I think the issue there is risk. Specifically, what is the likelihood of success if I attempt to migrate / change / remove X system? I can't understate the com

I think the issue there is risk. Specifically, what is the likelihood of success if I attempt to migrate / change / remove X system? I can't understate the complexity and intricacies. Imagine legally defining all possible medical transactions, then writing software thats compatible with those legal agreements, then running it, changing the agreements, and adding features over 50 years. While the systems being interacted with also mutate. And all of this being done haphazardly and uniquely because there's no one in control of the entire process (Medic-are/aid aside). I'm hard pressed to think of a messier computing system in aggregate. I'd guess even the financial system is more rigidly defined, has fewer players, and doesn't have to map with as high fidelity to real life. ACA provided a fair number of incentives and penalties, re: actual vs industry standard overhead. And it caused change, but there were a lot of failures.