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Tilly: Inflexibility and Obamacare

BY ZACH TILLY | OCTOBER 29, 2013 5:00 AM

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Since its rollout on Oct. 1, healthcare.gov has been a well-documented, thoroughly depressing, Hindenburgian disappointment. The online hub touted as an easy, one-stop destination for buying public or private health insurance has proven to be slow, creaky, and — for now, at least — virtually unusable. 

Since the site’s launch, users have been systematically booted or denied access. Some estimates from earlier this month pegged the site’s failure rate for prospective applicants at more than 99 percent. Not great.

Some critics have argued that the website’s failure represents the governmental ineptitude that many on the right have warned us about for more than three years. Indeed, the early failure of healthcare.gov is due in large part to the difficulty involved with massive government IT projects and may point to larger issues for Obamacare down the line.

According to a Computer World report, approximately 96 percent of all public sector IT projects costing more than $10 million resulted in failure — failure here defined as over-budget, late, or totally nonfunctional.

Yes, these projects are almost always contracted out to private companies, but there are a few major differences in the way developers handle government IT projects and private endeavors.

In the private sector, major software is usually developed by building a smaller product and then expanding it piece by piece in many iterations. In the public sector, the government sets out a number of upfront requirements and expects them to be met by its contractors.

In this case, the healthcare.gov website was built by a slew of private contractors ostensibly overseen by government. As Columbia University computer-science Professor Steve Bellovin wrote in a CNN op-ed earlier this month, the contractors’ messy final product was largely a result of poor oversight and integration of the site’s various components. Complex building requires a degree of flexibility that the government lacks.

That’s not to say that massive software builds come easy in the private sector, however. Such tech giants as Apple and Microsoft often roll out buggy or generally flawed products before they’re ready for primetime — think Apple Maps or Microsoft Vista.

Despite its many flaws, the federal insurance exchange will probably be fixed before Obamacare is fatally damaged. The administration’s point man on the healthcare.gov rehabilitation has targeted late November for full functionality, but this saga points toward major problems that may await health reform more broadly.

As Kimberley J. Morgan wrote in Foreign Affairs this month, Obamacare is a uniquely American piece of public policy — a globally unprecedented public-private mashup born of a fundamental distrust of government and characterized by its convolution.

Moving forward, that convolution will inevitably lead to a series of hang-ups in the program unless the government can find a suitable mechanism for tweaking the law during its implementation.

At the moment, such tweaks seem highly unlikely. In Congress, the conservatives have made clear that they prefer to dismantle rather than fix the law. Until those looking to repeal Obamacare recognize that that fight has been lost, there is little hope for future legislative fixes.

Any changes to the law by executive or bureaucratic action will be problematic as well. Their ability to change policy is limited, and any changes made by the president will be fraught with political risk.

Just last night, the Obama administration extended the window to apply for health insurance on the federal exchange without penalty by six weeks to March 31, a move certain to earn derision from the president’s opponents.

The government has proven that it lacks the flexibility to carry out a major IT build; time will tell if it is flexible enough to implement Obamacare.


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