The endgame was to get the young and healthy to buy more expensive insurance than they need or want. “Expanding the risk pool” and “spreading out the risk” by mandating — i.e., forcing — young people to buy insurance is just market-based spin for socialist ends. A risk pool is an actuarial device where a lot of people pay a small sum to cover themselves against a “rainy day” problem that will affect only a few people. Such “peace of mind” health insurance is gone. What we have now is health assurance. With health assurance, there are no “risk pools” really, only payment plans.

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% and the entire industry recorded profits of just $13 billion last year, close to a rounding error in Medicare fraud estimates.) Rather, healthcare 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.