Seven ‘Solutions’ That Won’t Save Obamacare

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Megan McArdle:

With Nov. 1 storming toward us and the health insurance exchanges still not working, we face the daunting possibility that people may not be able to sign up for January, or maybe even for 2014. The possibility of a total breakdown — the dreaded insurance death spiral — is heading straight for us. The “wait and see if they can’t get it together” option no longer seems viable; we have to acknowledge that these problems are much more than little glitches, and figure out what to do about them.

Most of what seems to be on the table ranges from not helpful to actively unhelpful. Here are seven popular “solutions” that don’t solve anything and may make things worse.

1. Denial: As we move into our fourth week of nonfunctioning exchanges, the administration’s communications strategy puts me in mind of a real estate agent who once showed me a basement apartment near Dupont Circle. It was admirably cheap — probably because in most of the apartment, the ceiling was exactly 74 inches from the ground. And how do I know exactly? Because I am exactly 74 inches tall, and my head was brushing the ceiling. The real estate agent looked straight at me and said, “Isn’t it wonderful? You don’t often get these tall ceilings in a basement apartment.” This sort of thing works for Obi-Wan Kenobi, waving his fingers at Imperial Storm Troopers and saying, “These are not the droids you’re looking for.” But he had the Force; President Barack Obama only has Jay Carney. For those of us who are not Jedi warriors, refusing to admit it when something has gone wrong usually makes the problem worse, not better. Once people understand that you’re willing to lie to them about how well things are going, you lose a lot of the support that you’ll need to fix the mess you’ve made.

2. Blamestorming: That’s a term from my upcoming book, and it describes the tendency of an organization in which things have gone wrong to waste a lot of time looking for a scapegoat rather than, say, fixing the problem. Republicans are having a field day denouncing the fecklessness of the administration’s decision-making, and in fairness, it seems to have been extraordinarily bad: Did end-to-end testing of the exchanges really not start until Sept. 26? Democrats, meanwhile, are oscillating between blaming Republicans for not implementing the law for them and the contractors for writing bad code. Maybe the contractors did screw up. But the focus on them suggests that the administration is spending too much time in meetings and anonymous press interviews screaming “not it!” instead of working with contractors to repair computer code.

3. Firing Kathleen Sebelius: I haven’t been particularly kind to Kathleen Sebelius over the years, and I’m not a huge fan of the direction in which she has taken the Department of Health and Human Services, or her expressed views on the market for health insurance. Yet although aspects of this failure are certainly her fault, I doubt that any other HHS secretary could have pulled off the impossible task that the law demanded. Firing Sebelius is not going to make the system overhaul proceed any faster. Instead, it will add managerial uncertainty and a power vacuum at the top to the overwhelming issues that the Affordable Care Act already faces.

4. Bringing in “the Best and the Brightest”: The White House’s use of this phrase to describe the outside help they were soliciting was unfortunate, since it was originally coined by an author describing how very smart, motivated idealists got us into a decade-plus quagmire in Vietnam. Also unfortunate, however, is the idea that the White House was trying to convey. Even if you could somehow assemble a dream team of crack developers and tech managers, and parachute them in to take over this operation, that wouldn’t magically enable the administration to fix this malfunctioning site by Nov. 15. In fact, it would pretty much ensure that the site didn’t get fixed in time. The new team would have to spend weeks figuring out how the site was put together, and who did what, and who they needed to talk to in order to purchase office supplies. And a developer friend, meditating on his brief experience as a consultant, points out that they would have to get all that information from people who in effect just received the following message: “You all suck, and we’re bringing in more expensive, better people to fix your crap. Please help them succeed.”

While outsiders may be valuable for small, concrete tasks and a fresh take on particularly tough problems, they can’t just come in and fix everything. If the contractors and HHS managers who built the federal exchange can’t fix it in the next month, then it’s just not going to get fixed in the next month. Or as the same developer friend put it: “Ramping up new people in a month? Hahahaha.”

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