Healthcare reform will be phased in over the next several years, and when you ask the experts what their opinions are regarding this new legislation, the universal answer that I’ve received is, “I don’t know.”  There is one very fundamental reason that leads to this answer, bureaucracy.   Much like HIPAA, the law was actually written by young health policy scholars, 50% of whom will not be in their current positions two or three years from now.  In fact, many of them will no longer be in the Metropolitan Washington D.C. area.  Consequently, the policy wonks will take over and the fundamental premises upon which the program was built will be left for in-depth interpretation by the “bureaucrat du jour.” 

Having spent a decade working in a government related, subcontract situation, this fact alone sends cold chills down my spine at the rate of thousands per second.  Recently, it was my distinct displeasure to sit across from two of these individuals, detail splitters, at a meeting on Capitol Hill.  Prior to the “opening bell,” they had formulated their opinions regarding their preferred outcome of the meeting, and they had dug in to ensure that none of the facts presented by the opposing side would be considered relevant.  They had made up their minds that the greater good would be served by their pre-meeting decision making.  Interestingly enough, their decisions in fact would result in hundreds of families being destroyed as their loved ones were forced to languish so that studies of the studies could be performed over the next several years. 

In HIPAA,  the Health Care  Insurance Portability and Accountability Act, the “wonks” took its well-intended core values and distorted them into a nightmare of implementation that forever changed health care in the United States, and, after literally billions of dollars of required implementation changes for thousands of hospitals, doctors, and health professionals, all one has to do to experience the absurdity of most of these privacy attempts is stand on the other side of a curtain in a surgi-center, a semi-private room, an emergency room, or even a registration area and listen.  What you will hear is hundreds of facts about the person beside you; condition upon admission, detailed diagnosis, phone numbers, et al, at which point you can lean back, smile and say, “HIPAA my A**. “

So, conceptually, is healthcare reform what needed to be done?  The answer is an unequivocal, “Yes.”  Was it the right thing to do to reach out to the uninsured?  Absolutely.  Should we as a country move toward electronic medical records?  Yes.  Does it make more sense to bundle payments so as to encourage physicians and hospitals to work together more closely?  No question.  Finally, was the system broken?  Beyond a doubt. It was completely broken. 

As a country we have slipped out of first place now in so many categories that it is embarrassing to delineate those statistical changes, but healthcare should improve now that this legislation has passed.  You may have detected that the operative word is SHOULD.  Will it?  On PBS’s Nova last evening I watched the day by day analysis of why we were not ready for the attacks on 911.  It was because of the bureaucracy.  It was because the NSA (which now has about 35,000 employees and has a budget well over $20B annually.) was NOT willing to share the information that they were obtaining with the FBI, and the FBI was not working with the CIA, and the CIA was not working with the FAA, and the FAA was . . .  Well, you get the picture. 

Healthcare reform?  We’ll see.

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