Complexity of Obamacare. Obamacare in Perspective.

In today’s July 21 reading of The Health Care Blog, I ran across this passage by Alan Weil, JD,, director of the National Academy of State Health Policy. In his piece, Weil comments,

“The Affordable Care Act’s guarantee of coverage is actually a patchwork quilt that includes Medicaid, the Children’s Health Insurance Program, employer-sponsored coverage, and plans purchased with subsidies through the new insurance exchanges. While almost everyone will be eligible for some form of coverage, the source of coverage matters because it determines the benefit package, the cost-sharing provisions (deductibles and co-pays), and how costs are allocated between state and federal governments.”

“This complexity must be invisible to the person seeking coverage. We need to build a system where a person provides basic information about his or her own circumstances and linked databases instantly verify that information and convert it into a set of coverage options. Manual processes, reserved for complex functions like determining if someone has a disability, must become the exception, not the rule.”

“Simplification of the enrollment system is the linchpin of success for the reformed health care system. Failure to achieve this vision will leave millions of people without insurance coverage even though low cost or no cost options are available to them. And failure to achieve this vision will mean more money spent on administrative processes when we need every available resource devoted to providing needed health care services.”

What are the lessons to be learned from Obamacare – now redubbed at the Affordable Care Act?

Here is my take:

• Complexity is, well, complex, so complex that not even the “experts” comprehend or anticipate its consequences.

• Health care is an intimate part of a complex world, and is not immune, isolated, or protected from its vicissitudes.


• Health care’s complexity is what makes it so resistant to change.

• In the complex interconnected worlds of humankind and healthcare, not everything, not every little detail can be planned linearly from the top.

We will remember 2010 as the year Obamacare passed, and complexity, the Internet, and globalization overcame and overwhelmed humankind.

Everything is complex, and not everything can be simplified. You cannot cover everyone, completely control human behavior, or preach prevention, or plead for rationality in all things, and you must heed informal relationships, gossip, rumors, and sidebar conversations, and these shadow behaviors – these completely human, sometimes irrational, reactions, are important because they foretell workable health and business models and subsequent actions with any chances of success.

The human world, and its health care derivatives, work by “chunking,” by allowing complex systems to emerge out of links with simple things, out of convenient, simple, inexpensive, predictable, patient-centered, physician-accepted disruptive innovations capable of operating independently rather functioning seamlessly as dictated by centralized bureaucracies.

Success usually flows from cooperation and competition rather than simplifying complexity.