The following quote from a District Court Judge in Washington, D.C., summarises the ways in which Medicare (the weathervane for health care in the United States) works in the United States: “Picture a law written by James Joyce and edited by E.E.  Cummings.  Such is the Medicare statute, which has been described as ‘among the most completely impenetrable texts within human experience.’” The same Court clarified that “by making this analogy, it is referring not to Joyce’s early work, such as Dubliners or A Portrait of the Artist as a Young Man, but his later period, specifically Finnegan’s Wake.” California has taken something labyrinthian and made it almost tortuous.

Some of the more intricate and interesting trends in health care today include the MS-DRG adjustments, the Hospital Value Based Purchasing Program (VBP), Hospital Readmissions Reduction Program (RRP), Hospital-Acquired Conditions (HAC) and Healthcare-Associated Infections (“HAI”), not to mention a total reconfiguration of Medicare disproportionate share (DSH) payments.  Poor performance these more complex trends and modifications will change the ways in which providers approach health care for decades to come.  Health care reform’s successes and failures so far have mostly been viewed on national and state platforms, yet it has always been the community within which a patient seeks care.  Focus should be on the local level.

The changes in health care and its impact are epic.  For health care reform to succeed, individuals must come to accept the harsh truth that the present path on which this country is headed may ultimately lead to the abolition of unrestrained entitlement to care.  Federal laws have created the functional equivalent of a constitutional right to emergency medical treatment at nearly every hospital across the country, extending even to those outside the protections granted by citizenship.  But many of these hospitals are closing, and with such an event, there is not only a loss in the community of this institution, but oftentimes the wound is much deeper.

The most recent climate of reform includes changes implemented by the Affordable Care Act (ACA), which is designed to expand coverage for a broader group of people.  These changes are noteworthy primarily because they add unprecedented layers of complexity such that it may be a matter of time before the confusion experienced by today’s providers proves to be Medicare’s undoing altogether.  The decades of trial and error upon which health care in the United States have been built may give way to industry-wide confusion and disruption as a result of newly enacted regulations.

Challenges to health care reform have come in all different shapes and sizes.  While epic battles of Constitutionality mixed with morality often take centre stage, the litigation worth watching may be the daily battles at the administrative law level.  Provider challenges to the tens of thousands of pages of ACA regulations will ultimately shape the future of health care.  The ACA and its 900 pages in the Federal Register have been eclipsed in comparison to the regulations promulgated by the executive branch.  This is the level at which health care reform has expanded, and will continue to mature.  For every provider that challenges an administrative regulation through litigation, there is a possibility that significant change may ultimately prevail.