Sunday, June 20, 2010

There's the Health Reform Law and Then There Are the Regulations

The nonviolent Disease Management Care Blog knows that there is more to a punch than just a punch. The distinction also helps it understand that there is more to health reform laws than just the laws themselves.

The DMCB explains.

It'd be easy to think that curling up the fingers and then making forceful contact meets the definition a punch. Popular media makes it look easy, but not so. Two techniques that can make a big difference in its execution include twisting (pronating) the forearm in the course of extension (if you watch closely, you'll see it happen just prior to the board breaking at the 37 sec mark) and pulling the punch back as fast as possible after contact (for example). These and other modifications can, when there's no other choice, make the difference between angering and disabling your opponent.

It's just as easy to think that passing a law meets the full definition of health reform. Regular DMCB readers know otherwise. For example, the Genetic Information Nondiscrimination Act (GINA) sure looked like a good idea until the supporting regulations that came out. All of a sudden, it looked like insurer sponsored health risk assessments could end up violating federal law. In other words, the fine tuning of the simple 'punch' of GINA with regulatory 'technique' made a huge difference.

And so it goes now with the Affordable Care Act (ACA). According to this article in the New York Times, the law's seemingly reasonable provisions on 'grandfathering' existing health insurance plans will be clarified through additional regulatory language to mean that even minor changes to the benefit will result in its loss of protected status. Paradoxically and despite Presidential assurances to the contrary, this could accelerate a flight from employer sponsored insurance. Looks like ACA packed a bigger punch than anticipated. The DMCB expects more of the same as more ACA regulatory language issues forth from the legions of federal lawyers, bureaucrats and policymakers that are now hard a work fine tuning the other disabling features of health reform.

Don't think the parallel with martial arts is too strained either. While the DMCB prefers martial arts hyungs (here's a classic for example), every insurer, physician group, device manufacturer, trade association, consumer group, employer-purchaser coalition, State and countless other lobbying groups will close in for hand-to-hand combat in the ditches and weeds of every exclusion/inclusion, every "and" vs. "or, " every comma, and every overlawyered extension of Federal power that goes along with them.

The only important difference between the fine tuning of a marshal arts technique and creating the health reform regulations is that the former is designed to bring an end to the confrontation, while the latter will be a fight that keeps on giving for years to come.

Image from Wikipeida

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