Policy

ObamaCare: "Springtime in Complexity Land"

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Jonathan Bush (cousin of the last president), who founded Athenanet, a company that electronically processes health care payments for medical providers, talks to The New York Times about medical entrepreneurship under the new health care law.

Q. What's the prognosis for bill collecting under health care reform?       
A. Well, there's going to be new connectors and a whole series of new insurance products that will be managed by the states' health insurance commissioners. And the law provides for every state to do all of these its own way, so they will have their own rules and regulations, and each state will do it differently. That sounds like springtime in Complexity Land.    

Q. What do you think will happen to the total cost of health care under reform?       
A. Oh, it's going to go through the roof! It's widely accepted that this is not a cost-reform bill — it's an access bill. It's in fact a cost-expansion bill.       

He is the borg.

Q. Last year, Dr. Atul Gawande made a pretty cogent case, writing in The New Yorker, not just that the small pilot projects in the reform would control costs but that they are the only way to control costs in an industry as sprawling as health care.        
A. I e-mail a lot with Atul and he's a product of the Borg, at some big institution, and thinks in terms of papers and grants from Washington. I totally agree that demonstration projects are what changes a market, but outside of the Borg, we call those businesses. I suppose Washington trying to be an innovator also is fine, but at some point the demonstration project is going to have to be consumers using their judgment about which things they want. [bold added]   

Right. On the one hand, the new law is probably going to create a lot of business opportunities for lawyers and document processors and various other minders who make sure that health care firms and insurance companies have all the proper paperwork is filled out and that all their day-to-day activity is regulation-friendly. But like tax compliance costs, that's something that policymakers ought to be working to reduce, not expand. The more time and effort that get spent working on ways to automate the regulatory compliance process, the fewer resources end up getting spent looking for ways to actually make medical care more efficient. The government's attempting to pick up some of the slack by playing innovator with its array of maybe-this'll-work pilot programs, but at the same time, it's also making it tougher for private innovators with provisions like the one that immediately bans expansion for doctor-owned hospitals.