Hi, this is Wayne again with a topic “Why Healthcare.gov came out broken”.
I want to get to this issue of exactly who is in charge of this project because you’re now blaming it on the contractors in saying it’s Verizon’s fault, so who is responsible for overseeing this project? We are we on the site. The site has had serious problems. I, who is in charge, Madam Secretary, the person now in charge as an integrator, is Q SSI, one of our who was in charge as it was in jail, was in charge. Up to that. That team, who is the individual L Schneider, is the Michelle Snyder.
Is the one responsible for this debacle? Well, excuse me, congresswoman, Michelle Snyder is not responsible for the debacle hold me accountable for the debauch, I’m responsible. Thank you. I yield back. The Patient, Protection and Affordable Care Act came into effect in 2010, and now every American is required to have health insurance. The government set up a website that was supposed to be the easiest way for everyone to shop and get enrolled, and that was healthcare.gov, which is arguably the largest consumer facing web app.
The government has ever built, I’m covered we’re covered now we’re covered enroll. Now, at the health insurance marketplace at healthcare.gov and on the first day October, 1st 2013, it didn’t work today was the first opportunity for millions of Americans to go to these new exchanges and sign up for insurance under Obamacare and it turned out. So many people tried to do that.
Computers crashed you’ve, probably heard that healthcare.gov hasn’t worked as smoothly as it was supposed to work. There were major problems all over the country. Web sites were slow or crashed all together, leaving a lot of folks angry and frustrated healthcare.gov. As the website is known, that’s some serious glitches into its system. Yesterday, there’s gon na be a lot of evaluation of how we got to this country. Healthcare.Gov has been called disappointing, frustrating a fiasco and a debacle and it’s when most people are used to using lots of websites that are well-designed and pretty much work.
Well all the time. The terribleness of healthcare.gov is frankly scary, especially when you consider that the government is only gon na have to build more web sites, not fewer. Now everyone from the President to his Republican critics to Silicon Valley, entrepreneurs are talking about what’s wrong with the federal IT process and how do we fix it? I think if you look at this from a long-term perspective, we’re in a really dangerous spot when it comes to government so think about Moore’s law. So Moore’s law says that technology gets twice as good or half as expensive every 18 months. And that’s that’s an exponential law, so there’s a you know a curve. That’S sort of you know the sort of quintessential hockey stick curve and the problem is, is that government has an efficiency problem when it comes to acquiring technology, and so it’s sort of behind that curve and as we progress through technology’s growth, that gap between what government Has access to and what the public has access to is growing further and further and further apart, I don’t care whether you’re a Democrat or a Republican, a conservative of socialist of libertarian, whatever you want to call yourself, I think what you want is for your government To be able to operate well, the problem is, is that if the gap between the public sector and the private sector grows too wide, then government’s not able to provide services to the public well or it has to spend an enormous amount of cost to try and Keep up with the private sector’s expectations and I think that’s really dangerous long term for the health of the country.
There is a larger problem that I probably could have identified earlier, and that is the way the federal government does procurement and does IT is just generally not very efficient. I think it’s fair to say that we have a pretty good track record of working with folks on technology and IT from our campaign, both in 2008 and 2012. We we did a pretty darn good job on that on my campaign, I could simply say who are the best folks out there: let’s get them around a table, let’s figure out what we’re doing and we’re just gon na continue to improve it and refine it and Work on our goals, if you’re doing at the federal government level, you know you’re going through. You know 40 pages of specs and this, and that the other and they’re all kinds of laws involved right now. The procurement process basically says that you have to buy a website like you, buy a battleship, how many different companies ended up working on the final product, the contract that CMS ended up using to fulfill. Most of this work had 16 contractors on it and if you go through and look at all of their subcontractors there’s, you know at least a dozen more. It was basically everyone you would expect in terms of big government contracting players. So a bunch of these technology contractors and contractors who just kind of do everything so you’ll see them contracting for pretty much every agency oftentimes, you see things like healthcare.gov pop up where you have subpar vendors, who have subpar talent working on projects because they don’t have To compete and regulation prevents them from hiring some of the best talent to work on this stuff. Building a website for the government isn’t as simple as building one for say a startup.
Not only are there rules such as the Federal Acquisition regulations that limit how the government can buy things, but there are many archaic regulations. You have to navigate as well like relatively low salary caps for employees of government contractors and onerous laws like the paperwork reduction Act for every information collection that the federal government puts out. They have to put that information out to public comment before the before that information collection can sort of be put out so wording of every question. Yeah in 2009 the president tried to tweet a question to the public and was prohibited from doing so because that would have been considered an information collection. Now those rules have since changed a bit. So the president can now end a tweet in a question mark, but it’s still a preposterous law and a preposterous amount of legislation that really prohibits. You know if you’re a web designer half of what you’re doing with web design is making forms and those all require these arduous public notice processes that don’t make any sense. The contractors that built healthcare.gov all large Beltway insiders like CGI and Lockheed Martin, were actually selected years before the Affordable Care Act passed before anybody knew we’d, be building a health insurance exchange. That’S because the government likes to buy things using broad indefinite delivery, indefinite quantity or IDIQ contracts that can cover all an agency’s projects for up to 10 years. This speeds things up a bit, but it’s not the way any technologist would decide who should build a website. Technology evolves quickly and critics say these long-term contracts ensure the government gets left behind. I think that just encourages entrenchment and it makes them less likely to embrace some other concepts that are fundamental to technology.
So iterating quickly – and you know popular one among startups – is failing hard and fast. So the idea is to fail before you scale so large that you affect that many people. I think in a time right now. I feel like in the age of the Internet, where technology is changing by the month that that’s totally inappropriate. The exchange is comprised of six complex systems and involves 55 contractors, including CGI federal five government agencies, 36 states and more than 300 insurers, with more than 4,500 insurance plans, all coming together in healthcare, gov right now, there’s no central technology authority inside of the federal government That doesn’t exist, there’s nobody who can say hey. You know that, except for the president, I guess could probably get on the phone with with Secretary Sebelius and say: hey fix, healthcare.gov, I’m pretty sure that conversations already happened. But, for the most part, the staff of the White House can’t just sort of Trump over to an agency and say: hey you do this, that’s not the way the government works. The insurance marketplace at healthcare.gov is a keystone of the Affordable Care Act. It’S supposed to allow anyone to shop and compare plans from different insurance companies guaranteeing the best rate and then actually purchase that insurance for themselves and their families.
Now the laws opponents are trying to use the busted website as an argument to repeal the entire law for want of a website. Health care reform could be lost anything that the federal government does usually ends up being too expensive to afford, and that certainly is what we have seen with the website and, unfortunately, what our constituents are beginning to realize it’s going to transpire with their health care. What do you think is the fix at this point. There’S only one fix for Obamacare got a repeal it.
This is his Network gun. I mean it’s, that’s the only fix we tried to delay it. We had a big fight about it now. People know why we fought so hard. I’M gon na see how bad it is when they see.
What’S the notices, they’re, getting your policies being dropped, increase in premiums, you’re, not gon na, be able keep your own doctor. The website doesn’t work. You can’t compare price now. They know why we fought so hard. The only answer is to repeal this, the president had to apologize for a website in the Rose Garden.
Like you know, that’s never happened before. This is a significant moment for information technology and government, but that doesn’t have anything to do with the Affordable Care Act other than this was the vessel. You know for the Affordable Care Act’s implementation. That law has been passed.
I don’t think that, because the website broke, it nullifies the spirit of the law or the the intent behind it. I think that it is indicative not of repealing the Affordable Care Act but fixing the procurement policies and regulations that caused this failure to happen, because they will happen again and again and again, there’s probably no bigger gap between the private sector and the public sector than It and we’ve seen that in, for example, the VA and the Department of Defense trying to deal with electronic medical records for our servicemen as they move into civilian life. We’Ve now had about a decade of experimentation spent billions of dollars, and it’s still not working the way it should.
So what we probably needed to do on the front end was to blow up how we procure for IT. Healthcare.Gov has become more stable since its launch, but its failure highlighted a bigger problem. The administration failed to bring the same technology literacy that helped Obama get elected with them into the White House, missing an opportunity to reform outdated policies and set up the federal government for success. Pretend America is a car and it’s sputtering down the road. It’S a big car and we’re having a debate in Congress about how we can make that car go faster.
What the Democrats say is in order to make the car go faster. What we have to do is put more gasoline in the engine. What the Republicans say is no, what we need to do is throw half of the car go out the back of the car. What I’m trying to say is: none of you guys are paying attention to the fact that we have a one mile per gallon engine and maybe what maybe the gains to be realized, aren’t in cutting spending or increasing taxes, but increasing the efficiency of the way that We spend the money this idea of how government uses technology isn’t like a backroom issue.
That’S for the management wants it’s something that we’ve all got a care about, like we care about global warming and climate change and like we care about the deficit and the budget, think about what good it would do if the government was spending its money not on You know 16 giant contractors, CGI federal is a Canadian company, but on small homra are our own small homegrown technology, businesses that have been so innovative and and smart in the past delivering services to us. .