Health Reform: A Vast Law with Half-Vast Consequences

As insurers adapt to the new world of reform, their actions will reverberate throughout the economy in unexpected ways; given the vast reach of the law, it seems certain there will be more than a little consequences.

J.K. Iglehart, “Defining Medical Expenses – An Early Skirmish over Insurance Reforms, “ New England Journal of Medicine, September 9. 2010

The operative phrase in the above quote is “vast reach of the law.” The key word is “vast.”

Use of the word vast brings to mind two personal experiences.

One was when my father warned me, “Son, don’t launch vast projects with half-vast ideas,” a slightly off-color but telling pun.

Two was a 1973 book I read by Dean Acheson, the former Secretary of State. It bore the title This Vast External Realm. Acheson was writing about how difficult it was for a President to control external events.

The Accountable Care Act is a case in point.

The vast reform law, which vastly covers every American in this vast continental nation, though debated for a year, was passed at the last minute under half-baked and rushed circumstances.

Here is how Peter Suderman describes its passage in the October issue of Reason in “The Revolt Against Obamacare.”

“Much of the language that passed into law was never intended to be final. It was more like beta software. Most of the important elements were the authors had intended to include were there, but not always in the final intended form. And the code was still crawling with bugs, particularly on the level of implementation at the states.”

“But the Democrats had heard the call of history. Passing any bill- even a creaky, obviously flawed beta version – was better, party leaders decided, than declaring defeat so tantalizing close to the finish line.”

So the bug-infested bill passed on March 23, 2010. The consequences, which may be unfounded, nevertheless are there for all to see.

• Disapproval by the American public by 56% to 40%.

• The Tea Party sentiment, calling for Repeal and Replacement,to counter Big Government.

• A revolt by the States, who say they cannot “afford” the “Affordable Care Act,” the individual mandate of which may be unconstitutional.

• Fear that ACA's promises may be empty, i.e., it will allow you to keep your plan, will bring down your premium costs, will cost taxpayers less than $1 trillion, won’t cut Medicare benefits in spite of $500 billion in cuts, and won't limit access to doctors, many of whom say they cease seeing Medicare and Medicaid patients under the conditions of reform.

• Growing unease among business leaders, who are uncertain they can shoulder the administration burdens and costs of reform.

• Multiple surveys among physicians indicating they feel reform will increase expenses, create hassles, and decrease quality.

• A palpable anxiety among health agents, brokers, and small insurance companies that they will be the first victims of health reform, even though they feel themselves indispensible in writing policies for individuals and small groups.

I am not saying the Affordable Care Act is “good” or “bad.” I am saying its final passage was rushed, and the difficulties of its implementation, and its unfullfillable promises were not thought through or anticipated.