Health and Human Services Secretary Kathleen Sebelius will finish her five-year tenure having implemented the biggest expansion of health insurance in 50 years. What should we learn from her success story? Three key lessons:
1. Don’t Panic
Yes, HealthCare.gov flopped at the start. But as anyone within earshot of my voice in the past six months knows, rough beginnings are typical for big projects, in both the public sector and the private sector.
Problems occur not necessarily because of rank incompetence, but because doing new things is hard and learning from mistakes is how people and institutions get smarter and sharper.
So when something goes wrong, there’s no need to panic. It’s just an unfortunate part of the process.
Figure out what your current team can still do to fix the problem, decide if some fresh eyes could also help. But panic firings only satisfy armchair generals. Serious governing requires more calm and trust.
This is the philosophy of President Obama, as reported by the National Journal earlier this month:
During the darkest days of the website meltdown, Obama made it clear to those who asked that it was crucial for him not to fire any high-ranking administration officials. Sebelius and McDonough both reasonably feared they would be shown the door.
Numerous business executives, even those who wish Obama well, criticized Obama publicly and privately for failing to “hold someone accountable” and using the power of a bureaucratic beheading to demonstrate his fury. Whether this is a sign of strength or weakness, it is characteristically Obama.
Holding a maligned, self-doubting team together in moments of peril is too often oversimplified by the phrase “No Drama Obama.” It’s more complex than that. Obama has convinced himself that scaring people with a ceremonial firing deepens fear, turns allies against one another, makes them risk-averse, and saps productivity. At no time was this distillation of presidential power put to more strenuous administration-wide test…
2. Ignore Pundits
Of course, panic firings is just what the pundit class, not to mention the army of Republican naysayers, was demanding.
Ezra Klein declared “Obama Needs to Fire Some People”, arguing that “It wasn’t just the technical challenges of HealthCare.gov that the administration managed poorly. The White House was completely unprepared for the furor over canceled insurance plans; that’s a political problem that Sebelius, a former insurance regulator, should’ve seen coming.”
The Daily Show’s Jon Stewart basically called Sebelius a liar after he wasn’t satisfied with her responses to his obtuse question that failed to grasp the difference between the individual mandate – the linchpin of the entire law that cannot be delayed without delaying the entire program – and the mandate on large employers – which has a very narrow impact and can be delayed to help businesses transition without undermining the program.
But being a pundit punching bag didn’t mean Sebelius couldn’t do her job. And since nothing succeeds like success, pundits will eventually shift with the wind. In fact just yesterday, Klein was singing a different tune: “…there was too much to be done to fire one of the few people who knew how to finish the job. Sebelius would stay. The White House wouldn’t panic in ways that made it harder to save the law. The evidence has piled up in recent weeks that the strategy worked.”
Pundits like to demand accountability from others. But being a pundit is the least accountable profession in the world. Those who govern have to take a longer view, and take in a wider range of feedback, to persevere.
3. Never Give Up
Less known is how Sebelius salvaged the Medicaid expansion component of Obamacare. The Supreme Court weakened it by giving states the ability to refuse federal funds to expand Medicaid, and many Republican governors were more interested in undercutting Obama than helping their citizens get health care.
It would have been easy to dismiss all the Republican governors as a lost cause. But as ThinkProgress’ Igor Volsky recounts, Sebelius did not give up on them.
…Sebelius traveled the country, urging Republican governors to reconsider. As of today, eight GOP-controlled states have approved expansion — in no small part because of the flexibility Sebelius and her team provided.
To convince political opponents like Iowa Gov. Terry Branstad (R) or Arkansas’ Republican-controlled legislature to adopt one of Obamacare’s most significant coverage provisions, HHS approved alternative proposals that allowed states to use federal funding to cover their low-income uninsured populations with private insurance. Similarly, Sebelius permitted Oklahoma to continue using federal Medicaid dollars to subsidize private health insurance for low-income workers and extended to Indiana a one-year extension of its pilot Medicaid program, which provides coverage for low-income residents. Michigan’s Republican Gov. Rick Snyder also signed a Medicaid expansion bill into law after receiving a federal waiver for cost-sharing provisions for Medicaid beneficiaries from the federal government
The solutions became politically tenable to Republican lawmakers because they could claim that they were covering their residents on their own terms, using unique state-tailored solutions that rejected the “one-size-fits all” prescription of Obamacare. Sebelius’ policy flexibility provided conservatives with enough political cover to implement key parts of the law.
This is another reason why a panic firing would have been dumb. Maybe Obama didn’t need Sebelius to fix code, but he needed her for other aspects of the program. As a former governor from a red state, Sebelius brought unique perspective to those negotiations that would have been lost had she been sacked.
I wrote previously that “Obamacare’s Troubles Will Be Good For Liberalism” in part because “we will not only be pleased with the final result, but we will also be better conditioned to tolerate a degree of initial imperfection, knowing that our government has the capacity to work through it.”
Sebelius is the personification of that lesson. Let’s treat the next government official in her position better.