Health Reform Law “Fiendishly Complicated”

"The problem for the (Obama) administration is healthcare reform is fiendishly complicated because the healthcare system is fiendishly complicated, and it is not politically feasible to tear up the system and build it again, Instead you have to build on the system that you have. When you try to build on a fiendishly complicated system, you have fiendishly complicated reforms."

Humphrey Taylor, chairman of Harris Poll, press release, July 29, 2010

Mr. Taylor, a supporter of the law, precisely puts his finger on the problem. Health reform is complicated because health care is complicated. Health care involves more than two billion individual transactions each year. For government to control and guide these transactions and to overhaul the system is a mind boggling proposition, especially in an individualistic country like the United States that increasingly and inherently distrusts government.

Of the 18 items in the poll, the majority of the 2100 adults polled were able to identify only four items in the poll correctly.

• 58 percent knew the law prohibits insurers from denying coverage to people with pre-existing illness because they are already sick.

• 55 percent knew the law permits children to stay on their parents' insurance plan until age 26.

• 52 percent realize that people who don't have insurance will be subject to financial penalties.

• 50 percent were aware employers with more than 50 employees will have to offer their workers affordable insurance.

On the downside, namely, those who were ignorant or uncertain abut specific provisions in the law.

• 82 percent thought the bill will result in rationing of health care or that it might.

• 79 percent didn't know or weren't sure if drug companies will pay an annual fee.

• 73 percent don't know the law establishes a new tax on the sale of medical devices.

• 66 percent didn't know or weren't sure if the legislation will result in insurance exchanges where people can shop for insurance.

• 63 percent weren't sure or didn’t know the new law will increase the number of people eligible for Medicaid.

A Finer Point

To put a finer point on the findings, more people tended to believe the “good news,” i.e. the news that the Obama administration hopes will sell the plan to the public. An even greater number of the people were oblivious to the “bad news,” that the plan forces drug companies and device makers to pay fees or taxes, which will raise costs, and force some into exchanges which may compel them to drop current plans.

The Vast Gray Zone

Between the good and bad news lie a vast gray zone of unanswered complicated questions.

Will comparative outcome research evolve into a form of rationing?

What does the appointment of Doctor Donald Berwick as head of Medicare and Medicaid, and a lover of the Britain’s National Health Service, portend?

Will the present supply of physicians be able to handle the flood of new Medicaid and Medicare patients?

Will access to physicians be a problem?

Indeed, will physicians accept new Medicare and Medicaid patients or restrict the services they offer to them at government-dictated reimbursement levels?

Is the public aware that the new law creates 68 grant programs, 47 bureaucratic entities, 29 demonstration or pilot programs, six regulatory systems, six compliance standards and two entitlements.

Getting this massive enterprise up and running will require more than $ 1 trillion over 10 years and close to $2.5 trillion over 15 years. In the eyes of critics, the new law will inevitably increase national debt and require new taxes.

It is tempting to believe sweeping health reform will simplify a "fiendishly complicated" health system. It may be more realistic to believe for every complex problem, there is a simple solution, and it may be wrong.