David Gratzer

Congress has a shoe fetish.

The basic problem with ObamaCare – the core problem – is buried deep in the 1,994 page bill passed by the House of Representatives. More unsettling than the full price tag – $3 trillion over ten years, when fully implemented, according to the CBO – and more ridiculous than the many bureaucracies it establishes – including, no kidding, an Office of Administrative Simplification – is the commitment of Congress to better your feet.

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The House would require that all health insurance cover orthotics. It’s a small idea, one easily overlooked, but it would put America’s foot – metaphorically speaking – in it.

For people with arthritics and diabetes, orthotics can be important. For others, they can bring comfort. But that single requirement suggests that ObamaCare – if finally passed by the Senate and signed into law – will raise the cost of health insurance.

And it’s just the beginning. The ObamaCare bill sets the stage for many more requirements and rules.

New Yorkers, of course, already know the problem of legislators who focus on, well, the feet first. New York State has one of the most dysfunctional health-insurance markets in the country. In 2005, a leading online insurance brokerage, eHealthInsurance, calculated the cost of a standard individual insurance policy across the nation’s 50 largest cities, comparing some 4,000 insurance plans offered by 140 companies. New York ranked as the most expensive city, its lowest premiums more than five times pricier than those of cities like Columbus and San Francisco.

Why the price tag? For years, Albany has regulated first, and asked questions later.

State lawmakers have mandated that all health plans cover a host of procedures and services. Even the most stripped-down plan must include coverage of off-label drugs, surgical second opinions, midwife services and, yes, orthotics. Each mandated benefit, of course, makes the policy more expensive. New York also demands that people pay roughly the same premium regardless of age or health status – a move that discourages younger, healthier people from buying insurance, and thus driving up premiums for those left willing to buy. Finally, the state has added billions of dollars in fees and other taxes to private insurance policies, making them even pricier still.

Since the state began aggressively regulating insurance in 1993, the number of individual-insurance policyholders has dropped by roughly 96%.

David Gratzer

Dr. David Gratzer, a physician, is a senior fellow at the Manhattan Institute. David Gratzer's most recent book is Why Obama's Government Takeover of Health Care Will Be a Disaster (Encounter Books, 2009).