I saw the talk version of that and it has lodged in my memory. The point he made was that "health.gov" was made by a bunch of teams that made sure that their part worked, but nobody was in charge of making the whole thing work.

This is sadly "normal" for large bureaucracies.

Every time I see a giant, multi-million dollar catastrophe, it's always "proper", "documented", "enterprise", "by the book", and... "a total failure". The reason is always that nobody actually cares about the final outcome, only the paperwork in front of them that they need fill out, the checkbox that needs to be ticked, or the compliance requirement that needs to be met.