Obama Finds Healthcare.gov’s New Hero
By any stretch of the imagination, the rollout of Healthcare.gov, the federal health insurance exchange, is going poorly. Three weeks into its existence, it doesn’t seem to work. Slow to anger and cast blame, the Obama administration is now taking action. It is bringing in a SWAT team, staging a technology surge, calling on “the best and the brightest,” as the Department of Health and Human Services noted in a blog post.
Health Department Secretary Kathleen Sebelius lacks the technology and management chops to bring this project home. So Obama has called in Jeffrey Zients, whom White House Spokesman Jay Carney called “an expert in the field of effective management.” Zients, who cut his teeth as a management consultant at Bain & Company, helped David Bradley build the Advisory Board Company, a health care consulting firm, into a juggernaut, and grew rich after it went public. Zients has served as a super capable Geek-on-Call, helping to fix programs that have gone awry and stepping in to fill crucial rolls. He worked on the Cash for Clunkers program in 2009, served as Chief Performance Officer at the White House, and served two stints as acting head of the Office of Management and Budget, from July 2010-November 2010, and from January 2012-April 2012.
It’s possible—even likely—that Zients will turn Healthcare.gov into a model of efficiency and high functionality. The problem for the White House—and it’s a recurring one—is that someone with Zients’s capabilities, stature, and record wasn’t running the operation from the beginning.
President Obama has shown a remarkable ability to get hyper-effective, brilliant, and public-spirited executives to come serve in the administration. But few of them have stayed for long. That’s in part because a job inside the White House is so exhausting, and it’s in part because the financial pressures outside the White House are simply too great and irresistible. So former Treasury Secretary and Harvard President Larry Summers came to run the National Economic Council, and stayed for about two years. Peter Orszag, another great economic mind, served as OMB Director—for about a year and a half. Gene Sperling, perhaps the longest-serving senior member of the economics team, joined Treasury in 2009—and just left after nearly five years. He looks as if he’s aged ten years.
It’s great the “best and the brightest” are willing to serve. (Of course, after the way the “Best and the Brightest” performed during the Vietnam Era, you’d think Democratic administrations would eschew the term on a permanent basis.) But what Obama needs isn’t an archetype from the Kennedy years. He needs an archetype from the Roosevelt years: a heroic, committed administrator with a long attention span, a bleeding heart, and a desire to achieve great things. Somebody who is fully committed and willing to stay the course, who regards a high-level government position as the culmination of a career, not as one of many stops. Someone who sees making government projects work for people as his or her life’s work, as a journey. He needs, in short, a Righteous Pilgrim. Someone like Harold L. Ickes.
Most politicos today probably are more familiar with his son, Harold M. Ickes, a combative campaign operative who worked in the early Clinton White House. But with all due respect to the son, the father was far more influential, and a far more towering figure in his day.
Nearly 20 years ago, when I interviewed Harold M. Ickes in his White House office, I saw a photograph on the wall. It showed Harold L. Ickes and a bunch of people at a groundbreaking for a huge building. The inscription read: ““Harold, stop making mud pies. Franklin Roosevelt.”
Ickes made mud pies, and a lot more, during his tenure at the Department of Interior. A native of rural Pennsylvania, he worked as a reporter and lawyer in Chicago, got into politics as a reforming Republican, and became an enthusiastic backer of FDR. At age 59, he came to Washington with the Brain Trusters, assumed his position in March, 1933, and stayed through February, 1946—nearly thirteen very consequential years. (Labor Secretary Frances Perkins was the only other original cabinet member to last as long.)
At Interior, Ickes had a significant reach. He was responsible for 50 million acres of federal land, for the Bureau of Reclamation, and for the territories Alaska, Hawaii, and the Virgin Islands. But his portfolio expanded during the 100 days. On July 8, 1933, Ickes was named to the post of Federal Emergency Administrator of Public Works. “The poor boy from Altoona had just been given responsibility for a budget larger than that of most European countries and the opportunity to remake much of America,” wrote T.H. Watkins in Righteous Pilgrim (which, incidentally, is the sort of book that doesn’t get written anymore and demands to be read.) The Public Works Administration was a centerpiece of the New Deal. It represented a significant expansion of the federal government in building valuable, life-saving infrastructure. Ickes’ job was, in his words, “to get honest work at honest wages on honest projects.” And to do it quickly.
By 1935, Watkins writes, some 19,000 individual projects and 368 street and highway projects had been authorized. Many of the projects, which PWA funded through loans and grants, were small and anonymous—a “$2 million expansion of facilities at Virginia State College for Negroes,” for example. But many were monumental. If you’re in New York today, look around: the Triborough Bridge, the Lincoln Tunnel, Grand Central Parkway, the Williamsburg Houses. These and so many other massive projects were part of the Public Works Administration.
Ickes’ department also oversaw the completion of the Hoover Dam, and a vast system of aqueducts and irrigation conduits in the west and southwest. And it expanded the National Parks System to include the Everglades, Joshua Tree National Park, and Big Bend National Park. On the mall in D.C., he planted a new Department of Interior headquarters, which was the first government building to have escalators. Ickes was also a force in fighting institutionalized bigotry, an area in which the Roosevelt administration too frequently fell short. When the African-American singer Marian Anderson was denied permission to sing at Constitution Hall, it was Ickes who opened up the Lincoln Memorial as a venue. And it was Ickes who introduced her: “Genius draws no color lines,” he said. Watch it here.
Many analysts would chalk up the Healthcare.gov problem—and other management issues that have cropped up—to President Obama’s lack of private-sector experience. That’s bollocks. Plenty of veteran private-sector mangers screw things up every day. And many presidents with little private-sector experience proved very effective at running the executive branch. What was missing in the Healthcare.gov roll-out was a lack of historical awareness.
It seems that the Health Department and the White House didn’t grasp the stakes, or the symbolism, of getting the exchange done right and on-time. Healthcare.gov isn’t just a website, or a payment processing machine. It’s a vital piece of commercial infrastructure, perhaps the most important such project undertaken in the past decade. The Affordable Care Act is the single most important public works program of the Obama administration. It will impact the lives of tens of millions of people, and change the way a truly massive industry does business. It’s the Hoover Dam, Appalachian Trail, TVA, and the Rural Electrification Authority rolled into one.
Now, many parts of the ACA have been implemented without a hitch. The Medicare surtax is collected efficiently and automatically. Insurance companies aren’t kicking 23-year-olds off their parents’ insurance. But given the states’ reluctance to set up their own exchanges, Healthcare.gov, the federal exchange, was destined to be a huge construction project. And that meant that it needed somebody in charge who would regard this not just as one of many projects he or she is overseeing, and not just as something he or she might spend a year or two working on before heading to Wall Street or academia. No, it needed someone who would see this construction project as the culmination of a life’s work.
The Obama administration now has somebody who is really good at cleaning up muddy problems on the case. What it really needed last year was someone in a position of authority who loves to make mud pies.