Three hiccups of wildly differing proportions recently showed just how unique and muddled the industry of health care is in America.

On the federal level, bad code and government inefficiency severely hampered?Obamacare before it even got off the ground.

On the state level, Cover Oregon’s rollout has been even worse. It is behind even the faltering federal system in the number of successful private health insurance sign-ups, none of which have been made through its much-touted online marketplace.

And on a local level, St. Anthony Hospital was not able to open on time — throwing off a moving operation that had been planned down to the smallest minutiae — because state permits were not in hand by opening day.

It goes to show there is just as much red tape in Salem as there is in Washington, D.C. — and that when it comes to health care, there is enough red tape to wrap all the Christmas presents in Eastern Oregon.

Why so?

Health care and insurance are both strange species in the phylum of economics. They don’t play by the basic tenants of capitalism:?supply and demand don’t set the price. There are intractable uncertainties (no one knows if they will need an appendix removed tomorrow) and the agent that makes most of the purchasing decisions — the physician — is not necessarily considerate of the price of the product or service they provide. We can’t put a price on one’s health, naturally.

The industry is also one of the country’s most heavily-regulated.?That’s understandable, of course. We want to be sure that the doctor who will perform our open heart surgery didn’t just come in off the street and — at the very least — washed his hands first.

But the bureaucracy that sets?and enforces the ever-increasing regulations is immense. It’s no wonder that health care costs are increasing much faster than inflation, wages and even higher education costs.

In fact, health care’s wildly increasing costs are helping keep wages down. Employers, instead of handing out raises, are having to funnel more cash each year into health insurance for their employees.

On the federal level, the amount of people and dollars behind the scene in health care would be large and obtuse it would be hard to get a sense of it. But here at the state level, it’s easier to understand.

In Oregon, there thousands of Oregon Health Authority employees, 700 of whom work in the public health division. Those folks are involved with drinking water testing, food stamps, insurance, licensing boards and more. Very few of them went to medical school and none of them are involved in “direct practice,”?i.e. setting a broken arm, giving a flu shot or dispensing a prescription.

We depend on that bureaucracy to make sure our hospitals and our nursing homes are clean and safe, our doctors and nurses are well-educated and licensed.

But it’s also this bureaucracy that hasn’t proven itself to be nimble enough to make big changes in a timely fashion. It’s why Obamacare and Cover Oregon have been such a bust in their first few months. And it’s why St. Anthony Hospital didn’t open on time.

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