Blue regulation works best in simple systems. Social Security doesn’t have a lot of whistles and bells. Retirement, retirement age, actuarial projects, payroll tax deductions: these are relatively simple things. (Even so, we’ve gotten it badly wrong, but Social Security is far from our most serious budgetary problem.) Social Security could be run by accountants with adding machines; there is no rocket science involved.

Not so the government’s brave ventures into health care. People who’ve devoted their lives to the study of our health care system (really, system of systems or just systemic chaos) don’t understand everything about it or how it all works. Tweak a Medicare reimbursement formula, and suddenly nurses are getting a windfall in Chicago while GP practices are shutting down across Kansas. As the numbers grow, and the complexity of the system increases, the opportunities and incentives for fraud balloon — again, often in ways that those trying to ‘fix’ the system don’t understand or predict.

Then comes the second problem: the throngs of cooks that spoil the broth of progressive legislation these days. As the system to be regulated becomes larger and more money flows through it, the ‘legislative space’ is suddenly populated with very effective and sophisticated lobbies. Everybody from the AARP to the NOW, the NCAA, the NAACP and the Catholic Church wants a bite at this apple. Community hospitals, teaching hospitals, outpatient clinics, drug manufacturers, chiropractors and osteopaths, firms selling catheters on television infomercials, psychologists, rehab clinics, pregnancy test manufacturers, doctors’ associations, staff unions: there is no end to the number of groups who want to tweak health legislation on this or that issue.