What should make everyone in America who is going to go through this nightmare over the next months mad is that most of what will be occurring was predictable - or actually predicted - by opponents.

It was a no brainer. Nothing is being phased in. The whole shebang is being dumped on a $2 trillion industry all at once, with little preparation and virtually no education.

So while consumers are in for some nasty surprises (see Nightmare #1), doctors and hospitals can see quite clearly the train heading toward them down the tracks, careening out of control.

Bloomberg:

Poorly controlled diabetes can cause stroke, kidney failure and blindness. Undiagnosed cancer can translate into complex end-of-life care, and untreated high blood pressure can lead to heart attacks. In effect, the 2010 health law's biggest promise becomes its most formidable challenge: unprecedented access to care for a needy population when the nation is already grappling with overtaxed emergency rooms and a shortage of physicians.

"When you're getting people that haven't had insurance, they have significant health issues," said Kevin Sexton, president and chief executive officer of Holy Cross Health, in a telephone interview. "A lot of people need these services."

About 25 million Americans are expected to gain coverage under the health law, commonly known as Obamacare. Starting Oct. 1, as many as 7 million uninsured Americans will begin shopping for private plans through government-run exchanges, with many people eligible to have their premiums subsidized by taxpayers. On Jan. 1, Medicaid programs for low-income people will be expanded in about half the U.S. states.

The increase in newly insured patients arrives at a time when the nation has 15,230 fewer primary-care doctors than it needs, according to an Aug. 28 assessment by the U.S. Department of Health and Human Services. And emergency rooms report being strained with visits that have risen at twice the rate of population growth.

"It's like we're handing out bus tickets and the bus is already full," said Perry Pugno, vice president for medical education at the American Academy of Family Physicians, by telephone. "The shortfall of primary-care access is not an insignificant problem, and it's going to get worse."

Almost half of all uninsured, non-elderly adults had a chronic condition, based on a 2005 report by the Urban Institute and the University of Maryland. One in six with hypertension reported no visits to health professionals in a year.

Most who come to Holy Cross's health center now lack insurance, and have lived for years with serious ailments, according to Elise Riley, the center's medical director. "It's frustrating to see diseases that could have been prevented," she said in an interview in her office.

More demand may lead to months-long waits to see doctors, delays in finding specialists, and strains on hospitals and outpatient clinics, others said.

Imagine now a gigantic increase in the paperwork burden for these physicians and hospitals and you're left with the inescapable conclusion that quality of health care for all - sick, well, rich, poor - is going to suffer.

Again, all of this was predictable. It's not rocket science, it's simple arithmetic.