Take the top 14 companies in the Fortune 500. These include such diverse names as GM, GE, Wal-Mart, AT&T, Exxon, McKesson, Fannie Mae, and CVS. Imagine that some government genius came up with a clever scheme that you can sign up online to access services from all these companies, and that the companies will be able to seamlessly communicate with each other, and that this will all be done through a centralized government hub linking diverse federal departments, and done all at once without beta testing. Yes, it’s an imperfect analogy to the ACA, but apt in that the combined sales of these corporate behemoths approximates the size of the broadly defined US healthcare industry.
So the insane scheme would be a gigantic disaster in the regular corporate world and its proponents would be run out of town on a rail, or more likely in prison for multiple frauds and other felonies. And it’s a disaster that naturally metastasizes as the initial screw-ups propagate much more complex screw-ups down the line, and the improvised attempts at fixes create the impossibility of stability and long-term planning that are critical to running any enterprise. So at the moment the tiny problems only include doctors with scalpels aready unable to get authorization to operate, people are leaving ER’s due to cost uncertainties, and babies that can’t be added to coverage in the simple old ways. (Note in the linked US pieces that the MSM are still covering for these idiots.)
Stay tuned for worse. The many errors and omissions will continue to propagate faster than they can be fixed, since (among other things) the whole edifice was built on the frauds that (a) the young will subsidize the old by buying illogical, expensive products; and (b) the thousands of errors in the Rube Goldberg machine will cease propagating new and novel errors that we can’t even imagine today. Centralization simply can not keep up with the billions or trillions of individual decisions made by hundreds of millions of people in a swiftly moving technology and IT environment.
Centralization can do some things well, as Cuba, the USSR, North Korea, Mao’s China, and so on have demonstrated over the last hundred years. It can grind things to a halt and create chaos, which is what is happening. The really bad news is that once all the existing, stable systems (as awful and imperfect as they have often been) are disabled, and professional routine and the collective knowledge of doing things according to habit have been lost, all you’ve got is Humpty Dumpty.