But even as designed, Obamacare was as much an expansion of Medicaid as it was anything else. With the exchanges proving so unattractive, it may happen that the majority of new coverage under Obamacare will amount simply to an expansion of the Medicaid rolls.
Medicaid expansion is expensive, but that won't be the worst problem. Medicaid systematically underpays doctors and hospitals. Yet doctors and hospitals are forbidden to refuse Medicaid patients. They compensate, therefore, by raising charges to other patients—an invisible subsidy that will now inevitably grow even larger than before—and that will show up, among other places, in yet higher costs on the exchanges, inducing more people to drop coverage, accelerating the death spiral.
Redistribution is not the core design flaw in Obamacare. The core design flaw is that Obamacare had its priorities upside down: it put coverage expansion first; cost control a very distant second. What we are discovering now is that without cost control, coverage expansion quickly devours itself.
The comment section is worth consideration too.
