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How To Fix Healthcare.gov

Late last night, the White House and the Department of Health and Human Services finally communicated with the public and let us know their plans on fixing Healthcare.gov with a "tech surge". Their plan?

Our team is bringing in some of the best and brightest from both inside and outside government to scrub in with the team and help improve HealthCare.gov.

So, it's a good step -- admitting that something has gone wrong is a big deal, especially for a modern presidential administration in the 24-hour, hyper-partisan news cycle. But the solution of "bring in experts"? Yikes! With the total cost of Healthcare.gov speculated to be anywhere between $100 and $500 million dollars, I'd have hoped that plenty of "experts" have been in there already.

The problem here isn't just the result of bad programming. It's the result of bad systems and bad architecture from the get-go. When you try and build the world's biggest shopping mall and the only place you can buy your support beams from is a balsa-wood mill, your building is going to collapse. The best thing that any outside experts can do in any reasonable amount of time is replace some drywall and paint. Otherwise, your experts are going to have to figure out where the balsa-wood is falling apart, and replace it with iron. That takes time.

That said, the opportunity to use Healthcare.gov's to create a model of success is something I couldn't pass up. The great news is that we've failed! Everybody's pissed! And while that may sound like a crisis, for a guy like me it smells like opportunity: there's nowhere to go but up! That means it's ripe for innovation, and I couldn't be more glad that Todd Park is helping to lead the cleanup crew.

So Todd, and the rest of the experts tasked with fixing this problem: if you're reading this, here's your playbook for how to turn Healthcare.gov into an amazing win. And this win? It's not just for the Affordable Care Act, but also for the system that created the fiasco we're in now.

1. Admit Failure, Make Failure Consequential

The first thing that you've got to do is hold the responsible parties accountable. There's lots of hysteria about firing the Secretary of Health and Human Services for this mess. I think that's a misstep. While her departure might be a political win for right-of-center adversaries, it's not actually going to do anything to solve the real problem of what's happened here.

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 -- clearly they're not capable of being in positions where they can assess those requirements and assume that risk. Replace them with people who are qualified to run a technical recovery option.

2. Open Everything. Even if you have to go slow

It was a lack of critical thought about architecture that got you into this problem in the first place. Continuing to not think about architecting a way out of it will make getting out of the mess even worse. So we need to design a system that's going to give you the best chance of success.

First step: bring back the old github repository for the front-end of Healthcare.gov. People were actually participating with you and you shut it down. Turn it back on and let them participate.

Second: you've got to know what some of the problems are inside. The ones that involve custom software code, can you open source them? Do it. As fast as you can. I know you're using a lot of commercial off the shelf software and that it's virtually impossible to open source that. Ask your vendor to do it, and if they don't say yes in 24 hours, tell them that it will be replaced with an open source version 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.

For those who don't know, when Todd Park says "the best and brightest from inside and outside of government", the folks he's referring to are the Presidential Innovation Fellows. So I suspect that's who will be tasked with this recovery operation. And some PIFs might be able to scrub-in to solve this problem. Are they wonderful and bright? You bet. DOBT was actually founded out of the inaugural round of the program.

But are they the right people to solve the issues at hand? I'm not sure. There are people lining up who want to solve this problem. Lots of them, DOBT included, would love to help. But we're blocked out.

During my round, I led the team that built RFP-EZ. The 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.

I understand you go to war with the army you have, not the army you want. But you have the ability to get the army you want in a matter of days -- all it takes is leadership. The leadership to end the cycle of blunders without accountability, the leadership to be clear, honest, and open about where problems are, and the leadership to allow for a different set of vendors to come in and fix the mess that your old set made for you.

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.

Two choices lie ahead: keep it locked down, and you win the battle. Open it up, and you win the war. 


Clay is the chairman and co-founder of The Department of Better Technology.

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