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The PPACA: Does It Pass The Playground Test?

Could understanding the tacit rules which govern play on a neighborhood playground help us explain why some aspects of implementing healthcare reform are unlikely to succeed? Recent news involving McDonald’s Corporation suggests so.

On the playground, there are some simple precepts — like the fact that older and stronger kids get to make up the game, and the rules. That’s understood and mostly okay. As if these leaders are considered modestly benevolent and the rules are workable, the game is good and all benefit. And all players on the playground know this basic tenet of fairness: That the rules of the game shouldn’t change in the midst of the competition, and, taking it one step further, if the rules have to be changed they weren’t very good in the first place. Soon, if those in power become too controlling, too conflicted, or too self-serving, kids stop showing up, and the games cease.

In enacting this, our government gave us a very complicated game, with oodles of rules. (For the record, the PPACA of 2010 is 475 pages and 393,000 words.) But then, on further consideration of the rules, important players (McDonald’s) decided that they could not play. They were pulling out of the game, and they had many friends (Home Depot, CVS, Staples, etc.) who may not have spoke outwardly, but surely felt the same way.

Hearing such, the leaders of the playground said that they will selectively consider changing the rules so some of these important players can play. From the Wall Street Journal Health blog (emphasis mine):

The Obama administration says HHS head Kathleen Sebelius will “exercise her discretion” in enforcing the requirement for those “mini-med” plans, which tend to have a higher proportion of administrative costs because of lower claims payments and higher turnover among the hourly employee workforce. Regulatory guidance won’t be out until late in the year.”

That much power in that few hands gets scary. It doesn’t work on the playground, and I doubt it will work in implementing healthcare reform.

To be fair to the reformists, it would be premature to use the word “flail.” But when major “players” in the game begin to take their bats and balls and go home, the end of the game is near. What to do?

In the electrophysiology lab, when we get mired down in an ablation strategy that continues to fail (flail), the solution that often rights the ship is to back up and start over, from the beginning.

JMM

*This blog post was originally published at Dr John M*


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