the prospect of success requires providing for slack in the schedule and the budget, structuring projects with clear accountabilities and frequent checkpoints and assigning oversight responsibility to people with extensive information technology experience rather than general managers with programmatic commitments.
Success also requires some trusting but more verifying. A homeowner who hires a general contractor to build an addition, discusses the project and then goes away for six months probably would be unhappy with the result. The same is true for public managers who hire contractors to perform essential tasks but fail to rigorously oversee every step.
Another 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. In football, the best teams stick to their playbooks even when they fall behind. When one has fallen behind on a project, 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. One instance of over-optimism will ultimately be forgotten or forgiven. Repeated overoptimism should not and will not be excused.
These are old truths that those responsible for implementing Obamacare should have heeded. Yet fairness requires recognizing the equally important, and in some ways more fundamental, factor behind the problems 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 without an organized constituency for failure. It is no exaggeration to say that the failure of Obamacare has been the prophecy and the hope of many of those responsible for funding implementation of the Affordable Care Act, confirming the appointments of those who will do the job and overseeing the results. They have been eager to seize on any problems and highlight any controversial judgments. All serve to 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 health-care 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 line that must be respected between political opposition and conscious subversion. Everyone understands that when the country is at war, even a war they oppose, vigorous oversight is essential, but, in the end, there is an obligation to support American troops. In the same way, history will not judge kindly those who, having lost political debates over policy, go beyond vigorous oversight and seek to subvert enacted programs.
There is a danger here that goes far beyond delays in access to health insurance. The risk is of a vicious cycle in which poor government performance leads, on the one hand, to overly bold promises of repair and, on the other hand, to reduced funding and support for those doing the work. This generates unmet expectations and disappointment, setting off the cycle anew. In the end, government loses the ability to deliver for citizens and citizens lose respect for government. Our democracy is the loser.