James Taranto:


If you want the really good plan with the lower deductible, you’re going to have to pony up for “Gold,” which is hardly solid. The deductible for your family is $2000, and copays don’t apply to it. Most folks will opt for a cheaper plan, but the incentives there get really perverse. Ed Morrissey explains:

The higher deductibles are the result of attempting to tamp down the premium hikes, but this raises a big question about the structure of the reform itself. If consumers end up with $4000 deductibles, how are these costs different than the alternate reform model of hospitalization insurance, health-savings accounts (HSAs), and emphasis on the cash/retail system for routine medical care? What we’ve ended up with is the same deductible costs — no one will use $4000 in routine medical care a year — without the cash-market reforms that would drive costs downward through price-signal clarity and competition, while incentivizing providers to get back into routine medical care by wiping out third-party payer red tape and costs.

Most families will face higher — in many cases, much higher — out-of-pocket expenses. Wealthier people opting for the Gold or Platinum plans will have lower out-of-pocket expenses, and since they won’t be getting any subsidies, why not? So we have a situation where the middle class pays more, while the rich (or politically connected) get better and cheaper service.

A few million on the bottom will do nicely — assuming they choose to take part. If these younger and healthier people choose not to buy insurance, just as they often do, then folks in the middle will feel an even bigger squeeze as premiums enter the “death spiral.”

And let’s not even think about the lost productivity gains and the lost tax revenue as people start taking Kathleen Pender’s advice and refuse pay-raises and promotions so that they may keep their ObamaCare subsidies.

If you think the rollout was a disaster, wait until this damnable thing starts working.