Rough water ahead

If it seemed a bit too easy at the turn of the year to slip past that perilous fiscal cliff, and then a few weeks later to whisk unscathed through the smooth straits of sequestration, here’s fair warning: There’s rough water ahead.

And I’m not talking mostly about the debt ceiling issue at the end of March. That debate may produce a bit of a kerfuffle—but nothing like the really big tsunami that’s headed Washington’s way. The tsunami will spill sloppily over the whole country.

That’s what’s bound to happen over the next 12-24 months as federal bureaucrats go about implementing various aspects of the “Obamacare” health coverage legislation. Whether by incompetence or evil design, there’s no way anybody anywhere in government is going to be able to make the new system work. Forget all the arguments you’ve heard pro and con. In one sense, there’s only one thing you have to know—which is the absurdity of abruptly taking on health coverage for 30 percent more people with no concurrent plan to pay for that coverage.

There’s no doubt that Americans bought into such an impossible bargain in large part because the system we’d developed over the last couple of decades had become so miserable. “What more do we have to lose?” folks seemed to ask.

But the funding of this impossibly structured “Patient Protection and Affordable Care Act” is just part of the assignment. Those of us who argue that the free market should be the primary shaper of healthcare delivery need to remember how complex and detailed the task really is. Here, as I’ve said in this space before, are a few of the tough nuts to crack:

1) Healthcare, by its very nature, is usually both personal and urgent. You don’t typically ask your neighbor where he’s recently gotten a good deal on treatment for hemorrhoids. Nor is comparison shopping a handy device when the doctor comes into the waiting room to say he’s about to proceed with an $80,000 quadruple bypass. It’s just one of those places where the free market becomes a clumsy tool.

2) High expectations. Few of us think we deserve to live in any house we choose, drive any car we choose, or fly first class every time we travel. So why do we all expect Cadillac healthcare, no matter what our malady? We don’t believe in third-rate heart surgeons, and if our baby girl needs plastic surgery after a car accident, we’ll talk about payment plans sometime after the procedures prove successful.

3) Insurance. Because health needs are typically unpredictable, it’s natural that we turn to insurance to take some of the bumps out of the road. More and more through the years—and not primarily because of the Obama influence—we’ve tended to use insurance not just to smooth the bumps, but to buy the road itself. We’ve come to use insurance not just for the unpredictable, but for the predictable as well. Of necessity, costs soar upward.

In all this, as providers develop and test new models of healthcare delivery, Americans will be forced to roll with the punches. A big part of that will indeed involve financial issues. But unprecedented adjustments will be needed on the other fronts noted above—government intrusiveness, high expectations, and insurance implications. Healthcare consumers like you and me will discover how much these adjustments will upset our lifetime habits.

We’ll get angry—and we’ll probably be tempted to blame Obamacare for all that inconvenient discomfort and dislocation. Obamacare deserves stacks of blame—and not least because it was so crudely drawn and carelessly legislated a couple of years ago. But healthcare delivery for a country of 330 million people, even apart from the financial issues, is a highly complex assignment. The evidence suggests that the transition ahead is going to be boisterous, rowdy, noisy, turbulent, and unsettling.

Email jbelz@worldmag.com