As I’ve written before, the costs of unnecessary complexity in health care reform are very high, and they are rising. There are at least three recent examples.

One is the flap over whether people who have received health insurance through the exchanges run by the federal government are eligible to receive government subsidies, as they have been led to believe. Courts have disagreed on this point, opening the door for yet one more food fight about the legality of portions of the Affordable Care Act.

Complex federal legislation, inevitably the product of many authors, is usually full of many minor (and some major) errors. These errors are usually corrected during the process of reconciling the differing House and Senate versions during the “conference committee” process.

Because of the divisive politics leading up to the passage of the ACA, no such committee was ever convened.The House of Representatives simply passed the Senate bill without changes — errors and all — eliminating the need for a House-Senate conference.

One of those errors was the granting of explicit authority for the exchanges run by the states, but not the federal government, to provide subsidies to people they enrolled, even though any common-sense interpretation would conclude that congressional intent was to give all exchanges, whether state or federal, such authority.

Nevertheless, that omission provided an exploitation opportunity to those looking for an excuse to sabotage the entire law. And exploit it they have, bringing a lawsuit that could end up in the Supreme Court. The costs of the ACA in dollars and confusion have risen as a result.

Another example is the (on its face) ridiculous attempt to sue President Barack Obama for failing to enforce with enough enthusiasm a provision of the law requiring some employers to offer health insurance to their employees or pay a fine. This puts Republicans in the interesting position of threatening to sue Obama for failing to vigorously enforce a law they have repeatedly tried to repeal.

Additionally, billions of dollars have been spent unsuccessfully trying to construct exchanges that comply with the complicated federal requirements imposed by the ACA in an attempt to perfect a marketplace for private insurance. Even some states (such as Massachusetts) where exchanges created pre-Obamacare were already working have experienced chaos, and because of it have thrown tons of their own and federal dollars down a rathole.

These are just a few examples of your tax (and health care) dollars at work. Even though these complexities provide full employment for thousands of lawyers, consultants, navigators and other helpers, they don’t buy even one Band-Aid’s worth of health care.

The real tragedy here is that if the “policymakers” in Washington were really interested in serving the needs of most of their constituents instead of those of their corporate contributors, all of this expense and confusion could have been avoided. Perhaps instead spent on providing care to the millions who will be left out, even after Obamacare is fully implemented.

The sole purpose of the exchanges is to provide a choice of insurance companies. But the fact is that most people don’t give a hoot about who their insurance carrier is. What they do care about is who their health care provider is. In yet another unintended consequence of this complex law, many insurance companies are doing their best to limit that choice in order to save themselves money.

Ironically, it is actually cheaper to cover everybody than it is to spend all of the unnecessary time, money and effort collecting the information needed to slice and dice people into smaller and smaller risk pools so we can then decide which of them “deserve” health care. Moreover, risk pools of different types of people (old/young, wealthy/poor, employed/not employed, well/sick) create yet another opportunity for politicians to play us off, one against the other.

I fully expect this unnecessary complexity of the ACA to continue to be exploited by those looking to make a quick buck or another destructive or disingenuous political point. That is unless and until we put a stop to it by sending an unmistakable message to politicians who refuse to do the right thing that we’re mad as hell and not going to take it anymore. A simple expansion of Medicare to everybody would do the trick, and eliminate almost all of the unnecessary complexity of our insurance industry.

If we were all in the the same system, we’d all have a stake in making it work. That’s how it is in other wealthy countries. Compared to the chaos we have here, that sounds pretty good to me.

What do you think?

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at or through his website at