Tuesday, November 12, 2013

New baby in government's nursery of software disasters

In October, 2013, New York Times reporters Robert Pear, Sharon LaFraniere and Ian Austen first reported gross conflicts and disorganization among contractors developing the health-care Web site, healthcare.com, and their supervisors who were federal government employees. [1] While the Times described problems soon after a crisis became public, its reporters did not explain how the problems developed. Three weeks later, Washington Post reporters Amy Goldstein and Juliet Eilperin traced them to blunders committed by lawyers who were serving as government officials but had no significant operations backgrounds, technical competence or business experience--their authority underwritten directly by Pres. Obama. [2]

Neither the Times nor the Post has yet described how a senior Administration official behind the blunders, Nancy-Ann Min DeParle--former director of the Office of Health Reform at the White House and from 2011 to 2013 Pres. Obama's deputy chief of staff for policy--was allowed to quit the government before the health-care reform program began operating. An ambitious person, regarded as a health-care policy expert, she had served in prominent positions in the federal government and the state government of Tennessee, where she spent much of her youth and graduated from college. Her most obvious blunder, failing to set and then freeze program requirements, allowed a stream of changes ordered when efforts were already gravely behind schedule. [3]

Not much remembered years later, Ms. DeParle was Pres. Obama's substitute for former Sen. Tom Daschle (D, SD), whom but for a dust-up over business activities and misreporting of taxable income he would have appointed health-care "czar" for his administration--that is, both as secretary of Health and Human Services and as chief Presidential advisor on health care. Kathleen Sebelius, former governor of Kansas, got the former post and Ms. DeParle the latter. [4]

Ms. DeParle served as the Obama administration's main contact with Congress during the 2009 health-care reform effort. She had been administrator of the U.S. Health Care Finance Administration, predecessor to the Centers for Medicare and Medicaid Services, during the second Clinton administration. Before that, she worked in the Office for Management and Budget, participating in the first Clinton administration's ill-fated foray into health-care reform. Previously, she had served as Tennessee commissioner for Human Services from 1987 to 1989, an appointee of former Gov. Ned McWherter. She is married to New York Times reporter Jason DeParle. [5]

According to some observers, Ms. DeParle left the Obama administration after Pres. Obama declined to appoint her chief of staff, following Jack Lew's promotion to become Secretary of the Treasury. Her position of deputy chief of staff was filled by Rob Nabors, formerly director of legislative affairs. Denis McDonough, formerly foreign policy advisor to Mr. Obama while he was a U.S. Senator and later the President's deputy national security advisor, took the position as chief of staff for the second Obama administration. [6]

Ms. DeParle's departure as deputy chief of staff for policy left the Administration's health-care reform programs rudderless. In 2011, the Administration had abolished the former Office of Health Reform she had headed, and since then there has been no one else close to the President working specifically on health-care policy. Jeanne Lambrew, a policy analyst, moved from the Department of Health and Human Services to the Domestic Policy Council, headed by director Melody Barnes, as a deputy assistant to the President for health policy. [7]

Following Ms. DeParle's exit, the Administration's health-care efforts look to have become increasingly chaotic. By then the Centers for Medicare and Medicaid Services had been given charge. Henry Chao, deputy chief information officer of the department, was designated chief architect of software, but he seems to have been treated as an errand-boy. His warnings starting early in 2013 that the software had big problems and was badly behind schedule were clearly ignored. When Chief Information Officer Tony Trenkle signed an authorization to operate the healthcare.com Web site on September 3, 2013, Mr. Chao was left out of the loop. [8] In early November, he told Congressional investigators that he had never been told of potential problems found during a audit of security issues. A week after Ms. Sebelius testified to Congress, apologizing for program failures, Mr. Trenkle resigned. [9] [10]

Given bias against business experience and technical competence in the Obama administration, it is unlikely anyone who could have made the federal health-care insurance Web site function would have been given authority to oversee the job. Little known to the public, similar blunders occurred with the Administration's initiative in electronic health records, leaving a patchwork of vague regulations that require many software interfaces but do not detail how they must work. As with the rollout of health-care reform, key advisors for electronic health records left the Administration before efforts they had overseen became operational. The Obama administration has also extended a long series of blunders in automating air-traffic control--an explosive legacy inherited from the Reagan, Herbert Bush, Clinton and Walker Bush administrations. [11] [12] [13]

[1] Robert Pear, Sharon LaFraniere and Ian Austen, From the start, signs of trouble in federal project, New York Times, October 13, 2013, at http://www.nytimes.com/2013/10/13/us/politics/from-the-start-signs-of-trouble-at-health-portal.html

[2] Amy Goldstein and Juliet Eilperin, HealthCare.gov: How political fear was pitted against technical needs, Washington Post, November 2, 2013, at http://www.washingtonpost.com/politics/challenges-have-dogged-obamas-health-plan-since-2010/2013/11/02/453fba42-426b-11e3-a624-41d661b0bb78_story.html

[3] Sharon LaFraniere, Ian Austen and Robert Pear, Specialists see weeks of work ahead on federal health-care exchange, New York Times, October 21, 2013, at http://www.nytimes.com/2013/10/21/us/insurance-site-seen-needing-weeks-to-fix.html

[4] Unattributed, Former Obama adviser Nancy-Ann DeParle joins N.Y. private equity firm, Nashville Tennessean, August 8, 2013, at http://www.tennessean.com/article/20130809/BUSINESS01/308090077/

[5] Michael Collins, Nancy-Ann DeParle, Roane native, leaves White House team, Knoxville News Sentinel, January 26, 2013, at https://www.knoxnews.com/news/2013/jan/26/nancy-ann-deparle-roane-native-leaves-white-team/

[6] Deborah Waroff, Resignation of White House point-person on ME/CFS, International Association for CFS/ME, January 15, 2013, at http://www.meassociation.org.uk/2013/01/resignation-of-white-house-point-person-on-mecfs-from-deborah-waroff-on-co-cure-15-january-2013/

[7] Matthew DoBias, White House reshuffles energy and health reform offices, National Journal, March 1, 2011, at http://www.nationaljournal.com/whitehouse/white-house-to-reshuffle-energy-health-reform-offices-20110301

[8] Robert Pear, Official at health-care site says he didn't know of risks, New York Times, November 12, 2013, at http://www.nytimes.com/2013/11/12/us/official-at-health-site-says-he-didnt-know-of-potential-risk.html

[9] Robert Pear, Sebelius apologizes for health-care Web site malfunctions, New York Times, October 31, 2013, at http://www.nytimes.com/2013/10/31/us/politics/sebelius-apologizes-for-health-sites-malfunctions.html

[10] Stephanie Baum, First casualty of healthcare.gov debacle, CMS CIO resigns, Med City News, November 7, 2013, at http://medcitynews.com/2013/11/first-casualty-healthcare-gov-debacle-cms-cio-resigning/

[11] Jeffrey B. Guzzetti, Weaknesses in program and contract management contribute to ERAM delays and put other NextGen initiatives at risk, USDOT Report No. AV-2012-179, September 13, 2012, at http://www.oig.dot.gov/sites/dot/files/ERAM%20Final%20Report%5E9-13-12.pdf

[12] Jeffrey B. Guzzetti, FAA has made progress fielding ERAM, but critical work on complex sites and key capabilities remains, USDOT Report No. AV-2013-119, August 15, 2013, at http://www.oig.dot.gov/sites/dot/files/DOT%20OIG%20ERAM%20Report%20508.pdf

[13] Sean Reilly, Air traffic controllers making more mistakes, inspector general finds, Federal Times, March 6, 2013, at http://www.federaltimes.com/article/20130306/AGENCY02/303060006/

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