One of the reasons blue programs jump the shark is that over time more and more special interests lobby politicians to get special features added. The small add-ons and tweaks make programs more expensive and complicated to administer—and much, much harder to reform. This process begins when the laws are written; the lobbyists are there to tuck special little surprises between the pages of the bill. It continues as the regulations necessary to implement the new laws are written; once again, lobbyists are on hand to mold the regs to their liking. And it persists year after year after year, as lobbyists look for ways to amend the existing laws or add new requirements by inserting language into other bills.
This is happening as states develop the requirements for insurance under Obamacare. Chiropractors and acupuncturists are lobbying to make sure that their services are included among the “essential” services that the new insurance must provide. The New York Times details some of this reportedly “marginal” tweaking that’s already going on:
According to proposals that the states have submitted to the Department of Health and Human Services, insurance plans will have to cover weight-loss surgery in New York and California, for example, but not in Minnesota or Connecticut. Infertility treatment will be a required benefit in New Hampshire, but not in Arizona.
Over all, the law requires that essential health benefits cover 10 broad categories, including emergency services, maternity and newborn care, hospitalization, preventive care and prescription drugs. But there is room for variation in those categories. Whether insurance will pay for hearing aids, foot care, speech therapy and various medications will vary significantly by state.
Whatever the merits of the claims, any new required service will inevitably drive up the cost of insurance.
This same process will happen again and again and again. The nurse lobby will make sure that only licensed nurses can provide certain procedures. Other groups will protect their vested interests by influencing the regulations following amending laws. Ultimately even the positive features of the law will be significantly compromised by the steady accretion of small changes, almost unnoticeable in themselves in many cases—and even well intended sometimes—that over time will turn the law into an unholy mess.
The law is a blunt instrument; fixing the health care system by government fiat is like neurosurgery with a hammer. It’s going to hurt more than you think, and will harm more than it helps. Let’s hope politicians figure that out before too much damage is done.