In October, 2013, New York Times reporters Robert Pear, Sharon LaFraniere and Ian Austen first reported gross conflicts and disorganization among contractors developing the major U.S. health-care Web site, healthcare.gov, and their supervisors who were federal government employees. While the Times described problems soon after a crisis became public, its reporters did not explain how the problems developed.
Three weeks later, Washington Post reporters Amy Goldstein and Juliet Eilperin traced them to blunders committed by lawyers who were serving as government officials but had no significant operations backgrounds, technical competence or business experience–their authority underwritten directly by Pres. Obama.
Protracted failures of the U.S. healthcare.gov Web site became a classic case of the “software runaway,” memorialized about 20 years ago in the like-named book by Robert L. Glass. Recently, the inspector general for the U.S. Department of Health and Human Services provided a legal-eye view of this epic disaster.
Within the industry, a disease had been recognized by the late 1960s, with crashes of early airline reservation systems as the major, public danger signs. After a few years, remedies were known, and software professionals were addressing issues when clients and employers allowed them the time and responsibility to do that. The Software Engineering Institute at Carnegie-Mellon University gradually created a new profession: “software architect.”
However, the lure of “coding” as a source of instant magic remained amazingly seductive and has continued to undermine efforts. Project failures remain common, although few become as dramatic as the one that almost capsized the federal Affordable Health Care program. The root causes are usually the same: muddlers in charge of projects–lacking strong skills and strong character. Muddlers can be pleasant to work with and are often successful in some roles. Developing new software is not one of those, nor is designing a new bridge.
Assigning blame: As Daniel Levinson, inspector general for Health and Human Services, wrote, core elements in the recent disaster were:
• Poor leadership: “HealthCare.gov lacked clear project leadership to give direction and unity of purpose, responsiveness in execution and a comprehensive view of progress.”
• Poor management: “[The office] mismanaged the key…development contract, with frequent changes, problematic technological decisions and limited oversight of contractor performance.”
The software, coordinating transactions between millions of users and hundreds of back-office systems, would have been a nightmare on a sunny day. As usual, the foul-ups began at the beginning: writing requirements. The approach in nearly all durable efforts has been to start modestly and build out in steps. Disregarding readily found advice, spun from a long history of painful failures, government nitwits bought into the aptly named “big bang” approach: launch everything–all at once–and make it slick and shiny, and thus very complicated.
Chief Muddler at Health and Human Services was Marilyn Tavenner, the former administrator of the Centers for Medicare and Medicaid Services–not a “dear, sweet woman” but by training a nurse and street-wise organizer. Trying to direct technology, she was out of her depth. She lacked the sense to find and hire someone who could do the job.
While manufacturing a disaster, she had plenty of help from White House nitwits. They had only dreams of sharing limelight in a splendid performance. They had no industry backgrounds and no role in making anything actually work. Up against those would-be luminaries, Ms. Tavenner lacked the character to say “No,” and she lacked the skills to see she was merely rearranging deck chairs on the Titanic.
Remedies and wreckers: Mr. Levinson, the inspector general, seems to think remedies are obvious. He calls for “clear leadership.” However, his approach of “project leaders” would not help when designated leaders were also nitwits or muddlers. He is on sounder ground seeking “factors of organizational culture” that might help. However, as a career bureaucrat and a lawyer, Mr. Levinson does not seem to understand just what those factors might be or how to get them.
No major news source has yet described how a senior Administration official behind the blunders, Nancy-Ann Min DeParle–former director of the Office of Health Reform at the White House and from 2011 to 2013 Pres. Obama’s deputy chief of staff for policy–was allowed to quit the government before the health-care reform program began operating.
An ambitious person, regarded as a health-care policy expert, Ms. DeParle had served in prominent positions in the federal government and the state government of Tennessee, where she spent much of her youth and graduated from college. Her most obvious blunder, failing to set and then freeze program requirements, allowed a stream of changes ordered when efforts were already gravely behind schedule.
By failing to name key perpetrators in the healthcare.gov collapse and failing to state plainly what they did wrong, Mr. Levinson, the inspector general, emulates ancient Tibetan lamas. He is spinning prayer-wheels. His report will be shelved and forgotten, as federal government lurches toward its next appointment with disaster.
– Craig Bolon, Brookline, MA, February 23, 2016
Daniel R. Levinson, U.S. HHS inspector general, CMMS management of the federal marketplace: case study, February, 2016
Amy Goldstein, HHS failed to heed many warnings that HealthCare.gov was in trouble, Washington Post, February 22, 2016
Robert Pear, Sharon LaFraniere and Ian Austen, From the start, signs of trouble in federal project, New York Times, October 13, 2013
Sharon LaFraniere, Ian Austen and Robert Pear, Specialists see weeks of work ahead on federal health-care exchange, New York Times, October 21, 2013
Amy Goldstein and Juliet Eilperin, HealthCare.gov: How political fear was pitted against technical needs, Washington Post, November 2, 2013
Robert L. Glass, Software Runaways: Monumental Software Disasters, Prentice Hall, 1997