Larry Summers

Larry Summers called for an implementation czar, but Obama’s top health aides said “we got this.”

The implementation of the Affordable Care Act has gone extremely poorly so far, and it seems part of the reason is that the administration refused to follow sage advice coming from some of their own people. From the Washington Post (the whole post is worth a read):

In May 2010, two months after the Affordable Care Act squeaked through Congress, President Obama’s top economic aides were getting worried. Larry Summers, director of the White House’s National Economic Council, and Peter Orszag, head of the Office of Management and Budget, had just received a pointed four-page memo from a trusted outside health adviser. It warned that no one in the administration was “up to the task” of overseeing the construction of an insurance exchange and other intricacies of translating the 2,000-page statute into reality.

Summers, Orszag and their staffs agreed. For weeks that spring, a tug of war played out inside the White House, according to five people familiar with the episode. On one side, members of the economic team and Obama health-care adviser Zeke Emanuel lobbied for the president to appoint an outside health reform “czar” with expertise in business, insurance and technology. On the other, the president’s top health aides — who had shepherded the legislation through its tortuous path on Capitol Hill and knew its every detail — argued that they could handle the job.

The administration chose to back a law that required the largest and most complex computer system ever created by the federal government and didn’t put someone in charge with the experience necessary to implement it. This Rube Goldberg device is like creating a new Amazon and requires someone with that level of experience.

Given the complexity it is still possible there would have been problems even if they chose the right type of person to lead the implementation, but this is a massive unforced error. Clearly a few states have done a much better job with their exchanges so it is possible the federal exchange could have been implemented more effectively.