The failed health care website and exchange was a President Obama Production from the start, and he bears direct responsibility for the botched rollout of his signature initiative.
That’s the message within – though of course not explicitly stated – a brilliantly reported story by the Washington Post that popped up over the weekend describing the internal machinery and machinations that resulted in the fiasco known as Healthcare.gov.
Obama, the piece makes clear, chose a flawed team to implement the Affordable Care Act.
What’s more, he was apprised of how things were going during regular progress meetings, and either his aides didn’t inform him that catastrophe was headed his way or they did and he failed to correct course or delay implementation. Either way, his management was incompetent.
According to the piece, Obama ignored the advice of his top economic aides, National Economic Council Director Larry Summers and OMB Director Peter Orszag, to put a “czar” with expertise in business, insurance and technology in charge of the project. Instead, he went with health care wonks like Nancy-Ann DeParle and Jeanne Lambrew.
From the piece:
“They were running the biggest start-up in the world, and they didn’t have anyone who had run a start-up, or even run a business,” said David Cutler, a Harvard professor and health adviser to Obama’s 2008 campaign . . . It’s very hard to think of a situation where the people best at getting legislation passed are best at implementing it. They are a different set of skills.
But why not, from Obama’s point of view? I mean, Obama’s running the country without a scintilla of experience relative to the job. Why would his Obamacare team need any?
Having put people in charge who were not competent to do the job, Obama then watched over them.
(The exchange) was not ready (October 1) even though, for months beginning last spring, the president emphasized the exchange’s central importance during regular staff meetings to monitor progress. No matter which aspects of the sprawling law had been that day’s focus, the official said, Obama invariably ended the meeting the same way: “All of that is well and good, but if the Web site doesn’t work, nothing else matters.”
This belies two points central to the recent White House spin. First of all, if Obama really didn’t understand the problems with the website and the rollout, he should have, because he should have picked it up at regular staff meetings to monitor progress. Obama either has aides who are unwilling to be straight with him or he has engendered atmosphere – likely one subsumed by politics – which doesn’t encourage advisers to be honest with the president.
According to the piece, aides were aware as early as the end of 2012 that work was lagging dangerously behind.
This makes Obama a feckless manager. What’s more, I’m not convinced he didn’t understand the gravity of the situation and just chose to roll ahead anyway. Either he or his aides may have decided to move ahead in order to deny victory to Republicans demanding an Obamacare delay.
Also untrue would be the repeated White House effort to downplay the catastrophe with spin such as, “Obamacare is more than just a website.” Well, someone should inform Obama, who said, “nothing else matters” without it.
Meanwhile, without adult supervision, the implementation project devolved into a disorganized mess.
From the piece:
The Medicaid center’s chief operating officer, a longtime career staffer named Michelle Snyder, nominally oversaw the various pieces, but, as one former administration official put it: “Implementing the exchange was one of 39 things she did. There wasn’t a person who said, ‘My job is the seamless implementation of the Affordable Care Act.’ ”
They couldn’t even get the principals to meetings:
A higher-level monthly meeting, intended to work through tough regulatory questions, was attended at first by Sebelius, Treasury Secretary Timothy Geithner, Chief of Staff Rahm Emanuel and Domestic Policy Council Director Melody Barnes. By late summer and early fall of 2010, the meetings petered out after some of the participants stopped attending, according to a former senior administration official.
Politics governed timelines:
Meanwhile, the White House also slowed down important regulations that had been drafted within CMS months earlier, appearing to wait until just after Obama’s reelection. Among the most significant were standards for insurance coverage under exchanges. The rules for these “essential health benefits” were proposed just before Thanksgiving last year and did not become final until February. Another late regulation spelled out important rules for insurance premiums . . .
A former HHS official said . . . “You had the policy people, largely at the White House, pushing the deadlines and tinkering with the policy, rather than the people who had to run the critical operating path design and program the system.”
The White House has pushed the buck in every direction but the Oval Office. But the Resolute Desk – the historic piece of furniture Obama often has his shoe on – is where the buck must stop.