If Everything Goes as Intended . . .

19 Nov 2012 /

If [Affordable Care Act] implementation goes as intended and widespread utilization and automation are achieved, providers could save about $11 billion per year.

Flying pig

You really can’t dispute something as vague as that but it does raise a number of questions:

  1. What does it mean for thousands of pages of legislation affecting the entire healthcare industry as well as every man, woman and child in America to go “as intended”? It’s a circular argument. If it goes as intended, we save $11 billion. If we don’t save $11 billion, it didn’t go as intended.
  2. Is “widespread utilization and automation” part of going “as intended” or is that a separate thing?
  3. Assuming that implementation does go as intended and widespread utilization and automation are achieved, the best we can say is that providers “could” save “about” $11 billion per year? Could they save more? Less? Break even? Could they lose $11 billion? It’s meaningless speculation.
  4. Can anyone remind me of a large-scale government program that went “as intended” and saved everyone a lot of money?
  5. Why, despite all evidence to the contrary, do people continue to believe that government can successfully engineer social aspirations?

In other news, if my plan to grow wings on pigs goes as intended, it could revolutionize the way we export bacon.

These things never go as intended. They can’t possibly go as intended. There are always unintended consequences. I can’t implement a policy in my own house and have it go as intended and there’s just two people and a dog.

I asked the friend who called the NEJM article to my attention what going “as intended” means in the context of the ACA and he said, “I think it means legislators don’t muck with it too much.” What does “muck” mean? What does “too much” mean? We could go on and on . . .


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