HealthCare.gov disaster symptom of larger problem

Introduction

The glitch-plagued HealthCare.gov website has, as expected, given critics of health care reform another opportunity to persuade the American public that Obamacare is a failure and should be scuttled.

The House Energy and Commerce committee hearing last week was — surprise — little more than a forum for critics of the Affordable Care Act to use the pithiest sound bites their staffers could come up with to embarrass the Obama administration.

Let’s suspend disbelief for a moment and pretend that members of Congress care more about the health and well-being of the country and its citizens than in getting re-elected and amassing more power. In such a make-believe world, what should Congress really be trying to do in light of the fiasco surrounding the rollout of the HealthCare.gov insurance marketplace website?

I posed that question to Clay Johnson, the much-quoted CEO of the Department of Better Technology, a nonprofit that helps government with technology, and former Presidential Innovation Fellow in the White House.

First of all, Johnson says it’s clear from the Congressional reaction to the HealthCare.gov mess that “Congress has no technical brains” and hasn’t since former House Speaker Newt Gingrich got rid of the Office of Technology Assessment in 1995.

The Office of Technology Assessment was created during the Nixon administration to provide members of Congress with unbiased analysis of scientific and technical issues. During its 24 years of existence, it churned out hundreds of studies on issues ranging from health care to climate change and was recognized as a global leader in encouraging cost-effective innovation in government services and programs.

When the Republicans took back the House in 1995, the OTA was cited by Gingrich and his “Contract with America” colleagues as an example of government waste. Congress defunded it, just as the current GOP-led House has tried repeatedly to defund Obamacare.

The fact that there is no OTA helps explain the embarrassing questions and comments from members of the House committee last week. So to start, Johnson says, Congress should realize it was a mistake to defund the OTA and reestablish it.

But Congress is not the only branch of government that has become part of the problem. Johnson says the way the executive branch goes about selecting and awarding contracts for projects like HealthCare.gov almost guaranteed that the website would not function properly when it launched.

HealthCare.gov is just the latest in a long history of projects that have underperformed because of long-standing protocols that discourage all but the biggest technology companies — and the ones with the best political connections — from even submitting bids for government projects.

As Johnson and Harper Reed, former chief technology officer of Obama for America, wrote in a New York Times op-ed Friday, “Much of the problem has to do with the way the government buys things.” As a consequence, an astonishing 94 percent of large federal information technology projects over the past decade failed to meet expectations in one way or another, according the Standish Group, a research firm. More than 40 percent were complete failures.

“The questions Congress should be asking would be about the procurement and hiring policies inside the Department of Health and Human Services and CMS (the Centers for Medicare and Medicaid Services, which was given the responsible of building HealthCare.gov),” said Johnson.

“How did HHS and CMS determine which contractors got to work on this stuff? The other question would be which policies prevented the U.S. federal government — the biggest customer in the entire world — from getting the absolute best and brightest (to do the work)? What is preventing government from getting that kind of talent?”

Johnson believes the answer to those questions can be traced back to procedures put in place over the past several years that make it cumbersome, time-consuming and expensive for private companies to bid on government contracts, so much so that relatively small firms — where many of our best and brightest work — won’t even consider submitting bids.

Johnson says Congress made matters worse in 1980 with the well-intentioned Paperwork Reduction Act, which was supposed to make it less burdensome for private businesses and regular folks to deal with the feds. While it has helped in some ways, the law has also created a bottleneck. Its requirements on the development of new government forms, for example, have contributed to slow-as-molasses bureaucratic decision-making.

Johnson, who says he is seeing evidence that the “tech surge” put in place to fix HealthCare.gov is working and that the site should be operating more smoothly within a few weeks, says President Obama should use the website debacle as a teachable moment and put a moratorium on large IT integrations “until we figure out what’s going wrong.” Then he should propose actions to fix what’s clearly badly broken.