The competition gave a fair shake to the little guy (and girl)—it was made easy for smaller entities, such as startups to participate, without the burden of much overhead and bureaucracy. At the close of the entry window, it had attracted 41 competitors, many with no history of selling to the VA. Announced in October 2013, the first-, second-, and third-prize winners reflected this diversity—a startup called MedRed; a fellow VISTA-using health care provider, California-based Oroville Hospital; and a coalition led by technology powerhouse, Hewlett-Packard, which agreed to donate the prize purse to a veterans service organization. The winners now have the potential to gain plenty more than their purses. The VA health system, a nearly $50-billion-per-year enterprise, stands as a possible powerful anchor customer.
Others in the industry may gain, too, through the VA’s establishment of a testing environment on open standards (a subject we will revisit later in the book). That will allow any health care system wishing to replicate the appointment service to more easily adopt the proven technology. The VA might offer more than the sort of online scheduling available for restaurants; it could even launch the health care equivalent of an iPhone app store, with ever lower barriers to entry for new innovative products competing on price, quality, and service.
While this is a fluid story, I have faith that it will deliver on its promise. And, as you will learn later in this book, similar techniques have resulted in thriving new government services that have even inspired private sector adoption, such as Blue Button, which allows veterans to download their own information safely and securely in a computer-friendly form. In this case, insurance companies like Aetna and United Healthcare replicated the government’s functionality when they started providing the service to their commercial customers.
In this way, the government has an opportunity to return to its role, from earlier stages of American history, of introducing new services and techniques to the private sector. It all starts with government embracing a need for a new approach, a mindset that is consistent with the American legacy.
George Washington recognized the need for such new approaches. In preparation for his retirement from service following America’s successful war for independence and six years before he would become its first President, Washington sent a circular letter to the states on June 8, 1783. Washington observed that the foundation of the United States “was not laid in the gloomy age of Ignorance and Superstition” and that “the Treasures of knowledge, acquired by the labours of Philosophers, Sages and Legislatures, through a long succession of years, are laid open for our use, and their collected wisdom may be happily applied in the Establishment of our forms of Government . . .”36
For Washington and the other founders, forms of government should be tried and discarded if they fail to work in favor of better, more up-to-date institutions. The Founders did exactly that. After casting off the British empire, they scrapped the first draft of America’s federal government—the Articles of Confederation—for a new, stronger, more effective federal government. With Washington presiding at the Philadelphia convention in 1787, they drafted a Constitution that allowed for change.
Americans have always understood that government is not some sacred entity with which the people should not tamper. Nor is it an evil, external force. It is a tool. Like other tools, it needs to be revised and upgraded to remain useful.
From the eighteenth century to the twenty-first, we Americans have remade our federal, state, and local governments every generation or two, to solve new problems or to address old challenges better with the latest in organization and technology. What our predecessors did with the technology of the steam age and the early industrial era, we can do with the technology of the information age.
Innovation in government is not alien to the American tradition. It is the American tradition. The purpose of this book is to show how we can be true to that tradition by remaking American government once again. This is not a conceptual framework. It is a practical guide, a playbook borne of the experience I gained while serving as the nation’s first Chief Technology Officer, working to instill a more open, innovative government that will meet the challenges of our day. To help put these concepts in context, and to share a bit of how I found them to be useful and effective, I’d like to take you back to some of my formative experiences.
Chapter 2
The Boy on the Chair
My father, Ram Chopra, was born in 1945, in a town called Padhana. At the time, that was India. But, two years later, when India gained independence at the price of partition with the new nation of Pakistan, his family found itself one mile on the other side of the new border. They could still see India from their doorstep but, they decided, in light of the region’s violence, to flee to New Delhi with whatever they could carry. There, his father Rishi was able to find employment, largely due to his rare commodity, a college degree. And he imparted the value of education in Ram, who excelled in school and eventually earned his own degree, in engineering, at the M.S. University of Baroda in Gujarat.
It was around that time that opportunity arose elsewhere; in 1965, both U.S. houses of Congress, in bipartisan fashion, passed the Hart-Celler Act to remove the annual caps on immigrants per country, including the countries of South Asia. Still in his early 20s, my father, like so many others around the world, found the prospect of America to be irresistibly appealing.1 So he enrolled in Villanova University’s graduate program in engineering. There, he would learn skills that would help him to earn three patents on refrigeration and defrost systems, which became embedded in products that remain operational today. Grateful for the opportunities that America had afforded him, his wife (also an Indian immigrant), and his two children (myself and my younger sister Monica), he instilled, and nurtured in me, his beliefs in education and innovation. He also emphasized giving back through civic participation.
All of the above serves to explain how, in 1983, I found myself on a plastic chair in a drab room on the second floor of a nondescript local government building in my hometown of Plainsboro, New Jersey. I had identified a problem, and, at age 11, was naive enough to believe that, if I merely brought the matter to an adult in authority, it would be solved. In building our subdivision, developers had failed to separate the public from the edge of Amtrak’s train tracks. After I told my father that I had seen kids my age playing dangerous games near the tracks, he took me to one of Congressman Chris Smith’s town hall meetings. There, I stood up, waved my arms, got the Congressman’s attention, and asked if he would do something to secure the tracks, either through government action or collaboration with our local community. He thanked me, expressed concern, and pledged to look into it when Congress took up Amtrak funding.
No fence was ever built, but my faith was not lost. And my father made sure I wouldn’t stop speaking up. As I progressed through high school, he would often speak in optimistic terms about all that a determined, creative person could accomplish. More often than not he would then provide an example of those who had played some role in solving the seemingly unsolvable. One such person happened to be a pioneer in emerging technology who, like my father, was a Baroda graduate.
That person, Sam Pitroda, had begun his formal education in a single-room school with no electricity in one of the poorest villages in rural India. He would earn a master’s degree in physics, specializing in electronics, by age 21. After coming to America with $400 and never having used a telephone, he would go on to create 100 patents in telecommunications, fuel a startup that Rockwell International would acquire, and do groundbreaking work on the “electronic diary” in the early 1970s that laid the groundwork for mobile computing. Yet, what he would later achieve back in, and for, India would dwarf even his incredible feats in America.
During a trip back to India in the early 1980s, Pitroda attempted something that should have been simple; from an upscale hotel in the capital, New Delhi, he tried to call his wife in Chic
ago. But he couldn’t get through. This caused him a minor inconvenience. For India as a whole, however, such telecommunications limitations had become a critical concern, isolating the country and, in Pitroda’s assessment, endangering its ability to compete economically with the rest of the world. At the time, the country had more than 700 million people and fewer than three million telephones. Nearly all of India’s 600,000 or so villages had no telephone access at all. If you wanted a line, you needed to wait, and wait, and wait. My own grandfather had experienced the interminable delays; after moving from a rural village to New Delhi in 1962, he waited nine years for a telephone line. Nor had there been much improvement in the decade since.
Pitroda wasn’t willing to wait any longer for someone else to effect transformational change. For a mere rupee-per-year salary, he relocated to India to lead a monumental endeavor: extending digital telecommunications across the country, even to the least advanced and most remote areas, such as the village of his youth. He understood that the commercially available products of that time were outdated and suboptimal. They were analog systems in a world transitioning to digital. But digital systems for widespread, commercial use were not yet available in India, especially systems that could meet the country’s unique requirements, with its heavily rural (and dispersed) population, and frequent power interruptions due to monsoons and other weather events. Pitroda believed a shift in mindset, from acquisition to innovation, could do the trick. Rather than invest billions in outdated technology, he organized a dedicated research and development effort charged with building India’s solution on a foundation of newer digital technologies. The effort invited Indian firms to license the technology and build up a domestic manufacturing base to supply the country’s telecom needs, so that everyone across its 600,000 rural villages could have access to telephone services by the turn of the century.
In a country of more than a billion people, Pitroda hired just 400 workers for a newly formed R&D lab called the Centre for Development of Telematics (C-DOT). He chose those with little or no experience but with a few key common characteristics: young (average age of 25), ambitious and optimistic, focused on possibilities rather than limitations. Free from the embedded bureaucratic restrictions of traditional government agencies, they pooled their recent engineering training and embarked on their Apollo mission. Within three years, they built four new telecom exchanges that met India’s requirements. They innovated in numerous ways. For instance, they designed a refrigerator-size metal box that was able to keep telecom equipment cool and protected from the elements, without air-conditioning, and costing just $8,000. While a typical telephone equipment company would have invested hundreds of millions to design a comparable suite of products, Pitroda’s innovation team spent less than $36 million. And they met their goal: every village in India got access to a telephone by the end of the century.
I must admit, some elements of the account were lost on me. Yes, I was Indian by heritage, but largely American by upbringing—I would visit India only once during my youth. We had phones in America, so it was hard to relate to the particular problem that Pitroda had addressed. Further, I didn’t have an advanced understanding of the technologies involved; after all, as a high school student growing up in the 1980s, my idea of “hi-tech” was largely limited to what was needed to play Mike Tyson’s Punch-Out on my Nintendo, to program at a primitive level on my Apple IIe, or to rewind a VCR tape.
Still, I appreciated Pitroda’s passion and persistence, not merely in identifying a problem, but in finding a way to solve it. My father made sure that I understood another point: that Pitroda couldn’t have done it alone, that his effort called for a sponsor in the Indian government, a collaborator capable of leadership and courage. After seeing the value in Pitroda’s proposal, Rajiv Gandhi—son of India’s then-Prime Minister Indira Gandhi—made it his cause too. While serving in his mother’s cabinet, Rajiv chose to invest his political capital in pitching the project to other government officials. He tapped Pitroda, rather than someone currently occupying that bureaucratic turf, to plan and oversee the assignment. And he cleared the traditional bureaucratic obstacles to give Pitroda the power to recruit and deploy the qualified workers whom he deemed most appropriate for the assignment.
The lesson was that government could be an engine for good. I took that optimism into my years at West Windsor-Plainsboro High School, and while many of my classmates were competing in sports, I was doing so through Model UN, Mock Trials and Debate Club, and as Vice President of Student Council. My coach and mentor was the charismatic Brian Welsh, who taught an eclectic hands-on course called Introduction to Political and Legal Experience. It was a laboratory for critical and creative thinking against the backdrop of modern American democracy, and it inspired me to engage further in this area, outside of school walls.
That led to two formative experiences in the summer following 11th grade. At Boys State, a citizenship and leadership program sponsored by the American Legion, I learned the value of outreach, coalition building, and compromise, especially after I was selected to represent New Jersey as one of two Boys Nation senators, just as Bill Clinton had represented Arkansas in 1962. Through the course of a contentious Boys Nation debate about flag burning, I became acutely aware of the painful processes and significant concessions required for even incremental movement on polarizing issues. And that was just pretend. In Washington, D.C., the consequences of divisive debates were real, and I got a sense of them while serving an unpaid internship in a cramped corner of Senator Bill Bradley’s mailroom. While sorting incoming correspondence into categories for Senator Bradley’s policy staffers, I took note of one stack towering above the rest, the one consisting of letters calling for the repeal of the Medicare Catastrophic Coverage Act (MCCA). Curious to learn more, I dug into countless reports from the Congressional Research Service, and gained greater appreciation of the critical linkage between effective policy making and grassroots activism. The MCCA had been hailed as a victory for bipartisanship—a policy that lowered overall health costs for Medicare beneficiaries and added a new prescription drug benefit.2 However, in order to pass the law, the entire cost of the bill was passed on to wealthier retirees, and their subsequent revolt led directly to its demise. When the dust settled, Congress’ approach might have appeared correct on paper, but as follow-on surveys showed, less than 40 percent of the impacted Medicare beneficiaries even knew they would benefit from the program.3
After enrolling at the Johns Hopkins University, I was determined to expand my activism, and not to confine my collegiate education to a course syllabus. I engaged in a variety of extracurricular activities, from the mundane (lobbying student affairs for an air hockey table in our dorm) to the aspirational (organizing career advice seminars as sophomore class president). Yet all of these activities were confined by the technology of the times. In the early 1990s, we didn’t have cell phones, we barely used campus e-mail, and we had no clue about how the nascent Internet would alter everything, socially and professionally, in the near future. We were still living largely in an off-line world, one that required door knocking and flyer posting to spread the word.
On rare occasions, that had its advantages, so long as you could be creative. That was the case during my junior year, after my college roommate Joseph Molko and I were chosen to cochair the next year’s Milton S. Eisenhower Symposium, the largest student-run lecture series in the country. We recognized that our provocative topic (“The Changing Role of Sexuality in America”) was no guarantee that we could afford worthy speakers and attract enthusiastic audiences—for that, we would need to raise money and awareness. We also recognized, from our own experience, that incoming students would be eager to get an early glimpse of their classmates. Facebook, as we know it today, would not exist for another decade. So we invited incoming freshmen to submit photos and biographical information for a “Freshman Profile” book, and convinced the university to include an offer for the book
(priced at $20) with its regular admissions and orientation mailers. We sold a bunch of books, which helped us attract a powerful lineup of speakers, including Camille Paglia, Angela Davis, Dr. Ruth Westheimer, and Ralph Reed, and, thus, large audiences. What is most remarkable to me, in retrospect, is that we did all of this without a web page. Forget social media, and all the promotional tweeting we could have done in this era. Think of how much a short previewing blog post could have helped. But while the first widely known browser, NCSA Mosaic, was released in September 1993, the same month that our series started, the Internet was still largely a mystery.4 Even by the time I graduated the following spring, I was only peripherally engaged with the Internet, entirely unaware how it would shape the next 20 years of my life.
In the fall of 1994, I came to New York to work for Morgan Stanley as an investment banking analyst, as part of a class of nearly 100 people who trained together before being dispersed throughout the firm. I was in the health care group, but I had friends in other divisions, including several in the technology group. They were extremely excited about one transaction they were underwriting: the forthcoming public offering of Netscape Corporation, which was commercializing its Internet browser Navigator, a descendant of NCSA Mosaic. The Internet itself had its origins in 1969, with the birth of the Advanced Research Projects Agency Network (ARPANET) in the Department of Defense and the standardization of TCP/IP communications protocol (the primary method for routing messages across the network), under the leadership of Vint Cerf and Bob Kahn.5 With funding support from the National Science Foundation Network (NSFNET), the network spread to universities and research labs through the 1980s. During the mid-1990s, the Clinton administration removed all remaining restrictions to widespread private sector use and commercialization. Web browsers would be the vehicle for democratizing the access. My colleagues in the technology group at Morgan Stanley believed that the Netscape IPO would spark a tech sector revolution with profound implications for the economy. They would be correct. The stock popped, and demand for it fueled a frenzied race between firms intent on underwriting the next big thing.
Innovative State Page 4