Lee Drutman reminds readers of a point that Milton Friedman made often:

And yet, start reading the actual legislation, and you quickly realize the U.S. health-care system is a dizzying jumble of a thousand and one interconnected pieces, which means a lot of little rules and incentives to get right if any reform is going to work (hence the very long bill). And so, while the public debate carries on in two colors and one dimension, a handful of Washington policy “experts” who actually can grasp the infinite subsections and crevices of health-care law work tirelessly to shape legislative language far from the spotlight.
And who are these “experts”? Well, mostly (though not entirely), they are the representatives of doctors, hospitals, insurers and pharmaceutical companies, i.e., the special interests that have both the resources and the stake to actually invest in the expertise one needs to deal in the details. The health-care industry is now reportedly spending more than $1.4 million a day on lobbying.

This is a fundamental problem with treating government as an overarching means of social organization. By the time activists and partisans have riled enough people to get an assertion of government power rolling, entrenched forces and special interests have positioned figure out how to roll it in their favor. One suspects, by the way, that the overlap between those doing the riling and those guiding the roll is significant.