How Silicon Valley Got Healthcare.gov Wrong
The healthcare.gov launch was an unmitigated disaster.
This much, of course, we already know. Since the chaos of October, the Obamacare website debacle has attracted no small amount of fairly predictable critiques from the garden-variety "they could have done it better if they did X," to the more high-minded "large-scale government projects will always fail." In general, the dominant swath of such criticism perceives the government as having little capacity to handle technological issues effectively, submitting that in the future, such issues should remain within the domain of the technologists.
Where are the technologists now?
Many quarters of Silicon Valley and the larger technology industry had much to say about the healthcare.gov episode when it first exploded. Some were didactic in tone, like startup founder Matthew Douglass, who confidently argues in a guest post on Venture Beat, "None of these missteps would have occurred if the contractors had taken a gradual, agile approach."
Matt Mullenweg, co-developer of WordPress, suggested that an open-source approach was the solution: "How cool would it have been if the site launched, didn't work, and some passionate coders came in and said, 'Oh, here's a problem, and here, and here?'"
Others were more overtly cynical, as described in New York magazine, observing that "around the coffee shops of San Francisco and the tech campuses of the South Bay … the topic of the government's health care push often elicited cynical jokes — one tech worker quipped that a Stanford computer-science class could have built healthcare.gov for a thousandth of the reported $400 million-plus budget and confusion."
Indeed, we can say a lot of things with the comforts afforded by the knowledge of the present. There should have been more transparency. There should have been a central coordinator among the 55 government contractors. The Obama administration, so technologically adept during election season, should have leveraged what preexisting infrastructure it cultivated and applied it to healthcare.gov. However, such charges, while warranted, aren't entirely fair.
Let me be clear, the government comprehensively and irrefutably fucked up. It's exacerbating their embarrassingly poor record of tackling large technology projects, and it's likely screwing the important goodwill needed to keep the American universal health care momentum going. The Byzantine arrangement of contractors and subcontractors is a textbook display of classically deleterious Washingtonian politics. The reports indicated a lack of central command to coordinate the complex building process and revealed complete lunacy. According to NPR, there was no lead contractor on the project, and CGI Federal, the biggest contractor, had no idea what the deal was with the other teams during construction. The "healthcare.gov mystery lady" apparently became a topic of importance, which unfortunately led to possible cyberbullying.
It should also be noted that healthcare.gov was an undertaking born and developed under incomparable conditions. The government does not share the luxury of the conditions technology companies typically enjoy – a decent runway of time and space to experiment, the ability to maintain relatively low public expectations, and much more freedom to fail with comparatively low stakes (a population without decent health insurance vs. unhappy iPhone consumers). Instead, the government had to contend with naturally-inflated expectations of immediate efficacy, demands of a huge build with little time or room for organic iteration, operational inexperience, a firm and politically-charged time limit, and the titanic burdens of intense public scrutiny.
Silicon Valley and the larger tech industry can suggest that they could have done it better if they were involved from the beginning, but this is unhelpful posturing. Aside from a few experts brought in to supply a much needed "tech surge" to fix the situation, Silicon Valley contributed little to solving this very real, consequential problem other than offering their own peripheral showpieces.
The past few days have indicated that the ongoing efforts to fix the site have moved it out of its complete disaster phase, but the larger tension remains. If the tech titans and the upstarts of Silicon Valley and the larger tech community truly believe they could do better, they are indeed harbingers of our ideal world. They only need to prove their worth in times like these. Anything less than that would not only be hot air, but it would also distract from real work. Health care remains an issue, and many people run the risk of life without much-needed support while the tech community buzzes with talk about disappearing texts and home-delivery drones.
