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ORIENT: Trading in the Obamacare lemon

A government shutdown is preferable to a wrecked economy

- - Wednesday, August 21, 2013

October, the month when everybody is supposed to get health insurance, is only six weeks away.

Hundreds of millions of dollars are being spent trying to spiff up and sell the mythical Obamacare product, which is like a fully loaded sports car with chrome wheels. It looks great on the showroom floor. The only problem is, there is hardly any fuel that can power its engine.

The economy runs on voluntary transactions that are mutually beneficial to buyer and seller. Obamacare is designed to run on coercion — "incentives" that are really punishments. Buy this health plan — or else. Provide the listed services and the gigabytes of compliance data — or face a penalty.

A high-performance engine cannot be powered by galley slaves.

To make Obamacare run will require huge numbers of people acting in ways that are contrary to their own interests. It depends on young healthy people spending the rent money on health plans that will mostly benefit high-risk individuals. It depends on businesses continuing to employ full-time workers when it is much to their advantage to avoid hiring and to cut the workweek. It depends on doctors continuing to care for the sick when they only get paid for withholding expensive care. Moreover, it depends on doctors keeping their offices open despite the likelihood that they won't get paid at all during 60 of the 90 days of the insurance "grace period."

The people who will get paid are the overseers and the promoters.

The expert consultants can't figure out how the exchanges are supposed to work. Rules haven't been written yet, or the law as passed is simply unworkable. It requires some things that don't even exist, such as use of nonprofit reinsurance companies.

Still, somehow "navigators" from agencies such as Planned Parenthood, with 20 to 30 hours of online training, will be able to figure out how to enroll millions of people, and in a culturally and linguistically sensitive manner. Whether the exchanges can process the application or accept payment, especially from people who don't have a bank account, is problematic and certainly untested. Finding a doctor for the sick is not in the navigators' job description.

It appears that most of the cash infusion is going to come from taxpayer subsidies. Since the government can't figure out how to verify the income information needed to calculate the subsidies, it will just trust people to tell the truth for now (and possibly punish them later). How much money will be bled from other programs — or charged to the government's maxed-out credit card — is a great unknown.

Obamacare is a contraption that cannot work as designed. At the same time, as in the Cash for Clunkers program, the government is smashing the old models. There will no longer be an individual insurance market with risk-based premiums for catastrophic coverage. Tens of thousands of policies have been canceled, and there is no longer an incentive for individuals to buy insurance while healthy, just a tax penalty for not buying it. The Constitution and the rule of law are being demolished — the administration is simply deciding what to enforce and what to ignore. The destruction of independent medical practices is well underway.

Funds being poured into Obamacare implementation are being wasted on trying to foist this lemon off on buyers and on destroying both the existing private medical system and taxpaying productive businesses throughout the economy.

Responsible members of Congress from both parties need to defund this monster. President Obama and Senate Majority Leader Harry Reid may threaten to shut down the rest of the government to keep their signature creation on life-support, but this creation will wreak much greater destruction later.

If Mr. Obama gives Congress a choice — temporary shutdown now or permanent destruction later — let us hope there are enough leaders with the vision and courage to choose the lesser disaster.

Dr. Jane M. Orient practices internal medicine in Tucson, Ariz., and is executive director of the Association of American Physicians and Surgeons.