Like many of the illnesses it treats less effectively and less economically, ObamaCare will arrive in stages.

As the monstrosity known as the Affordable Care Act phases in, it promises a fiscal sledgehammer effect in the short term, and a dull but persistent economic nausea over the longer term.

By almost any realistic measure, ObamaCare portends a re-distribution of federal and state funds on a gigantic scale, plus an onerous re-allocation of responsibility, from doctors and their patients (among whom medical choices are best made) to state and local governments, business owners and religious institutions.

The folly of it all is that ObamaCare ultimately thumbs its nose at affordability, which it was supposed to facilitate. Healthcare spending by the federal government will spike dramatically ($478 billion more than without passage during the next decade, Wall Street Journal, Aug. 7, 2012), and the trickle-down effect will be an “across-the-board surtax on virtually all expenditures by families and individuals,” according to an analysis by Jonathan Tobin for

The Heritage Foundation cites fresh Congressional Budget Office projections between next year and 2022 that anticipate 18 new taxes and penalties devised to generate more than $1 trillion to underwrite ObamaCare.

What a prescription. To dictate that healthcare accessible to everyone – even young people who don’t need it and would prefer a robust employment environment – we are supposed to believe there was no choice but to raise taxes, impose penalties (which the Supreme Court majority opinion has decided is also a tax), shift $716 billion out of Medicare and trigger higher consumer prices (as small businesses pass along the costs) to cover the inefficiencies and false assumptions connected to ObamaCare.

As former New York Lt. Governor Betsy McCaughey noted in a debunking of the ObamaCare “deficit reduction” myth for the Wall Street Journal, a significant revenue stream that was to have made the plan solvent is already in jeopardy. The Act was going to raise $111 billion by 2022 by imposing a 40% tax on families with “Cadillac” (all encompassing) health plans. But the unions – whose members have these plans – cried foul. So the tax has been deferred, for now, until 2018.

How do you make up $111 billion across a decade? Higher taxes, check. Artificially imposed price controls, check.

And, finally, there are the hidden costs that will mount in lock step with costs we already know about. These hidden costs are owed to the many hours that will now be devoted to filing lawsuits, requesting waivers and interpreting regulations. This loss of productivity will spread to small businesses, hospitals, religious institutions and universities.

Perhaps no aspect of ObamaCare is likely to be more cumbersome than the management of its many programs and fees through so-called state “exchanges”.  It is well documented by media reports that even states favorably disposed to the idea of mandated healthcare are struggling to create these new bureaucracies. Others have declined, hoping ObamaCare will collapse under its own weight.

But what happens if this nightmare unfolds anyway and a state is found to have made inadequate progress toward creating its healthcare “exchange”?

No problem. The Department of Health and Human Services, the long arm of ObamaCare, will come to the rescue.

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