The conversation started the first week after healthcare.gov launched. Maybe the problem was federal procurement, not Obamacare.
Clay Johnson is the founder of Department of Better Technology and a former White House Innovation Fellow. In an interview with NPR, he explained why healthcare.gov was not built by a company that knows how to build web sites:
“The problem is that the way that federal contracting works is so burdensome that the only people who get contracts like this are experts at lobbying and experts at regulations that require you to get these sorts of contracts. And they’re not experts at doing the job of building these websites.”
The following week on BuzzFeed, Alex Howard wrote a excellent analysis of why the first Internet president had the biggest Internet failure and explained in more detail the rules around procurement:
There are good reasons for having many tough rules on how technology can be bought, in other words. The trouble is that all those rules are selecting for huge companies that are very good at getting contracts not necessarily in delivering results. They’re also giving chief information officers and procurement officers an incentive to avoid the risk of working with newer firms, as opposed to managing it. … The sad truth is that unless we reform how government buys, builds, and maintains information technology, we will continue to get more Healthcare.govs.
Howard recommended Sean Gallagher’s post at ArsTechnica about the larger problems of federal IT procurement:
Over 50 percent of the federal workforce is over 48 years old—and nearly a quarter is within five years of retirement age. And the move to reliance on contractors for much of IT has drained the government of a younger generation of internal IT talent that might have a fresher eye toward what works in IT.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Both articles are worth a full read (Gallagher talked to an Army IT person who called parts of a new email system “a crime against humanity”). I recommend clicking through to understand why HIT in particular and IT in general is so fatally broken. Howard’s best recommendation is an action plan from Johnson. He outlined these three recommendations on how to replace the current IT procurement system with a 21st century version on the blog at The Department of Better Technology:
1. Admit failure, make failure consequential
Every new federal service has to get a Certification and Accreditation and an Authority to Operate. The people who signed those documents saying that this was a product that met and passed all the specified requirements assumed the risk of failure, and ought to be fired.2. Open everything, even if you have to go slow
Begin to make a real GitHub repository, one that includes all the code required to run Healthcare.gov.
Use the current Presidential Innovation Fellows to be community ambassadors and build managers to this open source community you’re about to build. They all know how to work GitHub. Let them figure out how to get the code out, documented, and workable by people on the outside who could help.3. RFP-EZ 10x.
The RFP-EZ system makes it easy for government to put out RFPs for less than $150,000, and easy for companies or individuals to bid on fixing the problem.Use this program to openly solicit new businesses to help. Write a clear, open, short, and honest RFP that allows experts to see where you think the problems are, and submit bids not to exceed $149,999 for how to solve that problem. Put out the RFPs on Monday, select the winners by Thursday, have them on the ground on the following Monday.
The most important thing? This is the best opportunity people like Todd Park and Jen Pahlka will have, during their entire careers, to show that government can work a different way. By using the playbook described above, they can turn the Healthcare.gov crisis into an opportunity that’ll cause rapid change in the way government buys things that’ll lead to a more cost-effective government, more jobs for small business creators, and most importantly, better service delivery from government to the people government serves.
And I thought the battle to reform healthcare was a hard one.
