Obamacare is not primarily an entitlement program. The entitlement component ”” the exchange subsidies ”” will involve about 2 percent of Americans during the first year. (Others will be added to Medicaid, which has been around since 1965.) About 20 million Americans will eventually get subsidized insurance ”” a check that goes not to the individual but to insurance companies. The remaining 170 million Americans will not experience ObamaÂcare as a sugary treat but as a series of complex regulatory changes that may make their existing insurance more costly, less generous and less secure.
The main problem with Obamacare is not its addictive generosity; it is its poor, unsustainable design. Its finances depend on forcing large numbers of young and healthy people to buy insurance ”” yet it makes their insurance more costly and securing coverage less urgent. (Because you can get coverage during each year’s enrollment period at the same price whether you’re healthy or sick, the incentive to buy coverage when healthy is much diminished.)
Heavy insurance regulations will lead some employers to restructure their plans, dump employees into the public exchanges or make greater use of part-time workers. In order to meet a few worthy goals ”” helping the poor buy insurance and covering preexisting conditions ”” Obamacare seems destined to destabilize much of our current health system.