Politics prevent IT best practices, all but dooming Obamacare to initial failure

Politics prevent IT best practices, all but dooming Obamacare to initial failure

Summary: From a technological implementation standpoint, there was no reason that healthcare.gov had to crash and burn so badly. Ah, but there was a reason it crashed: the nature of politics.


The Drudge report headlined "Emergency Surgery" this weekend, pointing out the various startup failures experienced by the IT backbone behind the Affordable Care Act, better known as Obamacare.

2013 10-20 obamacare
Image: Drudge Report

Coming right on the heals of the government shutdown designed to kill it, the first week of ACA registration and sign-up was an unmitigated disaster. Almost nobody was able to sign in the system. The Web interface failed regularly, and the entire launch of the system was a fiasco.

Our own Larry Seltzer details the challenges he had trying to log into healthcare.gov. It wasn't pretty. Larry continues his coverage with Health insurers getting bad data from healthcare.gov

Let's set aside, for a moment, whether or not Obamacare is good policy. I've written at length about the failings of our health insurance system (see my book for a free read), and while Obamacare does overcome some of the problems, it's really a very, very expensive band-aid pasted over a very, very cancerous organ.

But, like I said, let's not discuss health policy today. Let's just look at what it takes to launch a nationwide IT project with millions of expected users.

This is not breaking new ground. Facebook, Google and even Twitter, not to mention many smaller players, are able to easily support millions of users with impressive responsiveness and reliability.

The science of how to scale the consumer-facing side of a major IT system is not new. There are many examples, not just of the software, but even of how to implement a system to scale in hardware. Facebook has even open-sourced some of their IT infrastructure design, down to the hardware component level.

So, from a technological implementation standpoint, there was no reason that healthcare.gov had to crash and burn so badly.

Ah, but there was a reason it crashed: the nature of politics.

Let's separate out the question of the contractor. There has been some discussion why an American arm of a Canadian firm was contracted to do this project, but for the purpose of this discussion, we'll leave them out of it.

The fact is, there's one factor involved that may well have doomed any vendor to failure with Obamacare: politics.

Think about this for a second. Healthcare.gov rolled out to the entire United States population on one day. All at once. Of course it blew up.

That is not how you're supposed to roll out a system. Even Facebook started small, with limited functions, and supporting only Harvard students. It is a very bad practice to roll out your entire system to the full breadth of a huge user base. It pretty much stands no chance of succeeding.

Unfortunately, the nature of politics pretty much doomed the Obamacare rollout to failure. Imagine if HHS had tried to do a staged rollout. They could have chosen one town (like Google has done with fiber), and tested it in a microcosm. But then, the news channels, the bloggers, and the politicians would have screamed favoritism.

Or HHS could have opened the service up to a limited number of initial ticket holders, say a few hundred or a few thousand. But how those initial tickets would have been distributed would have caused an uproar. If they were originally distributed to government employees, more charges of favoritism would have been wielded. If they were offered to a specific category or group of people, again there would have been complaints.

And yet, that's exactly what should have happened. The healthcare.gov infrastructure should have been rolled out to a very small group, tested, refined, and then rolled out to a slightly larger group, with ever more testing and ever more debugging.

Sure, it might have taken a year or more to do the rollout, but it's how this stuff is done. You can't just hang best practices in the cloak room because the system is fraught with political debate.

Frankly, the biggest mistake made here was with the administration, which didn't firmly set expectations and didn't firmly express that best practices come before politics. On the other hand, you can't entirely blame them, since their entire system has been under extreme hostile fire since the day it was proposed.

That said, that's the purpose of senior management, in an enterprise or in government. Once you decide to deploy a system, it's up to the IT professionals to build it using accepted professional practice. And it's up to senior management to run interference and make it possible for the professionals to do their work.

This didn't happen this time, and it probably won't the next time.

You want to know the worst part of this story? Now that the rollout failed, because it didn't iterate from small to large like it should have, it's being patched. Zack Whittaker has that story. We all know how hard it is to maintain a spaghetti-coded patchwork of rush-job coding fixes.

Because best practices weren't assured from the beginning, we can be pretty well assured that this beast will be a costly problem to maintain from Day One going forward.

The sad part of this story is it didn't have to be this way. Once again, I blame the politicians.

Topics: Cloud, Big Data, Government, Government US, Security


David Gewirtz, Distinguished Lecturer at CBS Interactive, is an author, U.S. policy advisor, and computer scientist. He is featured in the History Channel special The President's Book of Secrets and is a member of the National Press Club.

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  • You lost me...

    When you referenced the Drudge report.
    • Why? All Drudge does is aggregate

      News stories. Or do you make it a habit of ignoring reality when you don't like the messenger?
  • Separation of Health Care and State

    There are no incentives in government for doing things efficiently or at low cost. There are virtually no incentives in government to have superior customer service. Why should they? They have a monopoly!

    That's one of the many reasons why we should not entrust things like health care to our government. We need a Separation of Health Care and State. Government intervention beginning in the 1940's is what has brought health care in the US to its broken state. More government intervention, such as Obamacare, is the exact opposite of the correct solution.
    • Alternative punishment

      Instead of execution, I think monetary punishment would work very well in the current climate.

      So instead of a 13Bn fine for JP Morgan ... 25Bn for each of the next 10 years.

      And if you really screw up in Government then your entire wealth is forfeit and you spend the rest of your life, not in prison (that costs money), but working in a low grade job well within your competence level on minimum wages.
  • The law has no rollout either.

    "Sure, it might have taken a year or more to do the rollout, but it's how this stuff is done."

    Slight problem: The law has no rollout either. So they can't rollout the website like that because people are legally required to have the insurance.

    . . . it was pretty much doomed from the start.
    • Rollout

      It is fairly obvious the politicians did not ask any IT experts what would be the best practices. And they expected the implementation to be easy. Many in IT were worried this would happen and the political response would keep charging at through the minefield praying that no more mines go off. The only way to fix it is to delay it at least 1 year and to possibly look at phased rollout of parts of the insurance.
      • IT experts

        Thee's the problem. You would expect an international IT company with 60,000 employees to be more careful on such an enormously high profile project. This is the Kansas DMV debacle magnified a million times and stuck out for the world to see.
    • And whose fault was that?

      The more I think about this, it occurs to me that the problem isn't politics, but bad politics.

      Whatever FDR and LBJ would have done, I'm quite sure it wouldn't have been this.
      John L. Ries
      • And you would have been wrong

        FDR ordered massive quantities of food be dumped into lakes to keep prices high. He made the owning of gold illegal. He created massive work programs that there were often little more than one crew digging holes and the other crew filling them back up.
        • Yes, but...

          ...right or wrong, he was a much more effective politician than Mr. Obama has ever been, which was my point. You may think he was such a tyrant that it really didn't matter who won WWII, but that's not relevant to the discussion.
          John L. Ries
  • "Politics prevent IT best practices"

    This NEVER happens in the business world.
    Rabid Howler Monkey
    • Oh, it does, but since there is always more than

      one business vying for your dollars for the same product, the effect is greatly minimized.
      • Depends on how competitive the market really is

        The sorts of oligopolistic markets that we've come to see as "mature" aren't all that free. And my own experience suggests that large corporations aren't much more efficient than the U.S. Government is.
        John L. Ries
        • That is no surprise

          Since, as our nation becomes less capitalist and more fascist, success becomes less about serving the customer and more about establishing the correct political connections.
    • That sounded sarcastic

      And you did catch the expected fish.
      John L. Ries
  • Rollout

    A staged rollout of features might have worked with a 2-3 period between each new phase. You would start with the most basic and add features. The political decisions were to ignore any real world IT experience and to rollout Obamacare with all the features at once. Another political decision was the funding of it by forced purchase rather than by taxes.
  • depends on goals

    Recall the goal of most of the advocates for Obamacare, is not the ACA, but a single payer NHS. To get there, ACA not only has to break the old model irreparably, but it, itself, must fail. Leaving open only that one final course of action.

    If the administration had wanted, they could have rolled it out iteratively, they could have even done it in a devious way, by launching the initial signups into poor but conservative areas of the South and/or rural Rocky Mountains to undercut the Tea's. But that would imply that they wanted satisfied customers. Satisfied customers won't insist on the next step.

    ACA has to end up as a barely working disaster, only slightly less disastrous than what it left behind.
    • Obama lost me when he dropped the public option

      The public option was not touted as "a single payer NHS". As a result of Obamacare, my health insurance costs have skyrocketed. More money in the pockets of Big Pharma.

      And the concept of requiring citizens to have health insurance also rankles me. Those with limited incomes shouldn't be told how to allocate their resources by the government.
      Rabid Howler Monkey
    • Government health care is never about

      health care. It's about power. It lets the government more easily buy your vote, and create enemy groups to turn you against (the fat, big pharma, greedy insurance, etc.)
    • We don't know if single payer was really the goal

      That has been frequently speculated, but mind reading is a highly inexact science. Certainly, that's what a fair number of Democrats on the left wing of the party wanted, but at this point, I think problems with the ACA are much more likely to be due to the incompetent politics we can see than the back-room maneuvering we can't.
      John L. Ries