Mt. Vernon Register-News

Opinion

November 12, 2013

Immediate lessons from health-care reform

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.

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