Many people have offered explanations for why the Affordable Care Act’s website, HealthCare.gov, has not worked as planned. Some blame President Obama, as if he were the programmer responsible. Some blame “government” more generally, meaning that government cannot do anything well, certainly not as well as private enterprise. Some blame liberalism, linking the politics of health care with the technological implementation of signing up for insurance.
Many of these explanations are openly partisan, created by conservatives who so badly want the Affordable Care Act to fail that they shut down the whole government.
Certainly, Obama must take some responsibility, as chief promoter of the legislation for which the website is supposed to act as gateway. Although he was far away from the details of constructing the website, he took political credit for winning the most ambitious transformation of American healthcare since the passage of Medicare in 1965. Because Republicans have attacked this legislation so vehemently since the day it was signed in 2010, the political significance attached to how it would work grew enormously.
Obama must take blame for two sets of failures: The technical problems of the website and the massive cancellations of private insurance policies that contradict his oft-stated promise that those who liked their healthcare plans could keep them. These two failures have significantly damaged the Democrats, but more important, they have made life more difficult for millions of Americans.
Republicans cannot give away all of the blame, though. They decided well before the Affordable Care Act came to a vote that they were going to oppose every element of healthcare reform. The possibility of reaching compromise ended already in July 2009, just six months after Obama took office, when Republican senators vowed to defeat any Democratic bill: Minority leader Mitch McConnell said, “We’re doing everything we can to defeat it.”
That was just the beginning of Republican efforts to torpedo the Affordable Care Act, a story which is well-known. At the federal level, House Republicans kept trying to repeal the bill. They refused to provide the funds requested by the Department of Health and Human Services to implement the act. At the state level, Republican-controlled states refused to work with the federal government to implement the insurance exchanges.
Is this just normal politics? Not if we look at the first version of Obamacare, which we could call Romneycare in Massachusetts. When Gov. Mitt Romney exulted about passage of his most significant legislative achievement in 2006, he was flanked by Democrats. The Massachusetts healthcare bill was a bipartisan creation, written by Jonathan Gruber, an MIT economist who is a Democrat, and Robert Moffit from the conservative Heritage Foundation. After its passage, Democrats helped to implement it. Now it functions to increase the number of people with insurance and reduce the annual growth of insurance costs. That’s how government is supposed to work.
Here’s one more reason, perhaps the most important, why HealthCare.gov failed to work properly. Giant new computer systems usually fail. Other huge government IT projects have had similar results. Last year, the Air Force scrapped a software project that cost $1 billion over seven years. A spokesman said that the Expeditionary Combat Support System “has not yielded any significant military capability.”
In case anyone believes that government is the problem here, giant commercial IT projects also fail. Last year, Apple rolled out Apple Maps, after two years of development, as a competitor to Google Maps, but it made embarrassing errors and CEO Tim Cook apologized publicly. A year later, however, Apple Maps is successfully taking customers away from Google. The 2010 merger of United Airlines and Continental caused massive foul-ups when the two reservation systems could not cooperate properly.
In August, the Department of Transportation fined United because 9,000 refund requests from customers were still delayed. These are not isolated cases. One survey of thousands of big IT development projects estimated that over 40 percent failed and 52 percent were “challenged,” meaning over-budget, behind schedule or not meeting user expectations. Even if those numbers are exaggerated, the likelihood of HealthCare.gov working on its first day, or even in its first month, was small.
That takes us back to the beginning – the responsibility of the Obama administration to integrate this knowledge into their planning. Because several different software development companies worked on different parts of the website, and its proper functioning required computer systems from many different government agencies and insurance companies to mesh smoothly, a long period of testing was necessary before the public rollout. That didn’t happen.
The Obama administration failed to deliver what it promised. Republican obstructionism contributed to the failure. But now more people who are eligible are enrolling for Medicaid. People who have signed up are already saving money on insurance.
Eventually the website problems will be fixed. Only then will we be able to weigh the value of this singular reform of our healthcare system.
Taking Back Our Lives
Tuesday, 19 November 2013