Late last October, the management expert Jeffrey Zients was given a mandate to fix HealthCare.gov, the website at the forefront of U.S. President Barack Obama’s health-care reform, after its disastrous launch. Refusing to engage in happy talk about how well things were going or how soon everything would be fixed, Zients established performance metrics for the site’s responsiveness, insisted on improvements to the underlying hardware, postponed work on nonessential features, demanded rapid reporting of significant problems, and took management oversight away from the Centers for Medicare and Medicaid Services (CMS, a federal agency within the Department of Health and Human Services) and gave it instead to a single contractor reporting to him. The result was a newly productive work environment that helped the website progress from grave dysfunction in early October to passable effectiveness two months later.
Zients’ efforts demonstrated the government’s ability to tackle complex technological challenges and handle them both quickly and effectively. Unfortunately for the Obama administration, the transformation came too late to rescue its reputation for technical competence. Given that the people who hired Zients clearly understood what kind of management was required to create a working online insurance marketplace, why did they wait to put in place that sort of management until the project had become an object of public ridicule? And more important, is there any way to prevent other such debacles in the future? The answers to both questions lie in the generally tortured way that the government plans and oversees technology.
THE MANAGEMENT DILEMMA
On October 1, rolling out the public face of the Affordable Care Act (ACA), his signature domestic policy initiative, Obama said this: "Just visit HealthCare.gov, and there you can compare insurance plans, side by side, the same way you’d shop for a plane ticket on Kayak or a TV on Amazon. You enter some basic information, you’ll be presented with a list of quality, affordable plans that are available in your area,