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Jim Moore Headshot

Affordable Care: A Disappointment So Far

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On a bitter, snow-covered and icy, winter night in 1967, I was driving my father's Oldsmobile Toronado -- a much sturdier and winter-worthy vehicle than my lighter, smaller VW bug. I was in a hurry to a pick up a new girlfriend in the Washington, D.C., suburbs, and go to the movies. When I saw the street sign in the headlights, I cranked the steering wheel over hard to the right, and the Toronado, all two-plus tons of it, began a sickening skid on sheet ice. The Olds' left front fender met with the grill of a parked and snow-covered Ford compact, and the physics of the collision demonstrated the inevitable: significant damage to the Ford, barely a dent to the Toronado.

In my haste to make it to my girlfriend's house, I did little more than leave a mostly illegible note under the Ford's windshield; I took no time to locate the owner, or call the police, or even call my dad. It seems that enough of my note was readable to the Ford's owner that a call had been made to my parents, who gave him my girlfriend's address. The man called the police, who then waited patiently for me to return. I fessed up, acknowledged that I'd been more interested in a date than in responsibility, and expressed as much teen-aged stupidity as I could muster. As far as the police and the Ford owner and his insurance company were concerned, the matter was resolved and I was left to drive home in the now-marred Toronado.

Back at my house, facing my folks, I knew what was coming, and I wished not to be there. My father said the four words that made the incident far worse than any crumpled metal or police inquiry: "I'm disappointed in you."

I don't think there are four more heart-dropping words that express the loss of confidence in a person than those four. My father had given over to me an important possession; he'd trusted me to take care of it, and I'd let him down. Not only that, I'd not owned up to my actions at the right time, and I'd cast doubt not only on my veracity, but, in the eyes of my girlfriend's parents, the owner of the Ford, and the State Police, I'd tarnished my family's veracity. "I'm disappointed in you." To this day, those remain the harshest words I can say to anyone who has let me down.

One month into the drive envisioned four years ago as the Affordable Care Act, President Obama's date with the American people -- particularly those with little or no health insurance -- there have been car wrecks aplenty. Icy patches of poor programming thwarted the president's ability to steer his program to success. Awkward moments in the Rose Garden watching the president try to explain the delays did little to instill confidence. House and Senate hearings where various administration officials and contractors were grilled by both Democrats and Republicans amounted to holding cell interrogations -- and were well-deserved.

Even though the president tried leaving a note or two about his frustration with the system; even though he apologized (and I give him a lot of credit for doing it, several times, with sincerity); even though he's considering administrative fixes to his plan, it is time to say to him, "I'm disappointed in you." And not only in him, but in his HHS team led by Secretary Sebelius, the plethora of IT experts and advisors, and the government-paid contractors who lost control of Obamacare and are just now towing it into the shop for what will certainly be costly, extensive, and time-delaying repairs. I do hope that behind the scenes, there are accountability sessions at the White House -- staff did not serve the president well by withholding doubts about the system's roll-out.

The repairs to the electrons of the ACA are the least of the administration's worries; the damage done to the public trust may be beyond repair, and there is no one to blame but the president and his team. There is simply no excuse for the failure of the government website to meet the public's expectations -- low as they were, they still reflected some measure of confidence in the system. But day after day news bulletins blare out tales of dropped connections, failed log-ins, incomplete entries, lack of call center responses, scrambled information, and, finally, enrollment data that confirmed what we were beginning to suspect -- a minuscule number of actual sign-ups compared to the administration's most pessimistic projections.

The news media didn't help things either when they set out to find, and then publicly embarrass the young woman whose portrait appeared on (and was subsequently deleted from) the website -- she was just an unpaid model, for goodness sake! Stay on topic, media.

The government's track record on developing large-scale information systems is hit-or-miss at best. The president said it himself during Thursday's press conference when he characterized federal information technology procurement as, "cumbersome, complicated and outdated." Some systems, like Social Security, have a good online presence and seem stable and useful. The Department of Veterans Affairs, operating the largest single health care system in the country, has introduced innovative features to its web services for veterans -- My HealtheVet is a popular and effective portal for veterans' health care services. On the other hand, a long- and much-promised unified electronic medical records system between VA and the Department of Defense remains as elusive as Bigfoot.

With respect to the Affordable Care Act website, the president was poorly advised from day one -- staff and contractors promised the moon and failed to deliver; oversight agencies and the relevant Hill committees did not question enough assumptions; there was not enough deep digging that might have unearthed the Catch 22 of cancelled policies; full stress tests on the system were not performed... the list of shoulda-coulda-wouldas goes on and on.

There's no doubt the problems will be fixed, people will enroll, health insurance will be available to those in need of it, and, in all likelihood, either the Congress will amend the ACA to fix the embarrassing problem of dropped policies or the White House will apply an administrative fix. But the damage to the average citizen's barely tepid faith in the government's ability to deliver on its promises has taken yet another blow to the body public. It's no wonder we're all disappointed.