WashPost A1, above fold, "Healthcare.gov: How a start-up failed to launch: POLITICAL FEARS VS. TECHNICAL NEEDS – Bells sounded that Oct. 1 rollout was too soon," by Amy Goldstein and Juliet Eilperin (online headline: "How political fear was pitted against technical needs"): "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 … 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 … argued that they could handle the job. …

"The president had already made up his mind … Obama wanted his health policy team – led by Nancy-Ann De­Parle, director of the White House Office of Health Reform – to be in charge of the law’s arduous implementation. … Three and a half years later, such insularity – in that decision and others that would follow – has emerged as a central factor in the disastrous rollout … ‘They were running the biggest start-up in the world, and they didn’t have anyone who had run a start-up, or even run a business,’ said David Cutler, a Harvard professor and health adviser to Obama’s 2008 campaign, who was not the individual who provided the memo to The Washington Post but confirmed he was the author. … Inside the Department of Health and Human Services’ Centers for Medicare and Medicaid, the main agency responsible for the exchanges, there was no single administrator whose full-time job was to manage the project. …

"[F]or months beginning last spring, the president emphasized the exchange’s central importance during regular staff meetings to monitor progress. No matter which aspects of the sprawling law had been that day’s focus, … Obama invariably ended the meeting the same way: ‘All of that is well and good, but if the Web site doesn’t work, nothing else matters.’ … ‘There wasn’t a person who said, "My job is the seamless implementation of the Affordable Care Act."’ … A [high-level] monthly meeting, intended to work through tough regulatory questions, was attended at first by Sebelius, Treasury Secretary Timothy Geithner, Chief of Staff Rahm Emanuel and Domestic Policy Council Director Melody Barnes. By late summer and early fall of 2010, the meetings petered out after some of the participants stopped attending …

"CMS staff members struggled at ‘multiple meetings’ during the spring of 2011 to persuade White House officials for permission to publish diagrams known as ‘concepts of operation,’ which they believed were necessary to show states what a federal exchange would look like. … [T]he White House was reluctant because the diagrams were complex, and they feared that the Republicans might reprise a tactic from the 1990s … After the election, Cutler, the Harvard professor, renewed his warnings that the White House had not put the right people in charge. ‘I said, "You have another chance to get a team in place,"’ he recalled. Nothing changed. … On Dec. 19, Obama met with roughly a dozen senior White House and HHS officials, including Sebelius. … The health-care law, he told the gathering, … was ‘the most important thing’ in his presidency. ‘We’ve got to do it right.’"
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