The Affordable Care Act signup website. You would think that the Health and Human Services department would have realized that (1) the most immediate, direct, and widespread contact that Americans would initially have with Obamacare would be the process of signing up for health insurance, and (2) that any glitches in this process would be blood in the water to circling sharks in the anti-Obamacare crowd.
So the sign-up process should have been tested and re-tested to destruction, to MAKE SURE that the sign-up process was friendly, smooth, and free of major problems.
Instead, the process seems to be a widespread failure. How could that be? There are several possible answers. One is that the Obamacare site has been hacked by pros paid by wealthy conservative enemies of Obamacare to make sure it has a flawed debut. Though unlikely, in this day of widespread cybercrime, I’d say that given how much money has been spent on lobbying by the enemies of Obamacare, it is not impossible that nefarious sources are spending a few more megabucks to discredit its operation. Oh my gosh, is that paranoid of me? Yes, of course — but since waterboarding, drone assassinations, NSA eavesdropping, and blanket information dumps by telecommunication and web providers — let’s just say that paranoia is not as ridiculous as it used to be.
One other answer is that the website was designed more for the convenience of HHS and its information needs than for the convenience of consumers. That also strikes me as eminently possible, knowing how hard it is for bureaucrats to adopt the viewpoint of people outside of government. But if so it is a terrible mistake in marketing of a program whose public profile needs all the help it can get.
Oh yes, there is another explanation, offered by the Obama administration itself: that the website was overwhelmed by the unexpectedly high volume of initial sign-ups. OK — perhaps the officials behind Obamacare expected that initially only a few people would sign up, and that the process would only slowly gather momentum as more and more people investigated the site as the January deadline for insurance coverage approached. Yet everyone involved in developing the Affordable Care Act knew that its success depended on signing up as many people for the health exchanges as possible; the biggest risk was that not enough people would sign up to spread the risks in the new exchanges over a large and varied pool of insured. So if you were going to err, you should err in favor of overcapacity for the website, to get as many people ensured as possible with no delays or hassles.
Perhaps the firestorm of criticism led even those inside the administration to believe that it would be a hard, uphill struggle to get people to sign up, and so they expected volumes would initially be low and any bugs could get worked out later.
But I have learned that when you find a government disaster, the most likely explanation has nothing rational about it. Rather, it is the result of knee-jerk reactions and satisficing in the face of events that went out of control.
My best guess is that what lies behind the disaster of the Obamacare roll-out is simply a scramble. The Obama administration initially expected that, as the law requested, the states would take the lead in setting up health insurance exchanges and signups for their citizens. And the states that have done so have had relatively few problems. But what the Obama administration did not expect was that so many states would refuse to set up these exchanges, leading far more people than planned no alternative except to use federal health exchanges, which had to be hastily thrown together and expanded once it became clear how many states would not comply.
Whereas President Obama thought that after his re-election most states would get with the program and set up their own exchanges as requested by the law, two months after his election it became clear that only 17 states would do so, leaving the vast majority of Americans to find their way on federally-established exchanges; something that a year ago the administration thought would hardly be needed. (Some of the other states have state-federal partnerships, but only 16 states plus D.C. are fully managing health insurance exchanges for their residents on their own).
So if you thought the lack of cooperation between Republicans and Democrats in Congress was the big story last month, you saw only the tip of the iceberg. In fact, refusal to expand Medicaid, to set up health exchanges, indeed to refuse to cooperate with Obamacare in any way possible, is rampant and effective at the state level. It is now there, rather than in Congress, that the real fight over Obamacare is taking place. And unlike in Congress that resistance is already doing real damage to the ability of Obamacare to make affordable health care available to Americans who desire it.
A fourth explanation comes from the acronym, LPTA. In the current budgetary environment, Federal Acquisitions have increasingly defaulted to Lowest Price Technically Acceptable as the primary contractor selection criteria. Few solicitations are classified as “Best Value to the Government” competitions, and minimally technically acceptable is an incredibly low bar for programs as important as health care IT systems.
This acquisition culture produces similar results across the federal sector. When price overwhelms all other criteria, the government ends up with marginally capable providers, providers who plan for the absolute minimum requirements, and cost overruns when the minimum fails. Even when a competition is categorized as best value, the price pressure on contractors is overwhelming to come in at a very low price. Government Health Care IT problems are only the tip of the iceberg that is a flawed and failing federal acquisition system.