It has nothing to do with the ACA itself, of course. The map is not the terrain, the messenger is not the message, and having seen some major IT projects go into the ditch I can tell you that their doing so didn't mean the policies and practices they were meant to fulfill were wrong.
(FWIW, from the sounds of it, it wouldn't have made any difference if it had been pushed back a year. Without strong program management, a project will not improve with time.)
(And, also FWIW, this is exactly the sort of system that should have had a pilot and phased roll-out. Implementing something like this "big bang" is practically begging for problems.)
Reshared post from +Andreas Schou
This is probably the best pre-post-mortem you'll see about healthcare.gov. Read it.
(An aside: for no good reason, since I met +David Auerbach on G+ before he started writing for Slate, I've been kind of hesitant to post this despite really having enjoyed it. I feel slightly like I'm confusing categories by posting this here — like I'm his grandmother clipping out his article and posting it on my fridge.)
What Really Went Wrong With Healthcare.gov?
Of all the terrible websites I’ve seen, healthcare.gov ranks somewhere in the middle. It has been difficult if not impossible to sign up, and customer service has been inadequate. But it’s certainly better than the NYC Department of Education site that I attempted to help a friend navigate two years…
Thoughtful planning and careful structuring in the earlier stages of legislative design could have mitigated many of these problems. But we're way beyond the design stage. With the law sitting three years on the books, one is appalled at this kind of failure to launch. If you're not going to a good job with it, don't force it down our throats. I mean, I would be embarrassed to defend the ACA.
I'm sure there are some good ideas in there for a lot of people, but I see too many red flags.
But we must have it! And we shall!
Chris, I think you missed the point of Dave's post. Just because the websites aren't up to snuff doesn't mean the law itself is problematic. There was a time when you had to sign up for government programs without the aid of a website at all.
+Chris Ruhs a good rule of thumb, read the post statement and article first. Next leave a comment.
I read it. I disagreed. Had the law included the acquisition of programming talent or collaboration with corporations who excel at back-end server technology, then the three years this law has been on the books would surely have been used to iron out the kinks.
I'm not sure there are any laws that get specific about how the web page for a government service — if any — is implemented. I'm not sure I see why it would be a good idea to include that in the law with the rapid pace that technology evolves.
The use of two separate contractors for the front end and the back end should not, in and of itself, caused a problem – if applicable interface standards had been hammered out beforehand. Of course, that is a huge "if."
One way in which the ACA legitimately enters into this discussion is when you consider the user base that will be accessing this website. Perhaps this is an incorrect assumption, but I would guess that people who are presently unable to afford healthcare are probably less technically savvy than the average user. Therefore, it would be ideal for the front-end designers (and, as necessary, the server designers) to take extra care to ensure that any encountered problems are explained in laymen's terms.
+Les Jenkins, I agree that the specifics of site implementation are not resolved at the legislative level. And for what it's worth, those issues are resolved by civil service workers, many of whom were present for the Obama administration and the GW Bush administration.
+John E. Bredehoft Arguably (and I think the article brings it up, unless I'm thinking of another article I ready recently), the dismantling of government technical talent in favor of contracting everything out plays at least some role here.
+Chris Ruhs For what it's worth, I would agree that (a) the problems could and should have been avoided, and (b) it would have been better for folks to fess up and delay the roll-out than tarnish the program as a whole by rolling out a profoundly flawed interface. I can understand the political arguments against it, but, as they say, you only get one chance at a first impression.
(Though that does make me wonder — how well did the roll-outs of Social Security or Medicare go?)
The only other mitigating thought is that the argument that the law has been three years on the books is a bit misleading. Many of the specifics of the implementation of the law itself, not just the interface, were done by the executive agencies responsible for its execution, and the specifics on regulations and program details have been an ongoing effort. That probably didn't help this development project any — but the fundamental issues of accountability of contractors and division of responsibilities, not to mention basic testing of capacity and elegance of failure , are all basics that the program should have handled.
Sadly, they are not unique to Healthcare.gov, nor to the public sector, nor even to development programs of this scope.
Well, at least it will lower all of our healthcare costs.
+Chris Ruhs It will (if it works as designed) lower aggregate societal health care costs (and a variety of other related social costs as well). There are certain folks for whom it will mean greater individual costs. But that's how both insurance and society (as shared risk and responsibility pools, respectively) work.
Great! Can't wait!
+Dave Hill – regarding the Social Security rollout, it appears that the implementation was easier than the implementation of the Affordable Care Act.
Social security payroll taxes were collected by the Federal Government from businesses – since businesses paid other taxes to the Federal Government, this was just the introduction of variant on a money collection method, instead of a whole new method. I haven't been able to locate any contemporary account of the implementation, and I'm sure that businesses had to go through a lot of effort to set things up, but the Republic survived RooseveltCare.
Another thing that probably helped was that Social Security payouts apparently didn't start until a few years after Social Security tax collection began.
And, there was one more thing that helped. Unlike the goal of the Affordable Care Act (INSURE ALL THE PEEPLZ), Social Security was initially not universal (even today it isn't; religious ministers, Federal employees, and others are exempt). In 1937, many more people were not included in Social Security. Wikipedia https://en.wikipedia.org/wiki/History_of_Social_Security_in_the_United_States#Initial_opposition
"Most women and minorities were excluded from the benefits of unemployment insurance and old age pensions. Employment definitions reflected typical white male categories and patterns.[6] Job categories that were not covered by the act included workers in agricultural labor, domestic service, government employees, and many teachers, nurses, hospital employees, librarians, and social workers.[7] The act also denied coverage to individuals who worked intermittently.[8] These jobs were dominated by women and minorities. For example, women made up 90 percent of domestic labor in 1940 and two-thirds of all employed black women were in domestic service.[9] Exclusions exempted nearly half of the working population.[8] Nearly two-thirds of all African Americans in the labor force, 70 to 80 percent in some areas in the South, and just over half of all women employed were not covered by Social Security.[10][11] At the time, the NAACP protested the Social Security Act, describing it as “a sieve with holes just big enough for the majority of Negroes to fall through.”[11]"
There is little doubt, +John E. Bredehoft, that much of the confusion and implementation brouhaha for the ACA would have been a lot simpler if (a) it was handled via payroll taxes, (b) it got employers out of the picture, and (c) it wasn't as focused on being a customer enhancement program for private, for-profit insurance firms.