When something goes awry, our first reaction is to find someone to blame. In some cases, it is easy. An accident may be directly attributable to a single person. In more complicated situations, it is never easy to assign fault but that doesn’t slow anyone down in seeking out those responsible and pointing fingers. The truth is always more complicated than that. There are multiple factors that play into who caused the problem and varying degrees of culpability. When we are angered by a failure, we are even more eager to hoist the perpetrator on his own petard.
The rollout of the Affordable Care Act enrollment is a perfect case. No one would suggest that it hasn’t been a problem. The descriptions range from “disastrous” to “catastrophic” and beyond. Heads must roll; people must be fired; the whole law should be rescinded. We have heard it all. The indictments continue and it is mandatory that we find out who is responsible and brought us to this mess. Hysteria and hyperbole are sweeping across the land and none of it is helpful.
It is impossible for the average citizen to understand the complexity of the problem; it may be beyond anyone’s ability but it is important to put it in perspective. When Social Security was enacted in 1935, the outcry against it was huge. With the ACA not since the inception of Medicare in 1966 has so sweeping an act been brought to bear. Those who were concerned about Medicare in the 1960s were no less hysterical and alarmed than we are today. It was rampant socialism; it would bankrupt the government which may well be true with predicted unfunded mandates for the whole social security system predicted to be more than 50 trillion dollars. It might be worthwhile to pause and reflect that that virtually no one receiving benefits from Social Security or Medicare would consider repealing those programs, although they were wildly unpopular when first passed.
When those acts became law the regulations were written with typewriters; it is hard to imagine how they were implemented without the aid of computers . . . but they were. The phrase “information technology” had not been devised. That those sweeping social programs functioned as well as they did at the outset is amazing. That the IT industry of today would have been able to make these massive programs spring to life without a hitch is most unlikely. Whether or not you approve of the ACA is not the issue: it was an idiotic assumption that it could be implemented in such a compressed time frame. There have been unforeseen complications of monumental proportions. It will take years to have it work smoothly, if the act survives.
It has always been so when complicated programs are launched. In the mid-1950s when space travel was first a possibility, the massive failures of those early years were eclipsed as the space industry learned from its mistakes. Can you imagine that in only 15 years after those early flights that never cleared the launching tower that we had reached the moon? Does any rational person think it could have been done in three years, the time we have had to launch ACA? Time and patience are mandatory, neither which seem to be in overabundant supply in our current situation.
Key questions remain about the implementation of the ACA plan. How were the original contracts proffered? Were they to the lowest bidder, the most experienced in the IT field? Was there a date-certain for the rollout devised by the government or by the software developers? Was there a meaningful run up to the launch date with proven results? Will those hired now to repair the programs be given more consideration than the original planners?
The Congressional testimony from CGI Federal and others was not very illuminating, at least not the coverage in the media. Does Congress even know what agency has oversight over the entire project? Is it Combined Medicare/Medicaid Services? Is it the Department of Health and Human Services? Is it the Office of Management and Budget? All are involved, who is in charge and do their computers speak the same language. Add to that the whole problem of federal versus state exchanges and it’s no wonder that nothing works. Maybe Catherine Sibelius, Secretary of HHS and Marilyn Tavenner, chief of Medicare, will clear it all up when they testify before Congress this week; that would be miraculous.
One thing seems certain: There are many who share responsibility for the problems. If we had attempted space travel in such a truncated time frame, we would never have reached the moon.
This is a time for cooler heads and less blaming. Unless we work together this could be just the next unraveling of the fabric of America and that’s the last thing we need.
– Hayden Hollingsworth
