A Rubik's Cube of laws must be changed to secure any flexible and functional change in American health care. That's the drawdown message of a concise, thoughtful assessment in the June issue of the Journal of the American Medical Association.

"Innovation will not occur if each novel way to organize and pay for care needs to be adjudicated case-by-case or is threatened with legal proceedings," say the authors, Timothy Jost, a lawyer, and Ezekiel Emanuel, a physician.

Among the points they cite:

• Patients visit doctors offices 1 billion times a year, with the average Medicare client seeing 7 different doctors -- most of whom are not linked electronically, clinically or otherwise. Fee-for-service reimbursement is an impediment to coordinated care.
• Some states require hospitals to meet a variety of certificate-of-need laws before establishing delivery systems. Some states, like California, prohibit corporations (hospitals like Community Medical Centers) from hiring physicians.
• Assorted tax laws limit for-profit, non-profit ventures. Federal anti-kickback and self-referral prohibitions create another level.
• Several federal jurisdictions have oversight of the same health arrangements, but different interpretations of how to exercise those rights.

While wisely citing the current banking crisis with respect to the perils of innovation, the authors conclude by suggesting:

"A federal commission with authority to permit delivery system innovations that are time limited and contingent on period evaluations demonstrating cost savings and improved quality could facilitate the necessary reforms."

Sure might save a lot of legal time trying to repeal or rewire existing laws governing a dysfunctional system.