Healthcare: It's Complicated


A popular 2009 movie, called "It's Complicated," was about relationships. The title of that movie also applies to solving the problem of providing affordable healthcare in the United States. It's complicated.

A recent article in The Wall Street Journal criticized the Affordable Care Act (a/k/a ObamaCare) as being too complicated. According to the WSJ, "the fundamental flaw is the law's mind-numbering complexity… ObamaCare is a highly complicated approach to addressing problems in health care that have simpler solutions."

There is no doubt the Affordable Care Act is an enormously complex piece of legislation. On October 1, 2013, when the public was first able to access the much-anticipated insurance exchanges to search for affordable health insurance, the software glitches which made it difficult, if not impossible, to compare policies and shop for insurance were almost certainly consequences of a highly complex system. A universe with hundreds, if not thousands of different insurors, health plans, and payment schemes, regulated by a patchwork of state insurance agencies, is unavoidably and extraordinarily complex. There is a great deal of truth to the WSJ's criticism, and its call for a "simpler approach."

On the other hand, solutions that appear to be simple are often not so simple after all. How about a single payor, to replace the mosaic of insurance companies and plans? Such an arrangement is simply not a politically realistic alternative. How about controlling health care costs by rationing care? The predicted response: perhaps in some totalitarian state, but never in the U.S. How about requiring doctors and hospitals to post the prices of all health care services and letting the market control costs (as suggested in the WSJ article)? A good start, but surely not a comprehensive answer to controlling costs and providing broader access to healthcare. Unfortunately, the solutions to complex problems are themselves often complex.

The Affordable Care Act has its defenders and its critics, and we will not know for some time whether it "works" or not, and who will be the winners and the losers. Yes, it is a complicated statute, but it is too early to tell whether such complexity is an avoidable problem with the current law, or whether it is a necessary response to a complex problem.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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