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President Obama and the Affordable Care Act Fumble

Affordable Care Act Roll-out Failure Surprised President Obama
I have managed a lot of big, complex business program rollouts – sometimes as a functional manager and sometimes as the consultant or coach. I have worked with teams from 1 to several hundred all co-located or scattered across several continents. I’ve been the direct line manager and I have managed through a variety of matrix management models in organizations as diverse as HP, the State of California, and Hawaiian Airlines.

One thing has always been constant – I believed in the people I lead and they trusted me to lead them. If a leader gives the team clear goals, good tools and clear lines of responsibility and holds them accountable for the results – 99% of the time they will deliver.

The one caution I always give my team – in the first hour, of the first day is – “don’t let me get surprised”!

In work and in life “stuff” happens. Sometimes it is good “stuff” and sometimes it is bad “stuff”. The important thing to remember is that “if I know as soon as ‘stuff’ happens, I can manage it to a soft landing”.

That little speech ends with one clear warning. “But, if you let me get surprised, it will only happen once.”

It is not enough to just give the little speech about surprises. An executive or a manager has to walk the walk as well as talk the talk. I would not take on a project that was not actively led by an executive sponsor with real profit and loss responsibility.

I learned from Andy Grove, the first CEO at Intel – for whom I managed Strategic Staffing, the wisdom of being a little paranoid about “stuff” happening. During the course of a project I work with groups and individuals on a continuous basis as well as conducting mile stone reviews led by the executive sponsor. “Don’t tell me, show me. I’m going to test that myself.”

Hands-on Executive Builds Trust

When it is time to “bring the project live” it’s all hands on deck – from the most senior business executive to the most remote factory worker. The executive sponsor and I can’t actually fix machinery that doesn’t work or find a computer program “bug” but our presence communicates the importance of the project, the value of the work being done and the importance of a successful outcome to the bottom-line. Being there, even if it’s just to order the pizza, demonstrates our accountability and builds trust.

The President of the United States is the Chief Executive of the nation. Governing is about execution. Execution is the conversion of politics and policy into delivered government services. The President surrounds himself with a hand-picked White House staff and a coterie of trusted political allies in Cabinet positions across the federal government. Their job is to execute but their first priority is making sure the President is never surprised and/or embarrassed. When the President is surprised, the people lose trust in government.

Affordable Care Act

From the beginning of his first term, the President endorsed the concept of “tiger teams” to break down barriers to government reform. The ACA rollout was a perfect “tiger team” moment.

Health care is 18% of the US economy. The Affordable Health Care Act is one of the most complicated and ambitious pieces of legislation ever enacted. It mandates the coordinated action of some of the most notoriously inefficient departments and agencies in the federal government. The concept has consistently polled with less than 50% support among a skeptical public. The initial rollout had to be flawless.

But there was no “tiger team” – no one executive appointed to coordinate across the government, between the government and the private insurance sector, between the federal government and the state governments. No single person responsible for delivering policy, regulation, public communication, Congressional communication and the enabling technology needed to convert the promise of the ACA into a reality!

There is a troubling juxtaposition between the President pictured in the Situation Room during the Bin Laden raid and the absence of any evidence the President and his health care policy and technology team ever conducted an ACA milestone review. In both situations the President was equally responsible for the “go/no go” decision.

Restore Public Confidence

If there had been a “tiger team”, a single accountable executive, and a series of quarterly milestone meetings of all the ACA stakeholders – including both majority and minority Congressional leaders – it is likely the technical and policy “surprises” of the past few weeks would have been identified and fleshed out at least a year ago. Once identified, the issues could have been managed to a “soft landing”.

The President and Congress must learn from the ACA debacle. To restore public confidence the Chief Executive must work with Congress and his Cabinet to modernize and reform the governing model – to focus on execution.

That starts with firing the people who let him get surprised!

Photo Credit: MCT/Getty Images

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