AoSHQ’s Dave In Texas is a bit surprised that the voluminous new healthcare law does not, in fact, define health care:

Wait until the public discovers the government is now literally determining what qualifies as “health care” in America.

That isn’t a typo. ObamaCare mandates that insurers spend a certain percentage of premium dollars on benefits, but Democrats never got around to writing the fine print of what counts as a benefit. So a handful of regulators are now choosing among the tens of thousands of services that doctors, hospitals and insurers offer. Few other government decisions will do more to shape tomorrow’s health market, or what’s left of it.

The WSJ piece just quoted is addressing what will count as medical benefits for insurance “medical loss ratios” under the new law. However, we will see a variation on the same theme when the new Health Choices Czar gets down to the business of deciding minimum levels of benefits for insurance plans to be offered through the government-created Potemkin market known as the Health Exchange.

If Dave — or anyone else — is surprised that the healthcare law does not define what health care gets financed and what does not, it is probably due to thinking that the Congressional intent was to establish healthcare policy. In reality, the Congressional intent was to pass a healthcare law assuming control over the system. One of the keys to passing ObamaCare was to buy off the “stakeholders” (interest groups) who were in a position to lobby and advertise against it — AHIP (Big Insurance), AMA, AHA, etc. Addressing issues like “what is health care” would have increased the odds of these groups fighting with each other and among themselves, contrary to the basic goal of passing a bill into law. Moreover, the flap over the US Preventive Services Task Force’s “guideline” — that women in their 40s should stop routine annual mammograms and older women should cut back to biannual exams — demonstrates why Congress would have no interest in the details of the government-defined insurance plans, where increasing numbers of people will eventually be dumped if the law gets fully implemented. The proles were already upset enough at the ruling class; Congress certainly wanted to avoid offending any constituency or group seeking inclusion of their disease, condition, or treatment in the government benefits package(s).

Indeed, Congress wanted to save those fights for later. Punting any issue likely to cause controversy keeps the Beltway carousel spinning. The interest groups already mentioned, plus those lobbying on everything to breast cancer to AIDS to chiropractic to medical device manufacturers will all be gearing up to lobby the vast new bureaucracies created under Obamacare for favorable consideration of one sort or another. Tossing the law’s hot potatoes to unelected civil servants allows Congresspeople to play the white knights, working the Rube Goldberg-esque machinery on behalf of their constituents and their donors. At the outset, this will be directed to establishing generous minimum benefits. Later, when the spiralling costs of the program produce plans for rationing care, pols will intervene to “save” valuable benefits from the bureaucratic reaper. The pols will also help steer groups to the crucial and costly counsel provided by their former staffers, to be employed at the K Street firm of “Don’t You Know Who I Am?”

In short, this process is how Congress disclaims responsibility for Leviathan it creates, as a way of squeezing money from the public to perpetuate their incumbency and their fiefdoms. It is a process Congress has honed over decades of legislation. But now that they are treading into matters of life and death, perhaps more people will see it for what it is.

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