What seems to me to be the critical bit: One highly unusual decision, reached early in the project, proved critical: the Medicare and Medicaid agency assumed t

What seems to me to be the critical bit: One highly unusual decision, reached early in the project, proved critical: the Medicare and Medicaid agency assumed the role of project quarterback, responsible for making sure each separately designed database and piece of software worked with the others, instead of assigning that task to a lead contractor. They seem to have not realized that this is a major engineering task in its own.