04/14/2010 05:12 am ET Updated May 25, 2011

Why It Takes 2,000 Pages to Reform Health Care

I used the phrase "nuclear option" Wednesday and nuclear explosions are fission chain reactions, which brings me to today's brief post. The health care reform legislation is lengthy and complex, and many people I've communicated with wonder why. They wish that it were easier to understand. They are distrustful of government at baseline, and a 2,000 page bill is all the evidence they need to be convinced that the government's "up to something." I think they envision the legislation being crafted in a backroom scenario like this:

Max Baucus: Well, Harry, I just don't know if the American people want the government telling their doctors what kind of care they can or cannot provide to their patients.
Harry Reid: Oh, shut up, Max! We'll hide that provision deep within a couple of thousand pages and focus on the other stuff they do want, like free ice cream for everybody on Wednesdays.
Max Baucus: But do you think they'll actually buy that?
Harry Reid: Of course they will, why wouldn't they?
Max Baucus: Well, don't you think they'll figure out that giving everyone free ice cream once a week would be prohibitively expensive, not to mention an administrative nightmare?
Harry Reid: Oh, Max. You assume that the poor people can read or think for themselves. **Evil laughter**

The fact of the matter is that the legislation is long because it proposes doing a lot of stuff. But suppose it didn't? Suppose it only wanted to end the practice of insurers denying people coverage on the basis of a preexisting condition? That's nearly as popular among the people as free ice cream Wednesdays. Surely that could have been accomplished in just a few pages, right? Well, the answer is "yes" if you are okay with the imminent collapse of the entire health care system.

You see, the problem is that many things are interconnected in the health care system. When you change one thing, you set off a chain reaction that requires you to consider other aspects of the system. And of course, like dominoes falling, when you attend to those other aspects of the system, there will be repercussions unless you attend to their own tangential factors. Princeton's Uwe Reinhardt makes just this point in a recent article that I highly recommend you read--especially if you are one of the many who grow cynical in the presence of lengthy legislation.

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