One of the unpleasant truths of legislative initiatives is that, more often than not, policymakers get more than they bargained for.

This article drives that point home with a broad look at the unintended consequences that have resulted from some major pieces of federal legislation over the last 50 years.

In the author’s eyes, “policymakers have not yet learned from the past and may be doomed to repeat and amplify those mistakes unless politicians, physicians, patients and payors can compromise on future healthcare legislation.”

To sum up just a few examples, he notes “the Social Security Amendments Act of 1965, which was conceived as a way to reduce health disparities, cost less than $3 billion—less than 2 percent of federal spending—in 1967. Medicare costs were projected to increase to $12 billion by 1990. However, Congress continued to expand eligibility and covered services. By 1990, Medicare costs had mushroomed to $98.1 billion, with Medicaid tacking on another $145.7 billion. Total Medicare and Medicaid reached $841.3 billion in 2011.”

How does this happen? He points in a few different directions.

To note just one cause, he argues “The first overarching theme about how and why unintended consequences occur is the sheer complexity of the issues and how challenging it is for Congress to understand them. Attempting to capture the almost infinite complexity of medical science and medical practice through laws having finite dimensions has clearly not worked as intended in many cases. Moreover, these laws are often largely crafted by people with limited knowledge of the health care system, an approach that has not worked in the past and will not work in the future.”

Inevitably, there is bound to be disagreement over this and the other causes he outlines, but for our purposes the question that comes to mind is, What unintended consequences of HITECH will stakeholders be lamenting in, say, five years?