A Competent Administration? Is That All It Takes?

To get an idea of just how complicated the next three years of health reform will be, check out this highly readable article by Christopher Jennings and Katherine Hayes appearing in the latest New England Journal of Medicine. While past civics teachers taught the gullible Disease Management Care Blog that the purpose of Federal law is to ..... well, set law, the Affordable Care Act (ACA) gives the Administration an astonishing amount of leeway in its interpretation and execution. While the Journal authors describe the leeway in the context of an enlightened, righteous and competent government determined to do good for its citizens, the DMCB instead gained an appreciation of how easily things could go wrong.

Not only is there the matter of having to constantly manage the grumpy opponents on the right and the left, the Administration is likewise vulnerable to under or overdoing it in the setting up of insurance exchanges, providing tax credits as well as other forms of financial assistance, defining the "grandfathering" of existing health insurance plans, enforcing the individual mandate and defining the composition of the medical loss ratio. Thanks to the potential of Congressional meddling, budgetary shortfalls, bureaucratic inertia, government employee incompetence, unintended consequences and political jockeying, the thousands of moving parts that make up the ACA could seize up in myriad ways - no matter who controls Congress or the White House - in the coming years.

Addendum: For a discussion of the definitional, legal, regulatory and political complexity of our brave new world of health insurance reform, see what Uwe has to say.