Henry Chao: Healthcare.gov’s Defender-In-Chief
(This post was written as an assignment for MLD670M, a course at the Harvard Kennedy School of Government)
Henry Chao, the former Deputy CIO of CMS and program manager of healthcare.gov, introduced himself to our class as an ‘explainer-in-chief’. This position was thrust upon him, he told us, because he was the only one that could actually articulate what had occurred, whether that was to members of Congress, international delegations, or groups of interested students. In the end though, his recollection and argument sounded less like a balanced explanation, and more a full-throated defence of his own professional judgement and competence.
It’s important to say at the outset that it was extremely brave for Henry Chao to attend our class. It’s provocatively titled ‘Preventing Digital Disaster’, and he was coming in to talk about the project that is serving as our archetypal digital implementation failure. He was willing to talk to us for over an hour, and will be returning to speak to us again later in the semester. Having read analysis of healthcare.gov’s challenges in preparation for the class, there was a degree to which the moment he stepped in the door there were already embedded preconceptions about the role that he played, and the nature of the insight he was likely to offer.
Yet from the beginning of his talk, his central argument was clear: healthcare.gov was not a failure of technology or management within particular agencies. This was about an inability of senior leaders to make decisions, which had impacts both on the time that individuals within the project had available and the clarity of their instructions. This central thesis was held to with an unflinching discipline — when questions were asked regarding the performance of contractors, or the lack of testing, or even how the different types of failures should be categorised into buckets, the response was always the same. We didn’t have the time, and we didn’t have clear instructions. It all goes back to that. It wasn’t us. Any other argument misunderstand the facts.
To be clear, I’m not saying that this central thesis is necessarily wrong. I don’t yet have a comprehensive grasp of the entire project, and it certainly seems true that a major flaw was the repeated delays at the political level and the lack of clarity on what the website would need to look like. But, to me, Chao’s argument did not place decision paralysis as one factor among many that could threaten a digital implementation, but placed responsibility solely and squarely above his head. In order to reinforce this argument, he even spent a protracted period of the class drawing attention to another element of the healthcare.gov project that worked well but never received any attention — the single gateway that his team developed to access sensitive personal data from other agencies. Yet he seemed to explain this element of the website not to comparatively illustrate, but to absolve blame.
As well as his central argument, there were other aspects of his approach that seemed particularly defensive. Instead of opening with a narrative of what happened and what his key lessons were, he put up a slide of all the questions that had been suggested in advance by our professor and went through one by one, parrying any potential criticism and focussing on what ‘other people’ or ‘journalists’ had repeatedly failed to understand. When it came to questions about other key actors that had been sent to assist the project, he’d raise his eyes, sigh, and describe them as a ‘nice guy’ and then go on to explain why they were also part of the problem.
When I worked at the UK’s Parliamentary and Health Service Ombudsman, part of my role was supporting investigations to understand failure by public servants and identify wider learning. It may therefore be that I’m just particularly sensitive to these defensive triggers. The best public sector leaders I’ve seen have been open and honest about what they think they could have done better, and then used that as a springboard to suggest how other actors or parts of the system could have been adjusted to enable their own stronger performance. Far from making them seem weaker or less competent, this demonstrated an impressive ability to see personal failure as a point of learning.
I think the lesson Chao wanted to impart on us through his talk is that when you’re dealt a bad hand, there’s not much you can do. The lesson I took away was somewhat different, and stems primarily from Marshall Ganz’s work on ‘public narrative’, which I’ve been lucky enough to study in depth at HKS.
In Ganz’s framework, he argues that in situations of ‘loss’ individuals have a choice between creating narratives of contamination or redemption. A contaminative narrative focusses on the inevitability of what went wrong, the passivity of those individuals in the story (including the narrator), and in some instances a denial of responsibility. A redemptive narrative recognises the loss, but then places it in a broader arc in which individuals have agency to move forward, and potentially gain value from what could have otherwise been a major setback. Ganz argues that it is only by consciously building redemptive narratives that we can mobilise the agency of others towards positive change. In choosing to apportion blame and deny (or at least de-emphasise) elements of the past, Chao failed to build a redemptive narrative that could mobilise a group of interested public servants to more effectively realise the potential that the government digital space has to offer.
It’s understandable that Chao chose to use his time to defend his record, and focus on the flaws of others, to explain what went wrong with healthcare.gov. In doing so, he missed an opportunity to impart a broader and much more crucial lesson about the value of recognising and learning from mistakes.
