Ok ok - on the ACA debacle rollout (or lack thereof) - It comes down to getting it working and beginning to make headway.  I do think someone needs to be fired - or ("take time off to pursue other interests")...or ("Spend more time with their family...").  Honestly if this happened where I work - heads would roll. Maybe not right at first, but eventually you would look around and see people "missing".   I think the President has many things to look over and worry about, so I am thinking unless there were some lyin' mo'fo's at staff meetings, the head of the agency needs to step down.  It's inconceivable that the head of the agency was totally shocked and unaware.  They should be fired for that alone.

So, not trying to put folks on the street but, in the end you have to deliver.  You didn't, so out you go.  If it were me, and I was head of HHS, I would resign.  Its too embarrassing. 

For example, I once worked for a person that accidentally sent out everyone's salary data to everyone in the company.  She didn't mean to, but she did. It was followed by a "don't read that...." email.  Sorry,  but that mistake is too big....She was fired...and if I had done it I would have totally understood them firing me.

So that's my 2 cents. You created a mess for the president and lots of hard working folks just trying to get health care. You didn't mean to, but ya gotta go.  It's too big of a fuck up.  Oh, and don't blame everyone under you, you're in charge - fall on your sword.