PP&ACA May Have Been Too Much Too Soon

For John, BLUF:  Sometimes the elephant needs to be eaten one bite at a time.  Nothing to see here; just move along.

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When I hear people talk about the Patient Protection and Affordable Care Act (PP&ACA) and the cost and confusion surrounding it I am not surprised by what they are talking about.  This is a system that is supposed to help bring order to some of the chaos in a program that is one-sixth of the national economy.  Of course it is going to be complicated and confusing.  That it works today is due to the hidden hand of the free market.

Now the Federal Government is trying to manage parts of it.  And just because it is the Federal Government, that doesn't mean that it is really, deep down inside, a great, well thought out approach.  It isn't.  But that should not be a shock to any of the 535 folks in the US Congress (or their Staffers).  Nor should it be to the White House or to the Office of Management and Budget.

My standard for comparison is the Department of Defense effort to audit its own books.  An abject failure since 1996.♠  Before then they didn't even try.

This article, from Reuters, tells part of the story of the Department of Defense trying to meet a Congressionally mandated requirement to be able to audit the books.  Going to the lede from the article (and my own Service):

The U.S. Air Force had great expectations for the Expeditionary Combat Support System when it launched the project in 2005.  This accountants’ silver bullet, the Air Force predicted a year later, “will fundamentally revolutionize the way the Air Force provides logistics support.”

The new computer-based logistics technology would replace 420 obsolete, inefficient and largely incompatible “legacy” systems with a single, unified means of tracking the hardware of warfare.  And it would be done for a mere $1.5 billion, combining three off-the-shelf products from Oracle Corp and modifying them only enough so that they could work together.

Seven years and $1.03 billion taxpayer dollars later, the Air Force announced in November 2012 that it was killing the project. ECSS had yielded “negligible” value and was “no longer a viable option,” the Air Force said.  It would have taken an estimated $1.1 billion more to turn it into a system that could perform about one-quarter of its originally planned tasks, and couldn’t be fielded until 2020

It goes down hill from there.

With that kind of a Federal Government track record it was hoping a lot that we would fix all the problems with health care for peanuts.  "The Obamacare website design contract was for $93 million."  That was the original cost.  The new estimate in October of this year was $630 million. The idea that we would fix all the problems of health care and provide some form of insurance for everyone at one fell swoop was flawed from the beginning.  Computer software, especially computer software that talks to other software, and is secure, is hard.  Most software programs die somewhere during the birthing process.

And this isn't all on Secretary of Health and Human Services Kathleen Sebelius, or even President Obama.  The Congress, with years of watching the Department of Defense, should have been on guard against expecting too much, especially for so little money Appropriated and Authorized for this project.

It is likely that piecemeal was the way to go.  But, that may have been a political non-starter.  Either way, we lost, at least for now.

We will see what the new year brings.

Regards  —  Cliff

♠  My youngest Brother, who worked for the Marines as a Civil Servant, notes that the DoD IG gave them a score of "UNQUALIFIED", which is the highest score possible—meaning no qualifications required to define their audit.