Megan McArdle, who has been all over the HealthCare.gov and the Affordable Care Act rollout like a rash, has a superb piece at Bloomberg on the reason that the implications of the ACA came as a surprise to most people:
"We all knew" that preventive care doesn't save money, electronic medical records don’t save money, reducing uncompensated care saves very little money, and "reining in the abusive practices" of insurance companies was likely to raise premiums, [my italics] not lower them, because those "abuses" mostly consist of refusing to cover very sick people. But that information did not get communicated very well to the public.This is, profoundly, what dooms any number of projects. For instance any software engineer or technical manager worth their salt will implicitly believe that a) testing a system with something like real traffic is the only way to detect and mitigate launch problems, and b) if you're only planning on testing one week before a hard deadline then You're Going To Have A Bad Time. Yet, if the project is being managed elsewhere and the project managers are not really asking the engineers about their opinions, just handing down features and deadlines, then the facts that "all the experts know" never get presented to the project manager in a way that makes them understand.
This reminded me of the testimony of CMS head Marilyn Tavenner about the awesome project fuck-up that was the HealthCare.gov launch and her part in it as the official directly responsible for its launch:
During the Tuesday hearing, Tavenner rejected the allegation that the CMS mishandled the health-care project, adding that the agency has successfully managed other big initiatives. She said the site and its components underwent continuous testing but erred in underestimating the crush of people who would try to get onto the site in its early days. "In retrospect, we could have done more about load testing," she said.You see what I mean? All the experts "know" that load testing a site that's going to be heavily used is not optional and not to be left to the last moment.
Reassuringly, Tavenner did demonstrate some skills in her area of competence: blame-shifting.
Under questioning, Tavenner pointed the finger at CGI Federal, saying the company sometimes missed deadlines. "We've had some issues with timing of delivery," she said.I'm sure that's right. I'm equally sure that it's the project manager's job to anticipate, plan for and adjust schedules to handle late (or even early) deliveries - and CMS was the project manager. You'll note from her bio that Tavenner is a life-long health administrator - I'd bet her early career as a nurse lasted just long enough to get her into admin - and has as much business leading a complicated software development project as I do running an emergency room. Less, probably, because at least I know that air goes in and out, blood goes round and round, and any variation on this is a bad thing.
Ironically the Chief Technology Officer of Health and Human Services (HHS being the parent department of the CMS) whose bio indicates reasonable technical chops wasn't actually involved much in the project:
...an employee of Amazon Web Services Inc (AWS) emailed two HHS officials on October 7 saying, "I hear there are some challenges with Healthcare.gov. Is there anything we can do to help?"The Chief Information Officer by contrast is an ex-IBM marketeer and strategizer, and is putting his strategizing skills to good use making clear his distance from the smoking wreck of the project:
HHS' Chief Technology Officer Bryan Sivak replied to Amazon by email on October 8: "I wish there was. I actually wish there was something I could do to help. [my emphasis]"
HHS' Chief Information Officer Frank Baitman replied to Amazon on October 7, "Thanks for the offer! Unfortunately, as you know, I haven't been involved with Healthcare.gov. I'm still trying to figure out how I can help, and may very well reach out for assistance should the opportunity present itself."Nice one, Frank. Of course, Sivak is the one who comes across as actually human.
It looks like Tavenner's CMS wanted all the glory and kudos from the HealthCare.gov launch, but instead has become the focus the frustrations and hate of millions of Americans. The lessons here: be careful what you wish for, and if you want to know what the "experts know" then you really need to ask them.