If you were developing a plan to make health insurance more affordable, would you use as a model the state whose laws have made health insurance the most expensive in the country? That’s what Nancy Pelosi and the Democratic majority in the House have done.

David Gratzer points out that PelosiCare will force insurance companies to cover orthotics. Unless you are a doctor or have foot problems, you probably don’t know even what orthotics are, but you’ll be covered for them if this bill becomes law. New York State also mandates the coverage of off-label drugs, chiropractors, in vitro fertilization, and a host of other services. Each additional mandate inescapably raises the premium.

Orthotics, of course, is hardly the only mandate in the 1,992-page PelosiCare bill.

Even worse, New York, with “guaranteed issue,” requires that health-insurance companies sell policies to anyone who asks for one and to cover pre-existing conditions. This is the equivalent of requiring fire-insurance companies to sell policies to people whose house burned down the day before — and then pay to rebuild the house. Naturally, premiums on the shmoes who carry health insurance when they are healthy must go up to cover the shnorrers who only begin paying premiums when they have claims.

PelosiCare will require guaranteed issue.

And New York severely limits the ability of insurance companies to charge the young, who have a very low risk of serious health issues, lower premiums than those charged to the not-so-young, who have a much higher risk. Since the young are wildly overcharged in order to subsidize seniors in New York, many decide not to buy health insurance, knowing that if they are very unlucky and get seriously sick, they can always buy the insurance then and be covered.

PelosiCare will do the same. To be sure, the bill calls for those who do not buy insurance to pay a fine of $2,000. As New Yorker Andrew R. Heinze writes, that’s about what he is currently paying just for the coverage of hospital care today, thanks to New York’s economic-reality-be-damned health-insurance laws. He plans to drop his insurance if PelosiCare becomes law and depend on good luck (and guaranteed issuance).

Residents of New York City pay about five times as much for health insurance as those who live in, say, Columbus, Ohio, because of these mandates, guaranteed issue, and restricted premium differentials. PelosiCare will make sure that those who live in Columbus will see their health-insurance bills soar. Or it will cause a collapse of the private health-insurance market, making a government takeover of health care inevitable.

It’s hard not to think that the latter is exactly what they have in mind.