In the 2008 election, President Obama’s advisers talked of their boss’s belief that it was time for an "iPod government." Obama, a technology addict who tools around on his iPad before going to sleep and who fought the U.S. Secret Service bureaucracy for the right to carry a smartphone, would be the first president truly at home in the Digital Age. That put him, he thought, in a unique position to pull the federal government into the Digital Age, too. His administration wouldn’t just be competent. It would be modern. And it would restore America’s faith that the public sector could do big things well.
After Obama got to the White House he tried to deliver on the promise. He created positions for a chief information officer and a chief technology officer. He embarked on a massive effort to open up government data. He created an online dashboard to bring transparency to the government’s spending on IT. "If a project is over budget or behind schedule, this site tells you that, and by how much—and it provides the name, the e-mail, and the phone number of the person responsible," Obama said in January 2010. "To date, the site has gotten 78 million hits."
To Obama, this was part of the core work of rescuing the idea that government could actually solve big problems. All too often, the best efforts of talented public servants "are thwarted because the technological revolution that has transformed our society over the past two decades has yet to reach many parts of our government," he said in that 2010 speech. "Many of these folks will tell you that their kids have better technology in their backpacks and in their bedrooms than they have at the desks at their work."
The disastrous launch of healthcare.gov,the online portal that was supposed to be the linchpin of the Affordable Care Act, has dealt a devastating blow to Obama’s vision. In the months leading up to the Oct. 1 rollout of the site, the president rarely compared his signature policy achievement to Medicare or Social Security. Instead, he favored analogies to e-commerce sites such as Orbitz, Travelocity, and Expedia. Obamacare was supposed to be the model for a 21st century social program, not a replica of programs built in the 20th. Now Republicans are seizing on the breakdown of the health exchange to reinforce the idea that government can’t do anything right—particularly not anything of this size. "The rollout of this law made a trip to the DMV look like a day in the park," says Senate Minority Leader Mitch McConnell (R-Ky.).
Even Obama’s allies acknowledge that the healthcare.gov debacle could do damage beyond the health-care system. "This plays into the suspicion that resides in really all Americans that, outside of narrow functions they can see and appreciate like Social Security and national parks, the government just can’t get it done," says Austan Goolsbee, who was Obama’s top economic adviser during the 2008 campaign.
Obama’s problems aren’t unique. In 2005 the website for the Medicare prescription drug benefit launched three weeks late—the Bush administration initially blamed the Jewish holiday Yom Kippur for the delay—and the early months of the benefit were pure chaos. In January 2006, 54 percent of Americans told Gallup the new law wasn’t working. In February 2006, then-House Majority Leader John Boehner (R-Ohio) called the rollout "horrendous" on Fox News Sunday. But the law survived. Today more than 90 percent of seniors approve of Medicare Part D, and Republicans regularly cite it as a model for future health-care reforms.
Jeffrey Zients, the White House official tasked with running the rescue of Obamacare, promises a swifter recovery. He says that "by the end of November, healthcare.gov will work smoothly for the vast majority of users." If he’s able to deliver, that will leave the law plenty of time to stabilize. Like Medicare Part D, it could emerge from a troubled launch to become a wildly successful program. But reviving the idea that government can do big things right will be harder.
The saga of healthcare.gov has been a symphony of government inefficiency. The effort, directly overseen by the IT department of the Centers for Medicare and Medicaid Services, involved no fewer than 55 contractors. The process was thick with lawyers and political interference. In violation of current best practices in the software world, the code was kept almost entirely secret; other engineers weren’t able to point out its flaws, and it wasn’t tested rigorously enough. The Obama administration has been assailed for not calling in Silicon Valley’s top minds to collaborate, but that misses the fundamental problem: The best coders in the Valley would’ve never agreed to work under such deadening, unpleasant conditions.
The flawed product poses real dangers to the law’s success. The front-end shopping experience—which is what people mean by "the website"—is busted, but there are also persistent errors in the systems that authenticate users, determine eligibility for subsidies or for Medicaid, and hand off purchase information to insurers. Obamacare’s coverage expansion sits atop a complex digital infrastructure, and that infrastructure is failing.
For all its deficiencies, healthcare.gov isn’t the worst disaster a government has experienced on a major IT project. That distinction belongs to the U.K.’s endeavor to create an electronic medical records system for its National Health Service. The effort, which began in 2002, tore through about $10 billion before the government admitted it simply couldn’t be salvaged. In an editorial at the time, the liberal Guardian newspaper declared, "The government is an inept purchaser of private services: indecisive, ponderous, overambitious, and wasteful. Mass centralisation does not reduce costs, but it kills flexibility."
"NHS just got tremendously burned by the rollout of electronic health record systems," says Fred Trotter, the founder of health-care software developer Not Only Development and the co-author of Hacking Healthcare. "It’s probably the biggest catastrophe before healthcare.gov. They also had a big-bang, all-at-once, one-big-vendor strategy. That did not work."
The British learned from their mistakes. The disaster empowered Francis Maude, the minister for the cabinet office, to bring in technologist Mike Bracken to overhaul how the British government did IT. Today, gov.uk is something of a wonder. It’s a single, centralized portal to pretty much everything the British government might be able to do for you. It’s designed for users. It’s nominated for awards. With the deep admiration of Silicon Valley boosters, Bracken is working to change everything about the way the British government builds technology. His keynote speech at the October Code for America conference received a standing ovation.
What Bracken has that Obama’s tribunes of iPod government lack is power, staff, and the political authority to leverage both. He controls the British government’s domain names, so his 300-person team has been methodically building better digital services for virtually everything the government does—and then simply shutting down the lackluster services that previously existed in those spaces. It’s the exact opposite of the process that led to healthcare.gov, in which the Obama administration respected the existing lines of authority, while depriving the tech talent they’d recruited, such as Chief Technology Officer Todd Park, of the resources or the power to take control of the project.
"This is a hard problem for government," Bracken says, "because it’s not really a technology problem. It’s a self-image problem. Government constructs its self-image in terms of size. It thinks of itself as huge and big. I’ve been in D.C. and seen your buildings. They’re very big! The harsh truth for governments all over the world is that many digital public services could be developed at a fraction of the size of nondigital services, and they can be created by very small teams of people in an open way."
There are people in Washington who share Bracken’s views, but their struggle against bureaucratic inertia can seem Sisyphean. "Government becomes really afraid of failure, which is a bit ironic, as this ends up leading to failure," says Clay Johnson, a technologist who was one of the White House’s presidential innovation fellows. "But that fear of failure leads them to only want to work with known quantities, and known quantities mean contractors who’ve done this work in the past. That puts them with a group of entrenched vendors who haven’t really had to compete in the world of technology."
That fear of failure has been institutionalized in the way the federal government awards contracts. The complex, arcane process favors those companies that devote resources to mastering it and repels the Silicon Valley startups the government desperately needs. "I realized I could figure out how to develop these very complex, very new software programs, or I could figure out how to contract with the government," says Trotter, who worked on health IT projects with the Veterans Administration. "And so I chose to do the thing that was innovative."
The Obama campaign didn’t think too hard about the metaphor underlying the idea of an iPod government. It sounded good, gesturing vaguely at modernization and simplicity. But the iPod was a disruptive innovation. It destroyed a lot of companies that manufactured parts and products for CD players. It accelerated a change toward a model of purchasing music that put music stores across the country out of business.
Actually creating an iPod government would be no less disruptive. It would require radically overhauling the federal procurement system. It would mean ripping through the IT departments of agency after agency. It would mean facing down lawsuits and union reps. And it would mean, inevitably, overcoming the trump card that IT offices everywhere use to circumscribe openness and transparency: security. "The security that government is obsessed with is often the counterpoint to usability," Bracken notes. "In many government services you really only see two voices: the voice of security and the voice of procurement. The voice of usability isn’t in there as well."
If Obama still intends to make the voice of usability—which is to say, the voice of the voter—a vital feature of the way government operates, he needs to fight a battle that animated him in 2008 but was clearly lost by 2013.
To start, the president could study the example of how the British government used the initial failure of its electronic medical records system as a catalyst for broader change. But he doesn’t even have to look that far. The Affordable Care Act, after all, isn’t the only product his administration has launched. The Consumer Financial Protection Bureau (CFPB), created by the Dodd-Frank financial reform act of 2010, has won wide plaudits for its remarkable, user-friendly deployment of technology. Merici Vinton, who recruited most of the original technology and digital team and oversaw the creation of consumerfinance.gov—her agency’s version of healthcare.gov—outlined three principles for making technology work in government:
Each of these principles sounds straightforward. They’re the kinds of things most private-sector technology companies adhere to by default. But they’re all terrifically hard to do inside the federal bureaucracy. In-house design and tech require the government to recruit high-priced technology talent to perform tasks that it long ago outsourced to contractors—and recruiting that kind of talent requires creating systems and a culture attractive to top technologists. Open-source and small-enough-to-fail are also hard sells. Both require a comfort with failure and experimentation that the federal government isn’t exactly known for.
The CFPB overcame this risk aversion because it was a new agency. "We were told ‘no’ to just about everything we wanted to do," Vinton says. "A very real part of your job is hearing ‘no’ as ‘maybe,’ and working through the real or perceived concerns, getting the lawyers on your side. And keep fighting." That’s a bigger challenge in an entrenched bureaucracy, like the Centers for Medicare and Medicaid Services, where the IT department is thick with 20-year veterans. Vinton notes that the CFPB benefited from Congress’s only mentioning the word "website" once in its statute. The ACA mentions it 118 times—which in effect handed control of the site’s development to lawyers, not engineers. "The way Congress looks at software is that there are these sites that do these amazing things, and we should do that, too," says Trotter. "They don’t realize that a tremendous amount of invention has gone on at these scaled websites to handle these processes."
But Obama and the people around him were supposed to know that. If they’re going to save their project to build an iPod government worthy of public confidence, they must force the rest of the federal bureaucracy to change. The iPod didn’t negotiate with the other music players on the market—it ruthlessly outcompeted them. The Obama administration needs to set that process loose in government, too. That begins with procurement reform, but it won’t end until the White House is ready to take IT tasks away from agencies that can’t handle them effectively and create a centralized IT group, such as Bracken’s in the U.K., that can.
"Improving the technology our government uses isn’t about having the fanciest bells and whistles on our website—it’s about how we use the American people’s hard-earned tax dollars to make government work better for them," Obama said in January 2010. "And this is something I’m very serious about."
If that’s the case, then healthcare.gov should be the spur he needs to do something about it. We live in an age when machines can learn. Can government?