What if they can’t fix the health care website?

When it became clear that  the problems with the Obamacare exchange website weren’t just the early glitches of an opening day rush, I felt a deep sense of dread.

One of the first front-page newspaper stories I ever did involved a project to implement a new computerized billing and collection system for the Philadelphia Water Department that crashed and burned after a couple of years effort and millions of dollars down the drain.

Since then, I’ve seen this happen again, in government and private industry: a big information technology project, months or years in the making rolls out and experiences problems. In-house geeks and IT contractors come in with fixes, and it still doesn’t work right. Then more geeks, contractors, fixes, more problems, lawsuits, new geeks and contractors, more problems, and eventually the damn thing gets abandoned and somebody has to start over.

I hope this isn’t the story of HealthCare.gov, but it seems that if these projects don’t on the right track early – with skilled managers, clear goals and specifications, and a team that keeps designers in close touch with user needs, things can get so messed up they can’t be patched. 

When these things happen, you usually see executives at the top barking orders and predicting that, by god, it will get fixed and fixed soon. But the truth is they don’t really understand the stuff and are at the mercy of IT people who may or not be telling them the truth. It isn’t pretty.

Original sin?

The damage to the health care reform that would result from the federal exchange running aground is awful to contemplate, and it reminds me that competence in government officials can be just as important as policy goals.

(A troubling local reminder of this principle is on display in the new documentary Let The Fire Burn about the 1985 police assault on the MOVE compound. Official incompetence in that case led to the death of 11 people, five of them kids, and the destruction of 61 homes. The film is playing now at the Ritz at the Bourse.)

There have been some interesting pieces in the New York Times here and here that suggest Obama administration officials, acting with the best of intentions, didn’t bird dog this as they should have.

And I found this Washington Post piece by Amy Goldstein and Juliet Eilperin fascinating. They note that the president himself failed to heed some good advice from a trusted health adviser that the president didn’t have the team he needed in the administration to set up and run the exchanges.

But politics also played a big role, as decisions were influenced by fear that Republicans would seize on something as too complicated or unfair. And there was the problem that GOP lawmakers would do everything they could do de-fund implementation of the Affordable Care Act.

This is from Goldstein and Eilperin’s piece..

Although the statute provided plenty of money to help states build their own insurance exchanges, it included no money for the development of a federal exchange — and Republicans would block any funding attempts. According to one former administration official, [HHS Secretary Kathleen] Sebelius simply could not scrounge together enough money to keep a group of people developing the exchanges working directly under her.Bureaucratic as this move may sound, it was fateful, according to current and former administration officials. It meant that the work of designing the federal health exchange — and of helping states that wanted to build their own — became fragmented. Technical staff, for instance, were separated from those assigned to write the necessary policies and regulations. The Medicaid center’s chief operating officer, a longtime career staffer named Michelle Snyder, nominally oversaw the various pieces, but, as one former administration official put it: “Implementing the exchange was one of 39 things she did. There wasn’t a person who said, ‘My job is the seamless implementation of the Affordable Care Act.’ ”

Maybe it will all be okay. Maybe the website will be humming by Thanksgiving Day.

If not, this will be one expensive turkey.