Will Insularity, Incompetence, and Lies Doom Obamacare?

Four lessons from the launch that could save the law and health care coverage for millions.

President Barack Obama waits for a translation of his remarks during a meeting with Iraqi Prime Minister Nuri al-Maliki in the Oval Office of the White House on November 1, 2013.
National Journal
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Ron Fournier
Nov. 4, 2013, 12:18 a.m.

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.