Insularity, incompetence, and deception doomed the launch of the Affordable Care Act, according to postmortems on President Obama's health insurance law. The president now has two choices: A) Accept the verdict and learn from it, or B) stick with insularity, incompetence, and deception.
Early signs point to Obama compounding rather than correcting his team's errors.
Staying the course is a losing option for Obamacare and the more than 40 million Americans who need health insurance. The trouble is far deeper than a "glitchy" website, according to numerous media reports, including an in-depth investigation by The Washington Post. Among other things, The Post uncovered a 2010 memo from a trusted outside health adviser warning that no one in the administration was "up to the task" of constructing an insurance exchange and other complexities of the 2,000-page law.
The good news is there is time to learn from--and recover from--the early stumbles. Here are four important lessons from the postmortems.
1) Reach out beyond your inner circle. Obama ignored efforts by Harvard professor David Cutler and his own economic team to get him to appoint an outside health reform "czar" with a background in technology, insurance, and business. Instead, the president stuck with his health policy team led by Nancy-Ann DeParle, a former Clinton appointee with a checkered record in the private sector. His team was built to pass legislation, not implement it.
"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," Cutler told The Post. "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."
Obama recently appointed manager-extraordinaire Jeff Zients to oversee efforts to fix the troubled website. It's not clear that Zients or any other accomplished leader will be put in charge of implementation at large. (Zients will become director of the National Economic Council in January.)
2) Don't lie. The Obama White House has a credibility problem, one that could infect his entire agenda. It started when the White House refused to release data on the number of people who enrolled in the online marketplace, an important metric for determining the effectiveness of the $400 million-plus site. Administration officials say they don't have the data, which is either a mark of extraordinary incompetence or a lie.
The problem was compounded when millions of self-insured Americans received notices that their health care policies were being canceled. For years, Obama pledged that "if you like your health care plan, you'll be able to keep your health care plan. Period." According to The Wall Street Journal, Obama's advisers knew the president was making a promise he couldn't keep, and debated whether to have the president "explain the nuances of the succinct line in his stump speeches." In other words, they debated whether to tell the full truth and decided against it. They knowingly told a falsehood, which is by definition a lie.
Rather than acknowledge the deception, the White House has launched a public-relations effort to mitigate it. The most brazen example is the White House's use of Twitter in an attempt to discredit an NBC story that accurately described the White House's deception. "NBC 'scoop' cites normal turnover in the indiv insurance market," White House spokesman Josh Earnest tweeted to his 9,500 followers on Twitter, according to a Reuters story on the operation.
3) Create an efficient health insurance bureaucracy. According to The Post, the decision to put ACA implementation in the hands of the Centers for Medicare and Medicaid Services was fateful. Politics played a role. Administration officials thought it would protect the project from House Republicans who are trying to undermine the law. Money was another reason. The ACA did not include funding for the development of a federal exchange, and the White House knew Republicans would block any attempts to get it. The result was a disastrously fragmented process. As a source told The Post, "There wasn't a person who said, 'My job is the seamless implementation of the Affordable Care Act.' "
The White House and its allies blame Republicans for the lack of money and options. It's an understandable reaction. The GOP-controlled House wants to gut the law.
But it's no excuse. Obama pushed a partisan law through a Democratic-controlled Congress and now bears the responsibility for implementing it. If Obama fails, history will judge the chief executive more harshly than one chamber of the legislative branch. More important, mismanagement of ACA would give a generation of Americans reason to question the Democratic Party's core argument that government can do good things.
4) New leadership is needed. The Post reports that Obama frequently tried to keep his team on task. Hours after the bill passed, the president told celebrating aides that the hard work of implementation begins in the morning. During regular staff meetings to monitor progress, he invariably turned attention to the website. If it doesn't work, Obama said, "nothing else matters." In one meeting, he told senior advisers that implementing ACA was the most important job of his presidency. "We've got to do it right," Obama said.
Those anecdotes seem to belie the impression that Obama was disengaged. Even so, the president needs to do some soul-searching. What did I miss, and why? What was kept from me, and why? Who failed to do their jobs right? Who failed to tell me the job wasn't getting done right? Do I have the right people on the job?
Because as long as the president sticks with the team that failed the country and lied, it's fair to assume that he hasn't learned the most basic lessons from the launch.
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