If somebody tells you to jump, you ask “how high?”, and they can’t tell you, that’s uncertainty:
The size and complexity of the Affordable Care Act meant that its implementation was never going to easy. But behind the scenes, even states that support or might support the Affordable Care Act are frustrated about the Health and Human Services Department’s special combination of rigidity and ineptitude.
To take one example, for the better part of a year states and groups like the bipartisan National Governors Association and the National Association of Medicaid Directors have been begging HHS merely for information about how they’re required to make ObamaCare work in practice. There was radio silence from Washington, with time running out. Louisiana and other states even took to filing Freedom of Information Act requests, which are still pending.
Now post-election, new regulations are pouring out from HHS—more than 13,000 pages so far and yet nuts-and-bolts questions are still unanswered. Most of what we know so far comes from a 17-page question-and-answer document that HHS divulged this week, though none of the answers have the force of law and HHS says they’re subject to change at any moment.
We have the better part of a century’s experience with the largest full-on public healthcare system in the world, larger than British National Health—the VA system. We have a half century’s experience with the largest single-payer system in the world—Medicare. We have no experience whatever with a public healthcare system with as many moving parts as the PPACA. The closest thing to it would be the Pentagon, that model of efficiency.
Fasten your seatbelts, we’re in for a bumpy ride.
Right, and this is going to save us money. Anybody who believes that is delusional.
As Fred Brooks pointed out in “The Mythical Man-Month”
http://en.wikipedia.org/wiki/The_Mythical_Man-Month
software development does not “scale” nicely. In fact, doubling the complexity can lead to a manyfold increase in both time and cost. You can quickly reach the point where the project becomes impossible to complete. Unfortunately by that time you’re up to your ass in alligators and forget that the task was to drain the swamp.
The same holds true for any complex system. Remember that the successful large scale systems that we see today (SABRE, AmEx, Visa, etc.) evolved over 60 years. I seriously doubt that we will ever see a functioning exchange.