When a public sector IT project is featured on Saturday Night Live’s opening parody, you know things aren’t good. Such was the case in late October when the technical woes that plagued the online launching of Obamacare provided fodder for late night television, not to mention a Congressional grilling of both public and private officials alike. According to some media reports, on the first day of online registration for new health care insurance plans, a mere six of the thousands that visited were able to sign on.
Back in 2001, the OECD published a short briefing entitled, The Hidden Threat to E-Government. The salient message remains all too relevant today: if governments cannot effectively manage information technology, e-government’s potential will be stunted at every turn. Given the high digital expectations surrounding the Obama Presidency, and the fact that health care was the signature achievement of the president’s first term, the mishandling of this initiative matters.
Openness and outsourcing are at the heart of the controversy. While the administration had initially pledged to release much of the source code it was developing, only a small portion was made public. In the weeks following the site’s faulty launch, a community of open source coders from around the world banded together online to offer fixes. Other observers suggested that a truly open-source platform from the beginning would have avoided many of the problems that subsequently emerged.
In fairness to government officials and their private contractors, hindsight has its advantages. Many of the difficulties stem not from simply devising online mechanisms for new registrants, but in aligning such processes with a myriad of government programs and databases run out of costly and often unwieldy legacy systems. Yet it seems true that the procurement of the new infrastructure fell victim to the traditionalism of government procurement shortcomings, namely costing pressures at the outset with constantly altering specifications that limited testing and doomed the website’s unveiling.
The technical and political fallout subsequently prompted President Obama to forge a “tech-surge” in order to marshal the resources and competencies to salvage his flagship expansion of health care insurance. Companies ranging from Google and Red Hat to Oracle have been brought onboard, and the notable mix of traditionally proprietary and more open-source businesses suggests a heightened willingness to embrace transparency, albeit after the fact.
No doubt the private sector as a whole understands that the implications run far deeper than insurance coverage, shaping to some degree the collective digital mindset and confidence of the American populous. Since nobody believes that health care systems will not become increasingly electronic in the future, this still-unfolding drama represents an important moment enjoining government, health care providers, and the technology sector.
Cost-benefit analysis, alas, is not for economists alone. Back in 2008, then-candidate Obama promised that the introduction of electronic health records would contribute substantively to paying for expanded health care coverage. It was not only Republicans that were dubious at such a claim, and certainly most everyone understands today that taking health care online may well be a strategic imperative, but it is one that is unlikely to generate cost savings anytime soon.
Canadians can relate. Despite billions of dollars being deployed in recent years in creating an e-health infrastructure, most health care experts agree that much more funding is needed. More worrisome is this country’s deteriorating stature internationally, along with the United States, in terms of the adoption rates of electronic health records by individuals and computerized medical systems amongst providers.
In both countries, it would seem that the absence of a strong national authority devoted to digitizing the entire health care system is proving to be a significant handicap. And yet, paradoxically, the launching of Obamacare underscores the dangers of large national IT projects managed centrally. Indeed, part of the U.S. government’s difficulty stems from the fact that many more states than expected deferred to the federal government’s creation of new online exchanges, rather than creating their own as some smaller states have done (with fewer technical problems plaguing these roll-outs).
The admittedly complex lesson, in short, is not to advocate for a massive national take-over of health care, but rather to embrace more political and technological openness – and in doing so, to devise new and improved coordinating mechanisms between the public and private sectors on the one hand, and across all layers of health care governance on the other hand. The future of our collective health is at stake.