By Lawrence Summers
As the president has recognized, the failure of his administration to deliver a functioning website that Americans can use to enroll in Obamacare represents an inexcusable error. Having succeeded after more than a century of failed efforts in achieving the progressive dream goal of legislating universal health insurance in America, it is tragic to be falling short on the mundane task of allowing Americans to actually enroll in the healthcare exchanges. Even if the goal of getting the health insurance exchanges working by November 30 is achieved, and this cannot be regarded by objective observers as a certainty, a shadow has been cast on the core competence of the federal government.
What should be learned from this episode? It is too soon to know with confidence, but worth reaching some preliminary judgments while the issue is front of mind.
At a basic level the implications go to public management. The dismal track record of the implementation of large-scale information technology initiatives, even in rigorous and focused corporate environments, points up their difficulty. Unexpected obstacles always arise, deadlines are usually missed, and budgets are usually overrun. Maximizing the prospect of success requires providing for slack in the schedule and the budget, structuring projects with very clear accountabilities and frequent checkpoints, and assigning oversight responsibility to people with extensive IT experience, rather than general managers with programmatic commitments.
Success also requires some trusting by more verifying. A homeowner who hires a general contractor to build an extension to his house, discusses the specifications, and then goes away for 6 months is usually unhappy with the result. The same is true for public managers who hire contractors to perform essential tasks and then trust them and fail to rigorously oversee every step.
An additional requisite for success is steadiness and realism in the face of difficulty. Once a project gets off track, there is an overwhelming temptation for everyone involved to circle the wagons and promise rapid repair so as to hold critics at bay. Yet the right response to failure is to surface problems as rapidly as possible and to move more deliberately and carefully, not more quickly. The best football teams stick to their playbooks even when they fall behind. So, too, when projects fall behind, it is important to mobilize new resources and management but not to overpromise with respect to how soon and how good a fix is possible. Overoptimism once will ultimately be forgotten and or forgiven. Repeated overoptimism should not and will not be excused.
These are old truths that those responsible for implementing Obamacare should surely have heeded. Yet, fairness requires recognizing that there is an equally important and in some ways more fundamental factor behind the problems in implementing Obamacare — the systematic effort of the president's opponents to delegitimize and undermine the project.
Large-scale information technology projects in the private sector are hard enough with no organized constituency rooting for failure. It is no exaggeration to say that it has been the prophecy and the hope many of those responsible for funding the implementation of Obamacare, confirming the appointment of those who will do the job, and overseeing the results that the project will fail. They have been eager to seize on any problems, highlight any controversial judgments, and create an environment in which failure becomes the expectation.
It is disingenuous for those who stood ready to turn any regulatory detail into an attack ad to profess outrage when guidance was not provided during an election campaign. It is hypocritical for those who held up confirmations of key officials with responsibility for managing federal healthcare programs and whose behavior deterred many able people from coming into government to lash out at the incompetence of government management. And it is indefensible to refuse to appropriate money to carry out a program and then attack it for being under-resourced.
There is a danger here that goes far beyond delays in access to health insurance. The risk is of a vicious cycle developing in which poor government performance leads on the one hand to overly bold promises of repair, and on the other to reduced funding and support for those doing the work. This then leads to unmet expectations and disappointment, setting off the cycle again. In the end, government loses the ability to deliver for citizens and citizens lose respect for government. Our democracy is the loser.