The Agnostic’s Guide To The Botched Obamacare Rollout

The Article: The Agnostic’s Guide to the Botched Obamacare Rollout by Kurt Eichenwald in Vanity Fair.

The Text: There isn’t a lot of honesty when it comes to discussing Obamacare. Too many Republicans lie about the implications of the health-insurance program and dismiss out of hand the reasons a massive overhaul of the long-time system is necessary. Too many Democrats dismiss the challenges that the program faces, its potential shortcomings, and the flaws in its design. Then, on both sides, there are the absolutists: conservatives who say the uninsured are just a bunch of lazy takers, and the liberals who say that only a single-payer system can solve the problems we face.

Small wonder it’s virtually impossible to get a clear understanding of how to look at the bumpy start to the Obamacare rollout.

I’ll give it a shot. While I’ve been writing about Obamacare of late—attacking the G.O.P. lies and explaining why an overhaul of our system is necessary—folks seem to have missed that I’ve never said whether I believe the president’s signature legislative victory is any good. There’s a reason for that: I don’t know. I am an Obamacare agnostic—if it works, as I hope it will for the good of the nation, then it’s a great thing. If it doesn’t, then that is a disappointing thing and we need to try something else. Unlike too many, I don’t believe pretending to be a soothsayer—“It will destroy America!” “It will save the world!”—is anything more than ideologically driven sophistry.

What is the agnostic’s view of the botched opening days of Obamacare? What should the folks who only care if the policy works think? Not a lot. But don’t fail to watch the weeks to come with a critical and suspicious eye.

Yes, it’s namby-pamby. But here is the reality: That’s all it can be. Anyone who is screaming that the troubles mean everything or that they mean nothing is advancing a purely ideological viewpoint disguised in the clothes of analysis. There is no way to look at this honestly without an “on the one hand/on the other hand” assessment. And if I can get folks to understand that, then perhaps they’ll sit back and wait for more information.

So, let’s break out the hands and show why both sides have a point:

The rollout troubles really don’t mean much about the Obamacare program.

This is true. In the early days of Twitter, the “fail whale”—the image used by the system to depict a crash—appeared almost every day. The huge system has experienced more recent, massive disruptions caused by unforeseen bugs. But conservatives did not run out to proclaim these problems showed that all social media—or even just Twitter—was a failure. Obama was also right to compare the problems to the recent rollout of iOS7, Apple’s new mobile operating system (which I hate, by the way). Fact is, releases of major software systems—whether on a Web site or inside personal hardware—is not unusual.

And there was little reason to expect the healthcare.gov site would be immune from this typical problem. The site is one of the most complicated Web-based undertakings ever envisioned not only by the federal government but possibly by any Internet product provider. It involves operations for or referrals to exchanges for 50 states. Of that, the federal exchange is responsible for the insurance assessment of 34 states that refused to set up their own operations. (Given that so many states with Republican governors refused to establish a state exchange, there is certainly an argument to be made that there was a concerted effort to make the federal operations as unwieldy as possible.) The Government Accountability Office spelled out the difficulties in a report it issued last June:

Development has been a complex undertaking, involving the coordinated actions of multiple federal, state, and private stakeholders, and the creation of an information system to support connectivity and near real-time data sharing between health insurance exchanges and multiple federal and state agencies.

Adding to the complexities, this effort involved 55 different contractors, all operating under the supervision of the Centers for Medicare & Medicaid Services. In other words, there are a lot of moving parts here—when one company can’t put out software without bugs, of course something with this amount of difficulty involving dozens of companies will have problems.

The administration has also moved quickly to create some strongly needed changes on the site. Now folks don’t have to set up an account to check policies in their area; they can just go to the site and run through a very simple series of steps to see what insurance they can obtain and for how much. I did it—and I could obtain insurance of the same quality I have for a lower cost through an exchange.

The reality, though, is that the rollout isn’t what matters—it’s the long-term performance. If, by March of next year, everyone who wants insurance has been able to obtain it, then the fact that there were serious problems in the early days will be an irrelevant footnote forgotten by most, except the Republicans who will want to keep beating the drum about how bugs in software prove a policy doesn’t work.

The disastrous rollout of the Obamacare Web site signals that the whole program could fail.

That is true. Although notice the tweaks I’ve made to the argument some conservatives are advancing: it doesn’t show that Obamacare will fail, no more than the opening few games of the Yankees’ next season will show that they won’t make it to the World Series. But it does raise the possibility that things will not work out.

The government folk involved in Obamacare have not been honest—either with themselves or with others—about the shortcomings in what they were doing. There were plenty of missed deadlines to suggest that there was a train wreck coming. In fact, these officials were on full notice as recently as June—in that same G.A.O. report I mention above—that they could be in trouble in terms of meeting the goal of opening the Web site on October 1. The report said:

Much remains to be accomplished within a relatively short amount of time. CMS’s timelines and targeted completion dates provide a roadmap to completion…. However, certain factors, such as the still-unknown and evolving scope of the exchange activities CMS will be required to perform in each state, and the large numbers of activities remaining to be performed—some close to the start of enrollment—suggest a potential for implementation challenges going forward. And while the missed interim deadlines may not affect implementation, additional missed deadlines closer to the start of enrollment could do so. CMS recently completed risk assessments and plans for mitigating identified risks associated with the data hub, and is also working on strategies to address state preparedness contingencies. Whether CMS’s contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined.

Faced with that hurdle, which was described in achingly specific detail in the G.A.O. report, Obamacare officials bubbled confidently that there would not be a problem. The report quotes them as saying:

In commenting on a draft of this report, the Department of Health and Human Services emphasized the progress it has made in establishing exchanges, and expressed its confidence that exchanges will be open and functioning in every state by October 1, 2013.

Oops. That didn’t work out as expected.

And there is the problem: if the people running this thing were not honest or capable enough to see the disaster that was coming, how can anyone trust that their predictions of solving the problems fast enough to allow Americans to obtain insurance before the March 1st deadline is true?

On top of that, let’s look at the contracting work that was done by the administration. The I.T. contractor that was responsible for much of the healthcare.gov site was a Canadian company called CGI Federal, a subsidiary of CGI Group. http://www.cgi.com/en The company was not a long-time player in the world of I.T. contracting for the American government. And its work in the health-care world has not been without struggles. A recent report in the Washington Examiner noted:

CGI Federal’s parent company, Montreal-based CGI Group, was officially terminated in September 2012 by an Ontario government health agency after the firm missed three years of deadlines and failed to deliver the province’s flagship online medical registry. . . . eHealth, the Ontario provincial agency, scrapped its high-profile online medical registry for diabetes sufferers and treatment providers, and cancelled CGI Group’s $46.2 million contract, on Sept. 5, 2012. The company was 14 months behind schedule when it was given notice of termination by the Ontario government agency. In the meantime, a group of other Ontario IT companies successfully replicated the registry, rendering CGI’s project obsolete. Because the contract terms stipulated payment only upon delivery of a satisfactory final product, the province has refused to pay CGI . CGI has not publicly discussed the eHealth failure, but has taken legal action, including filing a defamation suit against eHealth and the Toronto Star newspaper.

While that single event is not definitive, it certainly should have raised questions for Obama-administration officials about whether CGI—particularly given its comparatively recent appearance on the American-government-contracting scene—was the right company to entrust with such a complex and important project. And the fact that the company decided to bring even more attention to the negative news by suing the highest-circulation newspaper in Canada—regardless of what it said—says something about its strategic wisdom and temperament. That was guaranteed to bring even more attention to the story than just letting a news report slide.

So, all those problems add up to one thing: Are the administration officials who are responsible for Obamacare up to the task? Can they honestly assess their own performance and shortcomings, and are they exercising the care to make the right decisions up front?

Not sure. But these facts don’t bode well for their skill set here. And it is that reason—not whether or not the Web site worked on day one—that should give the honest assessor of Obamacare pause. These folks might not be up to this incredibly complicated task.

So, does all of this mean we should pull the plug on Obamacare? Of course not. Does it mean we shouldn’t worry, since Web sites have bugs? No again.

Unfortunately, there is only one correct answer: we have to wait. If Obamacare works, it works. If it doesn’t, it doesn’t. No amount of prognosticating now is worth the time it takes to utter the words.

One thing, though, that I fully believe in: democracy. If Obamacare is a disaster, I have little doubt that the G.O.P. will be voted into office and be able to unwind the whole system—the proper, Constitutional way to handle a program opposed by one party, rather than engaging in the extortion approach they exercised recently. And if Obamacare works, I have no doubt that the Democrats will be able to see the benefits at the voting booth for a long time to come.

And face facts: it is that reality—long-term political survival—that is the real basis for the partisan attacks and defenses of the botched opening days of Obamacare.