As Obama takes heavy flack from all sides for the malfunctioning website
healthcare.gov I can't help but be reminded of
my years (and tears) at Centers of Medicare/Medicaid Service (CMS) trying to implement all the bug-ridden,
oversold/under designed apps that came our way. They were provided courtesy of a pack of
opportunistic, parasitic, inept software application development companies that
proliferate around the Maryland and DC area, also known as "beltway bandits."
Over the years we had to watch as all Federal government agencies in in every possible way, under both the Dems and the Repubs, assiduously contracted out as much of our work as possible. This was especially true of information technology (IT). Somehow it became an article of faith under both Democratic and Republican administrations that the "private sector" could do everything better. This notion, of course, can be traced back to of one Ronald Reagan. By the time I left we as the regional office level IT support staff did not even have the authority to work on our own staff's PCs let alone manage the larger operation. Our IT contractor at the time, the Lockheed Martin Corp, was tasked to handle virtually everything. We were left to simply passively preside over the process.
Over the years we had to watch as all Federal government agencies in in every possible way, under both the Dems and the Repubs, assiduously contracted out as much of our work as possible. This was especially true of information technology (IT). Somehow it became an article of faith under both Democratic and Republican administrations that the "private sector" could do everything better. This notion, of course, can be traced back to of one Ronald Reagan. By the time I left we as the regional office level IT support staff did not even have the authority to work on our own staff's PCs let alone manage the larger operation. Our IT contractor at the time, the Lockheed Martin Corp, was tasked to handle virtually everything. We were left to simply passively preside over the process.
Privatizing all IT operations at CMS in time would become a recipe for disaster as people with little or no real world technical experience (but identifiable "management skills") eventually
migrated into key executive level positions. So it is no surprise to see CMS management deeply implicated in the Obamacare website roll-out debacle - see today's NY Times article. It is also no surprise that an outfit like
CGI-Federal weaseled its way into being the lead contractor on the most important technical project of
Barack Obama's presidency, and then did such an abysmally poor job. Obviously the Obamanista's in concert with DHHS/CMS upper echelon supergrades
let themselves be bamboozled into signing off on a grand plan, and then as things started to head southward were rendered helpless when the circular blame game set in among the multitude of contractors.
Yet the two most populous states, NY and Calif which set up their own "health care exchanges", were able to set up functioning websites for the Affordable Care Act (ACA.) Of course the Federal level website was many times more complex because it had many more private insurance companies to link to (35 vs 11 in Calif.) Interestingly it turns out that the State of Maryland, a Demo-run state with their own health care exchange is also having problems with their website. Maryland probably got lured into using the same 'beltway bandits' that CMS got stuck with. Inexplicably a "go your own way ethos" seems to be part of the problem. Why did the designers of the big Federal one-size-fits-all website for multiple states not compare their initial design with ones already further along at the State level - like California's? It seems like a scaled up version of a working site might have been easier that building a whopper from scratch. Also why not look to Massachusetts which had years of experience with their RomniCare? From the accounts in the news it sounds as if they went their own way.
Part of the problem is the basic concept of ACA. It is quite a rickety Rube Goldberg contraption. It will probably be problem ridden for a long time because it is inherently an unwieldy concept. Apparently Obama felt like he could not take on the powerful health insurance industry and their deadly effective lobbying and propaganda apparatus. Recall they successfully deep-sixed Clinton's health care plan back in the 1990s. Of course private health insurance plans are useless "middlemen" in terms of delivering health care. Their primary objective is not providing health care but selling insurance - and for a profit. In fact the primary concept of insurance as a business is betting that the insured will not need it, and then if they do the hoping lawyer-concocted small print will allow the insurer to escape paying. Wasn't it these packs of heartless bastards that caused all the grief in the first place: denying claims for (suddenly uncovered) per-existing conditions, capping claims therefore driving millions into bankruptcy as they are struggling with ungodly expensive treatment for life threatening conditions, and having administrative costs that far exceeded those of government-run Medicare/Medicaid? Including the insurance companies in any "reform" of the US health care system has the Republican Party ideology (courtesy of Heritage Institute) stamped all over. It still baffles many why Obama would not take a more straight forward approach - like simply expanding Medicare. At least he could have started there as an initial bargaining position.
Nevertheless, for better or worse Obamacare/ACA is the law of the land and was found Constitutional even by our right-leaning Supreme Court. Obamacare would have had hit heavy headwinds once it hit the streets even if its website had worked like a well oiled clock. It inherently has a soft underbelly very vulnerable to the long knives of the GOP and their right wing media. It is a major social program and the GOP have opposed 'em all from FDR's New Deal to LBJ's Medicare. They hate social change in general (unless it harkens backwards to some glorified imaginary past.) But what a monumental blunder to unveil a signature program through a kludgy, bug-ridden joke of a website.
The real irony is that the one thing everybody still agrees on is that the US is still at the forefront of information technology. With all the talent at their beck and call and all of Obama's donor friends in Silicon Valley, it really is a wonder how they let this happen. The answer is that years of privatization of IT operations and the atrophy of in-house IT expertise at the highest levels of CMS have led to an agency inadequately prepared for projects of this magnitude. Add to this to a bureaucratic culture that is too inflexibly tethered to a Pentagon-like contracting process to consider reaching out beyond the Beltway for help.
That said, since the administration is so deeply fused and identified with it's Affordable Care Act and its basically just nuts and bolts technical issues that need to be resolved (and despite Republican gloating and a campaign of sabotage), in time I believe it will work. And as crappy as ACA is, it will be a definite improvement over what we presently have.
Yet the two most populous states, NY and Calif which set up their own "health care exchanges", were able to set up functioning websites for the Affordable Care Act (ACA.) Of course the Federal level website was many times more complex because it had many more private insurance companies to link to (35 vs 11 in Calif.) Interestingly it turns out that the State of Maryland, a Demo-run state with their own health care exchange is also having problems with their website. Maryland probably got lured into using the same 'beltway bandits' that CMS got stuck with. Inexplicably a "go your own way ethos" seems to be part of the problem. Why did the designers of the big Federal one-size-fits-all website for multiple states not compare their initial design with ones already further along at the State level - like California's? It seems like a scaled up version of a working site might have been easier that building a whopper from scratch. Also why not look to Massachusetts which had years of experience with their RomniCare? From the accounts in the news it sounds as if they went their own way.
Part of the problem is the basic concept of ACA. It is quite a rickety Rube Goldberg contraption. It will probably be problem ridden for a long time because it is inherently an unwieldy concept. Apparently Obama felt like he could not take on the powerful health insurance industry and their deadly effective lobbying and propaganda apparatus. Recall they successfully deep-sixed Clinton's health care plan back in the 1990s. Of course private health insurance plans are useless "middlemen" in terms of delivering health care. Their primary objective is not providing health care but selling insurance - and for a profit. In fact the primary concept of insurance as a business is betting that the insured will not need it, and then if they do the hoping lawyer-concocted small print will allow the insurer to escape paying. Wasn't it these packs of heartless bastards that caused all the grief in the first place: denying claims for (suddenly uncovered) per-existing conditions, capping claims therefore driving millions into bankruptcy as they are struggling with ungodly expensive treatment for life threatening conditions, and having administrative costs that far exceeded those of government-run Medicare/Medicaid? Including the insurance companies in any "reform" of the US health care system has the Republican Party ideology (courtesy of Heritage Institute) stamped all over. It still baffles many why Obama would not take a more straight forward approach - like simply expanding Medicare. At least he could have started there as an initial bargaining position.
Nevertheless, for better or worse Obamacare/ACA is the law of the land and was found Constitutional even by our right-leaning Supreme Court. Obamacare would have had hit heavy headwinds once it hit the streets even if its website had worked like a well oiled clock. It inherently has a soft underbelly very vulnerable to the long knives of the GOP and their right wing media. It is a major social program and the GOP have opposed 'em all from FDR's New Deal to LBJ's Medicare. They hate social change in general (unless it harkens backwards to some glorified imaginary past.) But what a monumental blunder to unveil a signature program through a kludgy, bug-ridden joke of a website.
The real irony is that the one thing everybody still agrees on is that the US is still at the forefront of information technology. With all the talent at their beck and call and all of Obama's donor friends in Silicon Valley, it really is a wonder how they let this happen. The answer is that years of privatization of IT operations and the atrophy of in-house IT expertise at the highest levels of CMS have led to an agency inadequately prepared for projects of this magnitude. Add to this to a bureaucratic culture that is too inflexibly tethered to a Pentagon-like contracting process to consider reaching out beyond the Beltway for help.
That said, since the administration is so deeply fused and identified with it's Affordable Care Act and its basically just nuts and bolts technical issues that need to be resolved (and despite Republican gloating and a campaign of sabotage), in time I believe it will work. And as crappy as ACA is, it will be a definite improvement over what we presently have.
