“U.S. Health and Human Services Secretary Xavier Becerra and White House Domestic Policy Council Director Neera Tanden recently announced a [new] $500 million investment” to add more navigators to the Affordable Care Act program. They say the additional expense will help people navigate their way through the ever-changing, Byzantine regulatory labyrinth to the promised land of health coverage; not to receive timely medical care though, but just to have insurance.

Let’s be clear. Healthcare is so confusing, complex, and costly that they will solve the problem by... adding more rules, regulations, bureaucrats, and spending. Five hundred million for BARRCOME — bureaucracy, administration, rules, regulations, compliance, oversight, mandates, and enforcement — but not a penny for those who provide care. In fact, the money for the bureaucrats will be taken away from patient care. Witness former President Obama’s taking $716 billion from the Medicare Trust to pay (only partly) for his BARRCOME in his ACA.

The Biden administration acted like an arsonist who sets several fires and then cries, “We must hire more firemen!”

In his 1981 inaugural address, President Ronald Reagan said, “Government is not the solution to our problem; government is [italics added to mimic the tone of his voice] the problem.” The problem to which he referred was an economic crisis. His statement could just as easily apply to today’s healthcare crisis. 

The crisis is not a lack of insurance — the uninsured rate is now down to eight percent. Even illegal residents are being given no-charge (free to them, costly to taxpayers) Medicaid coverage. This laser focus on insurance intentionally ignores the seesaw effect. As the number of government-insured individuals goes UP, access to medical care goes DOWN. Expanding Medicaid or ACA subsidies produces the exact affect Americans don’t want: a closed door to the doctor’s office or worse, a retired physician. 

Washington’s approach to all healthcare problems is reminiscent of the 1966 Golden Hammer adage of psychologist Abraham Maslow (famed author of the Pyramid of Needs): “If the only tool you have is a hammer, it is tempting to treat everything as if it were a nail.”  Since government’s only tool is regulation, they try to solve everything, including healthcare complexity, by more regulation, which of course creates more complexity and more spending. Systems thinkers call this a “fix that backfires.”

Consider a 1970–2009 study of the growth in numbers of physicians, healthcare bureaucrats, and national healthcare spending. Over those 40 years, the supply of physicians increased 100%. The number of healthcare administrators (bureaucrats) increased more than 3,200%. Healthcare spending increased 2,300%, and the number of healthcare regulations grew by too many to count.

The ACA made things worse giving us the crisis we now face: no care and “unsustainable” (per Obama) spending. As the doctor shortage worsens, Medicaid enrollees grow, per ACA expansion of the program. Then Biden expanded the rolls further during CoViD. In 2022, Washington gave no-charge Medicaid coverage to 95 million Americans (28% of the nation.) Add too-few-doctors-for-too-many-patients new spending on BARRCOME.

The ACA created 68 grant programs, 47 new bureaucratic entities, 29 demonstration or pilot programs, six additional regulatory systems, six strict, new compliance standards, and two new entitlements. The number of new bureaucrats and thus additional non-clinical spending is not known but certainly in the tens of thousands. At the same time, more physicians are taking early retirement. 

The Texas Health and Human Services Department employs more than 62,000 bureaucrats. They are paid to oversee approximately 50,000 state-licensed physicians.  The ACA law just by itself cost American taxpayers $1.76 trillion, an amount similar to the GDP of Canada. Most of this spending went to BARRCOME. (I should know; this author was a Board Director on one of the 50 new state Health Insurance Exchanges established by the ACA.)

It was obvious from the first reading of the Affordable Care Act it was an undigestible regulatory pretzel. The fact that Nick Tate’s 2012 Obamacare Survival Guide was and remains a best-seller is testament to the impossible complexity of the ACA. Add the more than 100 major changes to the Act in fourteen years and you have a truly unnavigable, Byzantine in every sense of the word, set of ever-changing, ofttimes contradictory, always confusing, impossible-to-follow-precisely healthcare regulations.

Biden’s solution is (drumroll)... more navigators, requiring more rules and regulations to govern their behavior and ours, more compliance oversight, more enforcement, and of course, more spending; another half a billion of non-clinical “healthcare” spending.

Ask an experienced manager, any systems thinker, even (especially) a game show fifth-grader. Each would say the same thing: to solve a problem in complexity, simplify. Do not make the problem worse by adding more complexity. Don’t add more cost. And in healthcare, whatever you do, do not throw more dollars generating additional complexity while taking money away from what matters to patients: medical care. 

Reprising the 40th U.S. president, the problem with government-run healthcare is that it is government-run. What we need is someone else in control of health care: patients.

Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; former Director, New Mexico Health Insurance Exchange; and author of 12 books including multi-award winning, Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.

Image: Free image, Pixabay license.