Under the new law, all the exits from the system are blocked. You can't opt out or buy cheap, high-deductible Acme Car-type insurance, even if that's what you need. Ultimately, even that coercion won't be enough to make the whole thing work because the "cost curve" will not be bending.
Profit-hungry insurance companies were never the problem. (According to American Enterprise Institute economist Andrew Biggs, industry profit margins are around 3 percent, and the entire industry recorded profits of just $13 billion last year, close to a rounding error in Medicare fraud estimates.) Rather, health care costs have been skyrocketing because consumers treat health insurance like an expense account. Putting almost everyone into one "risk pool" doesn't change that dynamic; it universalizes it. And eventually, the only way to cut costs will be to ration care.
In September, Obama got into a semantic argument with ABC's George Stephanopoulos, who noted that requiring all Americans to pay premiums for a government-guaranteed service sounds an awful lot like a tax. "No. That's not true, George," Obama said. "For us to say that you've got to take a responsibility to get health insurance is absolutely not a tax increase. What it's saying is ... that we're not going to have other people carrying your burdens for you."
Stephanopoulos invoked a dictionary definition of a tax: "a charge, usually of money, imposed by authority on persons or property for public purposes." Obama laughed off the idea that a dictionary might outrank him as the final arbiter of a word's meaning: "George, the fact that you looked up ... the definition of tax increase indicates to me that you're stretching a little bit right now. Otherwise, you wouldn't have gone to the dictionary to check on the definition."
OK, put aside your dictionaries. The legislation allocates $10 billion to pay for 16,500 IRS agents who will collect and enforce mandatory "premiums." Does that sound like the private sector at work to you?