Earlier this week, an Obamacare hearing on the Hill revealed an astounding fact: according to the Henry Chao, the deputy chief information officer at the Centers for Medicare and Medicaid Services, upwards of 30 or 40 percent of the back-end of the online exchange has yet to be built. The NYT has more:
“We have yet — we still have to build the financial management aspects of the system, which includes our accounting system and payment system and reconciliation system,” Mr. Chao said. These parts of the system, he said, are “still being developed and tested.”
Think about that for a second: Chao seems to be talking about actually building new infrastructure, not just fixing broken parts and iteratively improving already-built systems. Moreover, the back-end of the site is arguably more important for making the system ultimately work than more superficial user interface problems.Any way you read Chao’s words, it now seems unlikely that the administration will finish the site in December, no less the November deadline they floated earlier. Even if Americans are able to use the site without difficulty, until the back end is built the site won’t be able to pay insurance companies for the products they are supposed to be dispensing. This is very bad news indeed. Experts have predicted that the site would experience a crush of users between Thanksgiving and Christmas, but it’s now unlikely the site will work by then.If you want to understand how such a large failure of management could happen, Clay Shirkey has an excellent post looking at the cultural problems that could give rise to something like the healthcare.gov debacle:
The management question, when trying anything new, is “When does reality trump planning?” For the officials overseeing Healthcare.gov, the preferred answer was “Never.” Every time there was a chance to create some sort of public experimentation, or even just some clarity about its methods and goals, the imperative was to deny the opposition anything to criticize […]The vision of “technology” as something you can buy according to a plan, then have delivered as if it were coming off a truck, flatters and relieves managers who have no idea and no interest in how this stuff works, but it’s also a breeding ground for disaster. The mismatch between technical competence and executive authority is at least as bad in government now as it was in media companies in the 1990s, but with much more at stake.
Read the whole thing. The whole piece echoes a familiar theme we’ve hit on here at VM over and over again: We don’t need more government. We need a smarter, better and more efficient government. Obamacare has big problems quite apart from a malfunctioning website. But the malfunctioning website itself shows that our government is still ill-equipped to build the kinds of complicated next-generation delivery vehicles for services that we will need going forward.