A selection of recent readings related to the Affordable Care Act
As Mike Myers, doing Linda Richman on "Coffee Talk," might have said: "The Affordable Care Act is neither affordable nor caring. Discuss." (And we're all a little verklemmt!)
When I first started reading comic strips more than 40 years ago, one of the most popular was Bil Keane’s Family Circus, a lighthearted look at childhood and family dynamics. One running gag had to do with the typical child’s response to accountability for errors and mischief.
Keane would draw a ghostlike figure running through a scene, behaving badly with a manic sort of glee while the mother demanded to know who had broken the lamp, created a mess in the living room, or let the dog out. Keane gave the ghost character the name of the inevitable response from the children – Ida Know.
Welcome to the Ida Know administration.
On Sunday night, I wrote a short post soliciting stories from my readers about how Obamacare has already immediately impacted their lives. I asked that all of these emails be directed to ObamacareMakesMeSick@Yahoo.com. I expected a response; I didn’t expect it to be quite so overwhelming.
Over the last 24 hours, my inbox has been flooded with hundreds of emails.
What exactly is broken?
It’s helpful to divide the problems into three categories: Getting in, getting eligible, and getting insurance.
The “unacceptable” speech is a staple of the Obama presidency. Through gritted teeth, the president acknowledges something he’d rather not, usually something his administration has screwed up royally—Benghazi, the IRS scandal, or the push for intervention in Syria. He detaches himself from the situation and all responsibility for what he’s acknowledging while offering a stern lecture for those who caused the problem— usually someone he hired and under his direct instruction— and promising to get to the bottom of it. He might show a flash of barely contained Spock-Obama anger to send a thrill up the legs of newscasters.
In the South Parkian parlance of the underpants gnomes, that’s Step 1. Step 2: ? Step 3: Problem solved.
Experts say the major problems with the Obamacare website can't reasonably be solved before the end of 2013, and the best fix would be to start over from scratch.
Obamacare isn't a political abstraction any longer. Its success doesn't depend on spin or solidarity. What matters for the law -- and for the people who are depending on it -- is how well it actually works. So far, it's not working well at all. If and when that changes, our coverage of the health-care law will change, too.
Failure isn’t rare for government IT projects – it’s the norm. Over 90% of them fail to deliver on time and on budget. But more frighteningly, over 40% of them fail absolutely and are never delivered. This is because the core requirements for a successful project – solid up-front analysis and requirements, tight control over requirements changes, and clear coordination of responsibility with accountability, are all things that government tends to be very poor at,
The mystery is why we keep letting them try.
Despite efforts to make government IT systems more modern and efficient, many agencies are stuck in a technology time warp that affects how projects like the healthcare exchange portal are built. Long procurement cycles for even minor government technology projects, the slow speed of approval to operate new technologies, and the vast installed base of systems that government IT managers have to deal with all contribute to the glacial adoption of new technology. With the faces at the top of agency IT organizations changing every few years, each bringing some marquee project to burnish their résumés, it can take a decade to effect changes that last.
As others have noted, the failure of healthcare.gov is not unique in the annals of government technology projects. But it is surprising that the Obama administration—which has tried to build a reputation for competence—did so spectacularly badly on its flagship project. Most likely, there were just not enough people in the chain of command who had enough understanding of technology to realize that things were going horribly wrong, which is a pretty clear management failure on the part of the administration.
The biggest problem with Healthcare.gov seems simple enough: It was built by people who are apparently far more familiar with government cronyism than they are with IT.
From the original Roosevelt/Wilson/Brandeis party, through the New Deal, to the Great Society, and now the Obama party of Hope and Change, Progressives have assiduously aligned themselves to the latest tech revolution, courted its leaders . . .and then extracted from it exactly the wrong lessons.
Three notes on our possible future: "Government Run Health Care: Surgery Caps in Canada," "IRS tax-credit scandal a bad omen for Obamacare," and "Why The Federal Government Wants To Redefine The Word 'Cancer'".
Finally, as almost always, a little humor helps ease the pain and dismay: Saturday Night Live's take and "New, Improved Obamacare Program Released On 35 Floppy Disks". (The Onion, of course.)