November 11, 2013

Healthcare.gov Didn't Have to Be a Disaster: Here's How to Fix It -- And Avoid Failure in the Future

By Abigail Ruscetta

Source: Foreign Affairs

Journalist(s) Shahid N. Shah

Assigning blame for Healthcare.gov’s disastrous rollout has been about as entertaining as thrashing about in a room full of piñatas without a blindfold. So plentiful are the targets that some wonder whether failure was inevitable and, more generally, whether democracy is incompatible with technocracy. In both cases, the answer is no. The problems with Healthcare.gov were easily avoidable. And there is no reason that Americans should resign themselves to such failures, now or in the future.

There are dozens of examples in which the government has successfully imagined and deployed astonishing new technologies. The creation of GPS, the “stealth utility,” as Brad Parkinson, the U.S. Air Force colonel who spearheaded its creation, likes to call it, is the example everyone points to today. The core idea behind GPS -- attaching atomic clocks to low-power radio beacons, launching a constellation of those beacons into orbit, and receiving their signals anywhere on the planet -- was far-fetched and expensive. Only the government had the resources, the military need, and the patience to even attempt such a feat. Once it did, though, the public reaped the rewards as well. 

That is not to say that the government should attempt all innovative projects on its own. In fact, government involvement tends to work best when the public sector provides the will and the private sector provides the ingenuity and technical prowess. In the medical field, many projects are simply too expensive for any single company to fund without government support. Yet once government support is granted, the research can result in breakthrough technologies that bring vast profits for private firms -- and benefits for the public, besides. Another example is the Internet. Together, the private and public sectors collaboratively scoped, executed, and deployed a system that neither could have possibly created on its own. 

And that is where Healthcare.gov failed: the Web site was an engineering problem that was attached to a political program, Obamacare. Rather than solving it like engineers, though, officials tried to solve it like politicians. They hid the strategy (and the software) in the naïve belief that they were capable of delivering a complex system in a technical vacuum. This approach is toxic when it comes to large-scale implementation, where one wants more transparency. The political decision that wreaked the most harm was to insist that a massive social program could be rolled out across the country on a single day without experienced management, detailed reporting, comprehensive testing, and a workable plan for integrating the whole system.

  • Abigail Ruscetta

    Next Generation National Security Fellow, 2009-2010, Congressional Appropriations Liaison, Secretary of the Air Force

    Major Abigail “Abby” L.W. Ruscetta is a Congressional Appropriations Liaison on the Secretary of the Air Force Staff.  As such, she is an Air Force Liaison to the Congres...