It is time to review in more detail the mistakes made in implementation of the online registration systems for the Affordable Care Act, a.k.a. Obamacare, both at the federal level and in Maryland, and to propose some short- and long-term solutions.
I have the benefit of experience in systems design and application in firms and agencies as small as 250 employees and as large as the Social Security Administration. This experience goes back to 1960. I have seen many mistakes, and have made more than a few.
Many angry citizens are looking for somebody in government to fire. The first candidate is Ms. Rosy Scenario, and all who allowed her blandishments to go up the chain of command.
Middle managers in both private and public sectors hate to give bad news to the boss. But Americans demand transparency, not CYA. The first rule is prepare for the worst case. The second is tell management bad news early. The third is provide plenty of lead time and testing time.
As a palliative to public outrage, the bug (error) lists could be made available online. Then we can all appreciate the true scale of the online registration problems and watch the progress.
Here are some more major errors. An early mistake was allowing an overly complex design of Obamacare itself. Managers always ask for more bells and whistles than are needed, and then complain about the cost, complexity and delay that results. Unfortunately we are stuck with the law as written until the tea party no longer rules the House of Representatives. When that particular clown circus is dethroned, then sensible simplifications can be considered. We need a House dedicated to making ACA work, not to sabotaging it.
Perhaps the biggest mistake was hiring a Canadian software firm with a track record of being fired by the Canadian government. In government procurement, you can give strong weight to past performance. Obviously, this was not done.
My own experience doing a typesetting/indexing job for a Canadian firm reinforces my view that Canada, for all its many virtues, is not a hotbed of systems expertise.
It is too late to simply fire the vendor and start all over from scratch. But planning for a replacement online system should begin now and can proceed in parallel. Successful systems in Colorado, Kentucky, New York and California are all candidates for study, modification and adoption.
Another major mistake was making the federal and Maryland registration systems live long before they were ready. Now we are stuck with a long period of waiting for competent folks to fix products that are bad to start with, and are already "live."
Hiring many more staff, called in the industry the "Mongolian Hordes" approach, may simply delay fixes further.
But we can both bypass the online system for now and fix a major design mistake. Systems like Medicare and Federal Employees Health Benefits were implemented long before there was an internet. Just because the internet exists doesn't mean we have to use it initially.
The similar FEHB system began in 1960 by making printed brochures available as an information source. It is cheap and easy to create brochures and make them available online as PDF files.
Both Web format and document format information dissemination can have errors, but catastrophic failure only occurs in Web format information systems, and correcting PDF documents is an easier and cheaper process.
This online brochure system will eliminate a major defect of the current system - the insistence on a lengthy sign-up procedure before the user has access to any information about his or her options. Phone registration will also be much simpler with informed customers.
For the short term we can rescue the federal and Maryland registration systems not by instantly demolishing a mountain of errors, but by walking around the mountain for now. Online PDF brochures and phone registration are the short-term solutions that will save the ACA.