One perverse result of centralizing the health care system and regulating it more through top down rules rather than price signals and incentives: Obamacare may actually make it harder to cut back unnecessary treatments and slow the rise of health costs. Patients and patient advocates all over the country are going to fight mandated cutbacks in medical services and allowable treatments, especially if these are perceived as being required by some Orwellian Ministry of Life. Pictures of grannies and toddlers denied lifesaving treatment by heartless bureaucrats will fill the media. (The Times piece features a breast cancer survivor who might not have survived under the new and ‘improved’ guidelines being proposed.)

Once the “Let my Mommy live!” campaigns start, and they surely will, laws and regulations will be changed, insurance and pharmaceutical lobbyists inserting phrases here and exceptions there, to mitigate whatever horror has the press and the blogosphere up in arms — this week. The inevitable result will be a ferocious cost bloat and an ever more complex, ever less workable and less affordable health care system.

A decentralized system with built in incentives (patients wanting to save money, for example) and malpractice protection that ends physicians’ need to practice defensive medicine will have the same or greater effect on costs as National Death Panel rulings, but will not elicit the same kind of focused outrage.