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Tuesday, October 15, 2013

Healthcare For All: Let's Make The Shot


We have all been to the emergency room at some point in our lives. And we have all seen poor families holding their sick children and elderly parents and praying that someone will help them.

It is a basic social need and duty to help those who can't help themselves. But we've gotten so busy fighting each other that we can't see our way clear to do that. Here is a suggested approach.

1. Forget the past and focus on moving forward. Not just politicians, all of us. The reality is that universal healthcare is a universal goal. The current version has its roots in the Clinton administration and integrates Republican input, such as the belief that people should buy their own coverage (the "individual mandate") rather than being automatically covered as under a socialized medicine system. As Ezra Klein notes,
"Members of the Republican Party didn’t express concerns that the individual mandate might be an unconstitutional assault on liberty when they devised the idea in the late 1980s, or when they wielded it against the Clinton White House in the 1990s, or when it was passed into law in Massachusetts in the mid-2000s."
Yes, the website is messed up - we can't pay the bills - we haven't got the details right. Now tell me something I don't know.

2. Take meaningful corrective action. Let's be blunt: The situation right now is bad for Democrats even if they think they are winning in the  polls. Even former presidential aide Robert Gibbs called the Healthcare.gov rollout an "excruciatingly embarrassing" disaster. Late-night comedian and political commentator Jon Stewart painfully said to Health and Human Services Secretary Kathleen Sebelius on national TV: 
“I’m going to attempt to download every movie ever made, and you’re going to try to sign up for Obamacare, and we’ll see which happens first.”
From a communication and a policy point of view, the President as our top leader has got to own the problem by saying:
  • Yes we screwed up the launch, for reasons to be understood and shared down the road. But the concept of healthcare reform is right. 
  • I need everyone's help in fixing this. Social responsibility and fiscal discipline go together.
  • Here's what we are going to do.
And then outline something like the following - the action plan:
  • Remove from the website project those who did not deliver or who cannot meaningfully contribute to its repair. 
  • Take legal action to recover as much money as possible from the nonperforming vendors. 
  • Review the agency process for managing this contracting process.
  • Release the list of companies who worked on the site, how much they were paid, and for what. The Sunlight Foundation has tried to piece together the list of contractors, but this is not a substitute. (Update October 16: The main contractor was CGI Federal and it's not clear whether they actually had to compete for the job, which is strange given its massive scope and importance. It's also not clear that they were the best company to carry out the work. See GAO denial of CGI bid protest against the HHS' Centers for Medicare and Medicaid Services in 2010.)
The contracting piece is essential to the public's trust particularly in light of the charge being thrown around about favoritism.

(It may actually be a blessing that people can't enroll right now, because cybersecurity experts have pointed out specific significant ways the initial version of the site puts users at risk of identity theft, such as "login fraud," "cookie theft," clickjacking," and "request forgery.") 

3. Assume a united front. Every single word out of leaders' mouths should be inclusive from here on out. This means the negative rhetoric and name-calling finally comes to an end. 

For example, Presidential media adviser Dan Pfeiffer compared opponents of Obamacare to suicide bombers, telling CNN, “What we’re not for is negotiating with people with a bomb strapped to their chest." Meanwhile, the Republicans repeatedly used the line, that "the White House will negotiation with the atomic ayatollahs but not with House Republicans." 

Another positive move would be to stop calling the Affordable Care Act "Obamacare." Republicans and Democrats agree on the need for a solution to the healthcare crisis, so it is counterproductive to make it a political win for one side. I remember when the President Clinton's healthcare reform was doomed at least in part by the negative moniker people gave it, "Hillarycare."

4. Crowdsource via the public. Government crowdsourcing is nothing new - nearly 10 agencies already use it - and there are untold numbers of people with time on their hands and a passion for helping government work better. How about the Code for America folks? Set up a space, virtual and/or in-person, where the public can get together to set up a website that actually works. Understanding that bad actors can try to infiltrate the process, establish government-managed protocols for keeping cybersecurity a #1 priority.

5. Recall additional furloughed government employees to assist. While it is not my call to say who is essential, the website is reliant on contractor execution, and it will take more than a few days to fix, it still seems to me that we should find a way to leverage federal web management expertise across the board. While, as the Office of Personnel Management states, "an affected agency would have to shut down any activities funded by annual appropriations that are not excepted by law," the Washington Post reports that agencies are bringing some employees back with various justifications. President Obama himself has said that restoring the functionality of Healthcare.gov is critical and people are working "around the clock" at the Department of Health and Human Services to fix it. We should bring additional HHS staff back as essential, and explore finding ways to put the government's top web specialists on the project as part of a temporary detail.

* All opinions my own. Thanks to Andy Blumenthal for the feedback.