Why We Need a Healthcare.gov Witch Hunt

It is the only way we have a shot of settling a big debate: Can government do big things?

Kathleen Sebelius

Health and Human Services Secretary Kathleen Sebelius is under fire for possible mishandling of the healthcare.gov website.

Photo by Jim Bourg/Reuters

Washington think tanks, your moment has arrived! Healthcare.gov is a mess and someone must chronicle exactly what went wrong. The press is trying, of course, but we also must cover the aftermath—the parade of predictable behavior that obscures more than it illuminates. Did you see the hearing in the House Energy and Commerce Committee yesterday? Despite the best efforts of Chairman Fred Upton, between the grandstanding, confused questions, and the witness fog machine, it’s a wonder anyone got out alive. Meanwhile, Republicans are pointing fingers, placing blame, and otherwise showing disgust that a program that they have tried to kill is being run so badly. (Perhaps they’re jealous that the administration is better at undermining Obamacare than they are.) Administration officials, on the other hand, are caught between covering their backsides, spouting plumes of happy talk, and hiring more people to collect the springs and sprockets from the launch pad where the whole thing went kaput. On Friday, officials in charge of the #techsurge said that healthcare.gov would be running smoothly by late November, two months after the launch.

Here’s why a controlled witch hunt is needed: This episode is about much more than a website. That’s true with respect to health care, as Ezra Klein points out, and it’s also true because there are big national issues at stake that have nothing to do with the specific issues of sickness and health. Can government do big things? Sen. Lamar Alexander famously said during the health care debates, “We don’t do comprehensive well”—meaning that any law that is big and complicated will fail. Is that right?

Alternatively, have partisanship and gridlock created a situation where small flaws in a law can’t be fixed through tweaking legislation because such legislation can never pass? Is there something about complex technology that confuses the bureaucracy? Is the procurement system nuts? Does the political nature of all administration activity mean that no one is capable of reporting that the launch of a key element of the president’s signature legislation is going to throw a rod? Some of the states seem to be doing just fine. Is that because they are smaller enterprises or because the people working on state health exchanges have more flexibility?

These are sloppy questions; experts can come up with better ones. But whatever questions are asked should be broad and sloppy, because right now everyone is scheduled to leave this drama with the answer they want. The experience will confirm their pre-existing views. That’s no good as a matter of logic, but it’s also a waste of rich material. This crack-up is a genuine disaster—it is expensive, it is worrying people who need and want insurance, and it is a huge waste of time. But it also provides rich material for a case study about the effectiveness of government.

Precision in this hunt is the key. Usually in investigations you need subpoena power. That doesn’t seem to be an issue. (Though I’d still put a hand on the shredders at Health and Human Services and the White House just to see if they’re warm.) In this case, what’s needed is some expertise, patience, and methodical reasoning. These attributes have long since been banned from congressional hearings. There are nevertheless people in Washington think tanks who will be excited to think through these matters.

A precise example of the kind of thinking that’s required is in David Auerbach’s wonderful deconstruction of yesterday’s hearing. Talking about the watery responses from the witnesses, Auerbach writes, “They don’t seem to understand the difference between acceptable and unacceptable bugs, and worse, they don’t seem to know that there is a difference.” The point is that there’s a distinction between garden-variety problems and catastrophic problems that you could either have seen coming or for which you should have been on guard because they’re so damaging. So, using that same fine screen: What problems here are the normal ones you’d have in any big enterprise, what are the problems that are the result of unique one-time-only stupidity, and what are the problems that result from this being a government rather than private enterprise? 

This project should be one everyone loves. Only the most devout libertarian doesn’t want the government to do anything. Those who want a smaller government should still want it to operate efficiently. Liberals, and people like the president, who believe in smart government, should be pushing hard for answers. If they’re not interested in a thorough deconstruction of what went wrong for policy reasons, they should care for political ones. Healthcare.gov is now a very good excuse for anyone who wants to oppose an activist federal government. All a lawmaker has to say is that they don’t want the same government that ran healthcare.gov in charge of X, where X is anything you want to see stopped in its tracks. 

Right now, no one in this drama is trying to learn from the mistake. That’s understandable, but it also guarantees that the mistake will be repeated.