The thing I don't understand most of all about this health bill is why they're waiting *four years* before the lion's share of the changes enacted take place. A few of the changes start immediately, but by-and-large the actual changes to the system won't occur for four years.

Why? I realize it'll take *some* degree of time to handle all the shifts is bureaucracy, and to talk the insurance companies off the ledge, etc. - but not four years. Why wait? Why not 1/1/11 or even 7/1/10 as a start date?