Politico reports that even health bureaucrats in California are worried about their ability to implement the state-based parts of the new health care law:
California Health and Human Services Secretary Kim Belshe tells us one of her biggest challenges implementing reform is stopping her staff from getting poached. "It's a very competitive marketplace," Belshe lamented to PULSE this week. "We're competing with consulting firms to keep the people who know how to implement health reform," noting that private competitors are eyeing state Medicaid directors. In a panel Tuesday, Belshe called the situation a "train wreck" and expanded in an interview, critiquing the Obama administration's "potential disconnect between what HHS has asked states to do and what we can handle internally."
This short passage suggests a couple of things. First, ObamaCare's state-side implementation is going to be very difficult and very complex. Even big, liberal states like California are going to have trouble keeping up with the law's requirements. Second, that complexity is going to set up a system that's 1) going to create a lot more interdependence between the government and the private sector and 2) begging to be gamed. That's presumably why private firms, especially in the consulting sector, are already investing heavily in staff who can explain what the government's doing and, presumably, how to take advantage of it. We already see a lot of this sort of thing at the federal level, with government workers taking advantage of their inside knowledge by cashing out and going to work for lobbying firms. And of course it also can't hurt to have a former insider working for you when lobbying for highly politicized regulatory waivers — a growing part of the way both businesses and unions are responding to the law.