When The New Republic’s Jonathan Cohn, the most rigorous defender of the entire reform project, wrote up his “five Obamacare anxieties” in May, the first one was structural: The system’s sustainability depends on getting enough healthy people to sign up, he pointed out, and if they don’t then insurers “will have to raise everyone’s premiums,” which “could create what actuaries call a ‘death spiral’: Rising premiums prompt people to drop out, causing premiums to increase even more.”



Cohn thought such a death spiral was unlikely. Between the stick of the mandate, the carrot of subsidies and the planned P.R. blitz, it seemed as if enough Americans would sign up to at least postpone the cost problem and get the system off the ground.



But it seemed that way because it was hard to imagine the Obama White House botching the design and execution of its national health care exchange. Building Web sites, mastering the Internet — this is what Team Obama does!



Except this time Team Obama didn’t.



Right now, the problems with the exchange Web site appear to be systemic — a mess on the front end, where people are supposed to shop for plans, and also a thicket at the back end, where insurers are supposed to process applications.



But if the fix-it effort moves too slowly, it’s possible to envision a worst-case scenario unfolding.



If the Web site doesn’t work soon, even liberals concede that the mandate would have to be delayed, because you can’t very well fine people for failing to buy a product they can’t access.



And that combination — a hard-to-navigate online portal and no penalty for staying uninsured — could effectively discourage all but the most desperate customers from shopping, which in turn would create an unsustainably expensive insurance pool, driving prices up and driving people away, and potentially wrecking the entire individual insurance market in short order.






http://www.nytimes.com/2013/10/20/opinion/sunday/douthat-obamacare-failing-ahead-of-schedule.html?_r=0