An article in Time Magazine explores the failed launch of HealthCare.gov, and analyzes how no one in the White House knew what was going on. The long in short of it, was that the White House thought it was above the implementation of the law (par for the course), and trusted the Centers for Medicare and Medicaid Services (CMS) to take care of all the details. Here are some of the highlights.
In the days after the launch of HealthCare.gov, the President and his staff worked assiduously to try to figure out what went wrong with the Centers for Medicare and Medicaid Services (CMS):
McDonough and the President had convened almost daily meetings since the Oct. 1 launch of the website with those in charge–including Health and Human Services Secretary Kathleen Sebelius, CMS administrator Marilyn Tavenner and White House health-reform policy director Jeanne Lambrew. But they couldn’t seem to get what McDonough calls “actionable intel” about how and why the website was failing in front of a national audience of stunned supporters, delirious Republican opponents and ravenous reporters.
“Those meetings drove the President crazy,” says one White House senior adviser who was there. “Nobody could even tell us if the system was up as we were sitting there, except by taking out laptops and trying to go on it. For Denis, going to Baltimore was like leaving Washington and visiting a war zone.”
Not even those at CMS knew the extent of this clusterf*ck.
But not even a trip to the war zone produced good intel. According to notes from a meeting in one of CMS’s three war rooms (yes, things were so uncoordinated that there were three), those assembled discussed the fact that “we heard that the capacity”–the number of possible simultaneous users–“was 100,000 people, and there are 150,000 people on it.” Yet five days later, White House chief technology officer Todd Park would tell USA Today that the capacity was 50,000 and that the website had collapsed because 250,000 people tried to use it at the same time. Park, a highly successful–but, for this job, disablingly mild-mannered–health care tech entrepreneur, had been kept out of the planning of the website. In fact, the site’s actual capacity at the time was “maybe a few thousand users,” according to a member of the team that later fixed it.
The President, as late as October 17 (two weeks after the launch), even considered scrapping the web site altogether, and starting from scratch.
Unknown to a nation following the fiasco, McDonough’s assignment from the President had boiled down to something more dire than how to fix the site. As the chief of staff remembers his mission, it was “Can it be patched and improved to work, or does it need to be scrapped to start over? He wanted to know if this thing is salvageable.”
Yes, on Oct. 17, the President was thinking of scrapping the whole thing and starting over.
The article alludes to the fact that the White House’s initial reaction to the failed launch–high volume–was not entirely accurate. I recall listening to the Diane Rehm show on the day it launched, and a caller suggested that Republicans were intentionally flooding the site with traffic so it wouldn’t fail. Ha!
Obama and McDonough had quietly brought Zients in the week before when it had become obvious that the early White House and CMS explanation for the website’s problems–astonishingly high volume–was anything but the whole story.
Was the site salvageable?
Zients, who is not an engineer, was teamed with Park, the White House chief technology officer. “On Oct. 17, I went from White House CTO to full-time HealthCare.gov fixer,” Park says. The two were charged, says Zients, with “finding fresh eyes who could decide whether the thing was salvageable.”
As one of the engineers they recruited put it, “Maybe we had to tell the world we’ll be back to you in six or nine months with a new site.”
The article also relates Jay Carney’s press briefing on October 17, the day the shutdown ended–and all attention focused on the web site.
As McDonough and Zients were digesting what the chief of staff had learned in Baltimore, White House press secretary Jay Carney was going through what one senior Obama aide calls “probably the most painful press briefing we’ve ever seen … It was like one of those scenes out of The West Wing where everyone’s yelling at him.”
Thursday, Oct. 17, was the day the government shutdown ended. Until then, the failed launch of the website on Oct. 1 had been overshadowed in the news–and in the questions Carney had to field every day–by the shutdown and the related threat of a debt-ceiling deadlock. Now the unfolding Obamacare disaster was center stage.
Carney tried to fend off the inquisition, but he had little to work with. Pressed repeatedly on when the site would be fixed, the best he could say was that “they are making improvements every day.”
“They” were, in fact, not making improvements, except by chance, much as you or I might reboot or otherwise play with a laptop to see if some shot in the dark somehow fixes a snafu.
The article also confirms my suspicion that no one in the White House had a fricking clue about the problem. The article suggests that this is due to the fact the White House was “above the nitty-gritty of implementing it.” Also, I suspect many in the chain of command were afraid of reporting failure.
It is also a story of an Obama Administration obsessed with health care reform policy but above the nitty-gritty of implementing it. No one in the White House meetings leading up to the launch had any idea whether the technology worked. Early on, Lambrew, highly regarded as a health care policy expert and advocate for medical care for the poor, kept Park off the invitation list for the planning meetings, according to two people who worked on the White House staff prior to the launch. (The White House declined to make Lambrew available for an interview.) The only explanation Park offers for his exclusion is that “The CTO helps set government technology policy but does not get involved in specific programs. The agencies do that.” The other attendees were also policy people, pollsters or communications specialists focused largely on the marketing and political challenges of enrolling Americans.
McDonough says that in meetings with the President prior to the launch, Obama always would end each session “by saying, ‘I want to remind the team that this only works if the technology works.'” The problem, of course, was that no one in the meetings had any idea whether the technology worked, nor did the President and his chief of staff have the inclination to dig in and find out. The President may have had the right instinct when he repeatedly reminded his team about the technology. But in the end he was as aloof from the people and facts he needed to avoid this catastrophe as he was from the people who ended up fixing it.
Such uninformed hubris, even 37 hours before the launch, they thought that it would “knock your socks off.”
When the President said he would not have said it would work like Amazon if he knew that, this is not answering the question.
McDonough, as chief of staff, was supposed to be tending to everything associated with the rollout, including the technology. But he and Lambrew simply accepted the assurances from the CMS staff that everything was a go. Two friends and former colleagues of McDonough’s say they spoke to him 36 hours prior to the launch, and in both conversations he assured them that everything was working. “When we turn it on tomorrow morning,” he told one friend, “we’re gonna knock your socks off.”
The rest of the article focuses on how a dream team of whiz kids was assembled to fix everything.
Here was their initial assessment of the site:
When the meetings ended at a CMS outpost in Herndon, Va., at about 7:00 p.m., the rescue squad already on the scene realized they had more work to do. One of the things that shocked Burt and Park’s team most–“among many jaw-dropping aspects of what we found,” as one put it–was that the people running HealthCare.gov had no “dashboard,” no quick way for engineers to measure what was going on at the website, such as how many people were using it, what the response times were for various click-throughs and where traffic was getting tied up. So late into the night of Oct. 18, Burt and the others spent about five hours coding and putting up a dashboard.
What they saw, says Park, was a site with wild gyrations. “It looked awfully spiky,” recalls Panchadsaram. “The question was whether we could ride that bull. Could we fix it?”
The initial task was to decide if the site could be saved, or must be killed.
Nor did the President volunteer that he had recruited a team whose first job was to decide whether to kill the website and start over.
“The first red flag you look for,” says Abbott, “is whether there is a willingness by the people there to have outside help. If not, then I’d say it’s simpler to write it new than to understand the code base as it is if the people who wrote it are not cooperating. But they were eager to cooperate.”
“The second thing, of course, was, What were the tech problems? Were they beyond repair? Nothing I saw was beyond repair. Yes, it was messed up. Software wasn’t built to talk to other software, stuff like that. A lot of that,” Abbott continues, “was because they had made the most basic mistake you can ever make. The government is not used to shipping products to consumers. You never open a service like this to everyone at once. You open it in small concentric circles and expand”–such as one state first, then a few more–“so you can watch it, fix it and scale it.”
Interestingly, no one knew who was in charge of anything!
What Abbott could not find, however, was leadership. He says that to this day he cannot figure out who was supposed to have been in charge of the HealthCare.gov launch. Instead he saw multiple contractors bickering with one another and no one taking ownership for anything. Someone would have to be put in charge, he told Zients. Beyond that, Abbott recalls, “there was a total lack of urgency” despite the fact that the website was becoming a national joke and crippling the Obama presidency.
The Washington Examiner had another exclusive this week–that an HHS official found the White House in “disarray” in the months before Obamacare rollout.
A senior Health and Human Services official was so frustrated last May over the White House‘s “disarray” on health care before the launch ofObamacare insurance exchanges that he warned of needing a “come to Jesus meeting” with his counterparts.
The comment from Anton Gunn, then-HHS director of external affairs, came in an email exchange with Anne Filipic, the president of the outside group Enroll America, a nonprofit with close ties to the White House that was formed to promote the fall Obamacare rollout and boost enrollment — an effort the two were working on closely.
While criticism of the botched healthcare rollout has focused on Health and Human Services Secretary Kathleen Sebelius and her department’s failures, the email exchange dated May 1 between Gunn and Filipic reveals that HHS officials harbored deep frustrations about the White House’s own health care messaging and preparations in the middle of 2013, months before the troubled rollout. (
From top to bottom, this law has been plagued by a series of unfortunate failures that would make Lemony Snicket cringe. From lies to sell it (if you like your insurance you can keep it), procedural shenanigans to pass it (using the reconciliation process to rewrite the entire bill, not subject to the filibuster), dubious constitutional argumentation (it’s not a tax, but it is a tax, but it’s not a tax), threats to the states, (if you turn down Medicaid expansion money, you lose your entire budget), leaning on companies not to criticize the law (remember those comments from Secretary Sebelius), executive non-enforcement (delaying mandates without authorization from congress), and I could go on and on and on. After teaching this case now, it still boggles my mind the manner in which this Levithan was created. It was marked at every step by misrepresentations, misleading statements, and incompetence.