[This post was written several days prior to the launch of Healthcare.gov on October 1, 2013 — I’d say that most of my predictions have been borne out, particularly in Update #3]
For nearly 20 years, my professional focus has been on large-scale IT projects: why they succeed and why they so often fail. One of my observations — which dates all the way back to my time as a contract programmer at Apple Computer in the late 1980s — is that
In many large or even medium-sized IT projects, there exists a thermocline of truth, a line drawn across the organizational chart that represents a barrier to accurate information regarding the project’s progress. Those below this level tend to know how well the project is actually going; those above it tend to have a more optimistic (if unrealistic) view.
I wrote a post about this on my professional blog several years ago, and I keep coming back to this concept, mostly because it keeps reappearing in real life. In that post, I talked about the various reasons for the thermocline, then observed:
As the project delivery deadline draws near, the thermocline of truth starts moving up the levels of management because it is becoming harder and harder to deny or hide just where the project stands. Even with that, the thermocline may not reach the top level of management until weeks or even just days before the project is scheduled to ship or go into production. This leads to the classic pattern of having a major schedule slip — or even outright project failure — happen just before the ship/production date.
I think we’re starting to see that as the ‘go-live’ date for Obamacare approaches. The Obama Administration has already unilaterally deferred various aspect of Obamacare, for reasons that I suspect are both political and practical. But the individual mandate has not been deferred (yet), which means that all the various state exchanges are supposed to be up and functioning next week. Some problems are already being reported, and I suspect quite a few more are going to crop up.
But I think the thermocline analogy applies beyond the IT portion of Obamacare. I suspect that the real-life implications and requirements of Obamacare are inexorably being pushed to the top, and that we are going to reach a point where all of its awfulness — well-intentioned, perhaps, but poorly drafted and implemented, with numerous unintended consequences — will be public and undeniable. Jim Geraghty (of National Review Online) has started to point out the “Obamacare train wrecks” — see here and here — and I believe he is very much correct that “there are many more to come.”
And it will be interesting to see what happens then. ..bruce w..
UPDATE #1: Back in September 2009, I wrote a two-part analysis of HR 3200 — the original House-based health-care reform legislation — from a systems design point of view. As it turned out, my analysis anticipated not only the implementation issues surrounding Obamacare, but the political issues as well:
- HR 3200 from a systems design perspective (Part I)
- HR 3200 from a systems design perspective (Part II)
UPDATE #2 (09/30/13): Many thanks to Jim Geraghty for the pull-quote and link in his Morning Jolt e-mail newsletter! If you’re not reading it, you should be.
UPDATE #3 (09/30/13): In my original “thermocline of truth” article, I describe what happens when the project pushes ahead anyway, which may give us a taste of what’s to come with Obamacare in general and the state exchanges in particular:
Sometimes, even then management may not be willing to hear or acknowledge where things really are but instead insist on a “quick fix” to get things done. Or management will order the project to be shipped or put into production, at which point all parties discover (a) that the actual business drivers and requirements never successfully made it down through the thermocline to those building the system, (b) that there are serious (and perhaps fatal) quality issues with the delivered systems, and thus (c) that the delivered project doesn’t do what top management really requires.
Be prepared for a lot of “chewing gum and bailing wire” stories regarding the various state exchanges, with a high likelihood of more deferrals and delays, either de facto or de jure.
Also, here’s a post with a link to an insightful article on why large-scale government IT projects are so prone to failure, or at least significant delays and cost overruns.
UPDATE #4 (10/07/13): Here’s a follow-up post I wrote a few days later (and have updated several times since) about the actual problems that Healthcare.gov has been experiencing. I think the paragraph in Update #3 above pretty much sums up what has been happening.
UPDATE #5 (10/09/13): And here are more observations about the Healthcare.gov launch.