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On the Third Hand: It's complicated

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State and federal efforts to set up the Patient Protection and Affordable Care Act (PPACA) exchange program are, obviously, facing problems and delays.

I actually did my first PPACA delay blog entry back in February. 

I have contributed to the delay-related pile-on by tweeting links to Rube Goldberg cartoons.

Yesterday, I had fun linking to a really, really complicated flowchart that purports to explain how PPACA exchange health plans will be priced, how folks will figure out what each consumer will pay, and how the payments will actually get into the hands of the folks are supposed to get the payments. That flowchart is, really, useful in one way and kind of funny in another way.

Of course, the same could be said about a PPACA eligibility flowchart developed by an arm of the National Association of Insurance Commissioners (NAIC).

Some people want to kill PPACA dead with a stake, and it seems reasonable to think that could still happen. To me, it seems as if reporters who write “PPACA will do X” on such and such a date without putting any “supposed tos” or “coulds” in are playing with declarative mood fire.

On the other hand: Whether people want PPACA to ooze to life or not, it might ooze to life anyway. Even if everyone agreed to kill it, who knows if that’s possible. Maybe it’s got zombie-like powers of regeneration. Maybe even the people with silver stakes in their pockets should take an interest in civilizing PPACA, to the extent possible, in case, for example, the exchanges really do open. 

On the other hand: Whether we keep our current system, or kill PPACA and end up with some new, PPACA II system, or a PPACA Slayer system, that will probably be complicated, too.

The Health Insurance Association of America made great fun of Clinton Care by creating funny diagrams about how complicated it would be, but, if HIAA’s daughter, America’s Health Insurance Plans, developed any new proposal that involved any government or insurance company involvement whatsoever, that would be complicated, too.

If consumers pay doctors and hospitals directly, and insurance companies and no government health plans and government requirements are involved, the world is simple. Sunforester smiles. All is well.

Once you have any government or insurance company involvement, you end up with the providers doing battle with the payers and ever escalating bureaucracy.

Health care systems are usually complicated in other countries, too. When they don’t ssee to be, that’s usually because the countries have hidden anger, inefficiency and/or rationing in some other pocket. Or are blowing through fossil-fuel related revenue. 

On the third hand: Maybe someone could do something to make the machinery in PPACA work a little better, and fix the parts that add gratuitous complexity because they’re absurd.

If the Republicans would agree to let one bill that would fix the very most bipartisanly stupid stuff in PPACA get through the House — and someone would distract the lefter Democrats with a graphic novel version of Das Kapital, that would help. Example: Make it crystal clear that PPACA does not require states to offer Medicaid nursing home benefits to low-income billionaires. 

On the fourth hand: The idea of compromise in Congress is too funny even to contemplate. I have to end this column so I can go and start breathing again. 

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