The staff of the House Oversight and Government Reform Committee puts out some great reading material about implementation of the Patient Protection and Affordable Care Act (PPACA). Its latest work, a report on why the HealthCare.gov exchange website worked so poorly when it launched, is hilarious.
The staff makes the cause that the site had problems because the staff at the Centers for Medicare & Medicaid Services (CMS), an arm of the U.S. Department and Health and Human Services (HHS) was in an office politics war with the HHS tech people.
One HHS tech specialist told a senior HHS manager, “Your leadership only wanted to hear beautiful music and talk about rainbows and unicorns,” according to an e-mail quoted in the report.
Shortly after HealthCare.gov went live, Henry Chao, the CMS deputy chief information officer, called the site a “burning house” and questioned the sincerity of HHS officials who asked for progress reports.
What Your Peers Are Reading
On the one hand, any day House Committee staffers can quote e-mail like that in a report is a good report writing day.
On the other hand, just the idea, that privately, behind the scenes, CMS and HHS tech people understood that the HealthCare.gov project was a mess is comforting. Everything in life takes longer and costs more. Everything that can go wrong will go wrong. The people working on HealthCare.gov faced horrendous political, timing and budget pressure. Even people working on great, successful projects for large, successful organizations squabble. Think of all the awful things Mr. Spock said about Dr. McCoy on Star Trek, and vice versa.
When Rep. Elijah Cummings, D-Md., talked about the lives that he thinks PPACA has saved, and expressed disgust at seeing House Republicans obsess about problems at HealthCare.gov, I think he had a point. At some level, who cares about a stupid website? We know that the federal government has many complicated websites that work well and are secure enough to get us through the day. Even if HealthCare.gov and everyone at HHS and CMS were horrible, that would have no direct bearing on whether the PPACA exchange system and the PPACA commercial health insurance rules make sense or not. If the Republicans showed a little flexibility, Obama could simply wave a hand and have Apple, IBM or Google replace HealthCare.gov with a system that would work great and give us lattes decorated with little skim milk hearts.
The core of whether the PPACA commercial health insurance exchanges work is whether the defenses against anti-selection work, and whether the measures intended to hold down health care costs work.
On the fourth hand: I think how the Obama administration is handling communications about HealthCare.gov problems does have a bearing on whether implementing the PPACA commercial health insurance programs is feasible.