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The Obama Administration has certainly mangled the roll-out of the Affordable Care Act. Healthcare.gov  is more clunky than an old pickup truck. The President has had to deal with the discomfort of his past promises meeting present reality (“If you like your current health insurance, you can keep it”). The political implications for the Democrats are inauspicious: The botch-a-thon has been greeted with enthusiastic glee by Congressional Republicans, giving them a convenient escape from the fallout of their own government shutdown debacle. Congressional Democrats, including some Senators, who are up for re-election next year, are anxious about the negative impact the difficulties with the ACA roll-out will have on their re-election campaigns.

Setting aside the roadblocks that have been thrown in the path of implementation of the ACA (forty-two votes for repeal in the House), the Administration was obviously not prepared to go from zero-to-sixty with an enterprise-type website. In hearings before Congress, HHS Secretary Kathleen Sebelius and other surrogates apologized for the poor performance. This week found the President himself taking responsibility for the debacle in various interviews.

In light of this wide-spread panning of the roll-out, what conclusions can we draw? For the opponents of the ACA, this is proof that the program is not workable. The libertarian fringe sees the episode is another example of why large government programs must be avoided. For supporters of health-care reform, the lack of cooperation (the GOP-controlled states that refused to set up exchanges, for example, or those states that opted out of the Medicaid expansion) is a major reason for the ACA stumbling out of the gate.

While these media-bites play well with the respective constituencies, both the devil and angel are in the details. There is almost no place for nuance in the media marketplace, but those shadings are often what gives us a clear picture. Historically, large-scale programs, whether public or private, have often had rough beginnings (Medicare, Part D, struggled through its introduction not that long ago). If we think that the goals of the program are worthwhile, we usually remain patient through the growing-pain stage. It is either misguided or disingenuous to suggest that, if the execution is poor, the principle must be rejected. Yet, this has been a theme of post-modern American conservatism for the past thirty years: Government does not do much well, so it should limit what it endeavors to achieve. To ensure that the public comprehends this fecklessness, Republican administrations beginning with Ronald Reagan have set out to diminish the ability of the government to act effectively by cutting budgets, eliminating programs or appointing poor managers. One theory of the cause of the 2008 financial crisis was the failure of government financial regulators to keep the banks from engaging in risky practices led to eventual meltdown.

For their part, the Democrats have not always proven to govern better than the GOP. It was Bill Clinton who signed the repeal of the Glass-Steagall Act and unleashed the banks; and it was his economic advisers, led by Robert Rubin and Lawrence Summers, who marginalized Brooksley Born, Chair of the Commodity Futures Trading Commision, after she pushed for the authority to have the CFTC oversee the trading of over-the-counter derivatives. It was these same derivatives that turned into “toxic assets” by 2008.

There is a sin of omission here, and it is intentional: We are led to believe that, rather than acting for the common good, the Federal government is at best bulky and awkward. Most issues, this argument goes, are best left to the States. Anecdotally, though, it is probably true that corruption occurs with greater frequency on the State and local level than on the Federal. What is missing is the motivation to make the Federal government more effective and more efficient.  

The irony of the healthcare.gov  snafu is that most of the implementation was done by a group of private sector contractors. To fix it, the government has called in engineers and technologists from the private sector.