On October 1, 2013, the Affordable Care Act (formerly known as Obamacare), the flagship healthcare initiative of the Obama Administration, began with a disaster. The day HealthCare.gov launched — a site designed to extend healthcare access to millions of Americans — the site crashed and only a tiny number of people successfully enrolled for care. To rescue the platform, the White House enlisted top technologists from the private sector, an effort so successful the Obama Administration later institutionalized it in the US Digital Service (USDS) under the Executive Branch. Mina Hsiang was a key member of the HealthCare.gov rescue team.
Before stepping into her current role as Administrator of USDS, Hsiang was a Senior Advisor in early 2021, serving on the Biden-Harris Transition Team, and worked with the COVID and Health and Human Services teams to oversee the delivery of Vaccines.gov. Hsiang has also worked in the private sector as Vice President of Product and New Market Development for Devoted Health, and also led new product development for the analytics department of Optum, a $60B healthcare tech & services company. Perhaps no one in tech understands the complex interplay between the private and public sectors better. Hsiang joined Round to discuss how her team at USDS is using technology to modernize government services. Here are four key takeaways.
Technology itself is never the point of anything; it serves to meet a need. Hsiang said she has never worked anywhere else where she felt able to so completely focus on doing what is objectively best for the public. “I’ve had USDS engineers who have cried at a launch and said to me: I used to work on optimizing ads and I just made it easier for millions of veterans to access benefits they are owed because of their service to our country,” she said. Now that the pandemic has expanded the scope of online government service delivery, the impact of USDS’s work is greater than ever. From creating safer resettlement pathways for refugees, to supporting veterans and connecting people with food assistance, USDS’s portfolio spans agencies across the federal government.
Since 2014, USDS has grown from a group small enough to sit around a table to an organization with over 200 technologists assisting federal agencies with design, product, engineering and data for services and technologies. Hsiang credits some of USDS’s success to the unit’s tour-of-duty model, where technologists join the federal government for a limited term, not unlike the Peace Corps. Working in the government can be an unexpected career option, and a limited term can feel less risky. Especially given high salaries in the private sector, this time limited-service model helps attract talent that might otherwise balk at working in government. The tour-of-duty model also prevents stagnation and ensures that USDS employees feel empowered to challenge the status quo when working with federal agencies.
Working for the government has different constraints around scope, schedule, budget, or target populations than other work, which can serve as a valuable motivation and opportunity to do things differently and it can breed ingenuity. For example, in the private sector, you typically choose your customer base using marketing principles, but many federal services must be accessible to everyone. Take for example vaccines.gov, a website to help the public understand and find covid vaccines. USDS helped HHS and CDC launch the tool in English and Spanish, with full accessibility, but in parallel also helped launch a call center with over 100+ languages supported and a text service. Together these capabilities enabled more people to access the critical information they needed. Another good example from one of USDS’s partners is login.gov, which is a critical shared log-in system for many federal agencies, and a growing number of states. Equitable and accessible identity verification is challenging, but they were able to identify and implement a key access solution: the United States Postal Service. Since 95 percent of people in the U.S. live within 10 miles of a postal office, offering postal office-based identity proofing creates a dramatically more accessible and trusted way for people to use the service.
Along with recruiting from the private sector, USDS also engages with the private sector to learn about the capabilities and product choices of companies— work they consider important to prevent government technology from stagnating. But while the public sector has plenty to learn from the tech industry, Hsiang thinks the reverse is also true. Government creates the regulatory environment we all swim in and pays for many things across society from roads to healthcare, so there’s tremendous value in understanding the interplay between the public and private sectors. Or as she put it: “How can you build something without understanding the initial conditions of your environment?”
Every designer working today is trying to make the world a better place, yet it is often forgotten that we are not only designing for people but also for the planet.
IKEA’s Senior Advisor and former Chief Sustainability Officer tells us how companies can lead positively by reconciling sustainability and business goals.
Building responsible and equitable algorithms is one of the toughest challenges technologists face today. Expert Cathy O'Neil explains why and what to do about it.