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Obamacare: You (still) can't fix stupid

The officially reported numbers of people signing up for health insurance on the new Obamacare state and federal exchanges still really aren't all that encouraging. With estimates that the number of uninsured Americans was somewhere between 40 and 50 million before the ACA, the sobering fact was that the overwhelming majority of those people still weren't signing up for health insurance even when it was "free."

Let's first just check the math. The government tells us there are now 16 million people who signed up for health insurance coverage or were enrolled onto Medicaid via the exchanges since Obamacare went into effect. The government also tells us it believes 60 percent of those 16 million enrollees were not previously insured. So, even according to those potentially generous Obama administration estimates, only 9.6 million of the 40-50 million uninsured Americans who were supposedly desperate for health insurance bothered to actually sign up for it, even though the program was massively promoted and poor people receive this insurance at no cost to them thanks to massive taxpayer subsidies.

That's less than a third! They also refuse to sign up despite a tax penalty for those who don't have coverage.

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Thomas Lehmann | Getty Images

Why? Because you still just can't fix stupid. People refusing to get any kind of health coverage are being stupid. If they simply don't like the quality of the Obamacare coverage plans, or understandably object to a government intrusion into their lives, they should still get coverage from a completely private option. No excuses.

And the stupid factor doesn't stop there. Many ACA proponents are celebrating the news that doctors' offices aren't being overrun with new patients who just signed up with an ACA plan.

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Well I'm glad it's not standing room only — especially at my local orthopedist. But there are other data showing patients streaming into hospitals is rising steadily. In other words, Obamacare or no Obamacare, more people are going to the ER first. And we were promised that the ACA would cut down on those more costly hospital visits and get more people to that less expensive primary care at the doctor's office.

So, one year later, we still have a lot of stupid people out there. But we also have a lot of richer insurance companies and hospitals. They're making out like bandits as the profits coming from those 9.6 million people with new coverage or Medicaid is mostly going into their pockets. It's more like an indirect subsidy for insurance companies and hospitals. Remember, health insurance isn't health care. And too many Obamacare plan enrollees have found out the hard way that "coverage" doesn't mean you can get in to see a doctor. Others haven't been so unlucky, but there's no evidence we're seeing a net gain in actual "care."

Was adding to insurance-company profits, shoring up hospital balance sheets, and creating a whole new list of winners and losers in patient coverage the point of this whole Obamacare thing? I'm pretty sure the voters don't think so, which is why they again voted heavily against candidates who supported the ACA in the 2014 midterms.

But that won't stop the government from trying and trying and trying to push this down the public's throat. That is, unless we do something about it. Simply put, the individual insurance mandate should be repealed — and the sooner the better. And so should the new powers the Obama administration gave itself to disqualify many of the low cost "major medical" catastrophic plans that make so much sense for young and healthy people.

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Am I saying every enrollment program is a failure if it doesn't sign up at least half of the eligible public? No. But it is a big problem when enrolling fewer than a third of those people comes at such a massive financial, political and social cost.

Instead, we should bolster what is really the best thing about the ACA: That's the fact that many state governments and the feds have been forced to at least try to offer enrollees more and more insurance options from more and more competitors. The states where exchanges have failed, like Oregon and Maryland, have largely failed because they just couldn't attract enough free market-style competition among existing insurers. It's a wonderful thing when Democrats in state houses and in Congress see the free market at work. Perhaps some of them will learn from that and reduce all the barriers to entry that stop insurance companies for competing for your health insurance business across state lines. The good part of Obamacare are the aspects of it that exemplify the free market. The worst part of it is the individual mandate that forces taxpayers to force feed insurance down the throats of millions of people who are too irresponsible to do it for themselves.

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So that's the compromise: We take away the draconian and unrealistic individual mandate that hopes to make irresponsible people somehow become responsible, and replace it with a reward for those who actually do want to do the right thing without any government coercion. But wait, wouldn't that also make the insurance companies richer, you ask? Yes it would, but only the ones who offered the best plans for the best prices, not the ones who got your money because the government forced you to buy their plan whether you liked it or not. By that measure, the worst insurance companies offering the worst coverage and service will rightfully fail instead of being propped up by public money. The individual mandate is stupid because you can't fix stupid. But the competition we're seeing in some of the best state exchanges is smart and should be expanded and broadened nationwide. Call me crazy, but I want a government that spends its time and efforts on behalf of responsible people instead of obsessing over ways to supposedly protect, but really politically co-opt, everyone else.

Otherwise, all we get is a government of the stupid, by the stupid, and for the stupid.

Commentary by Jake Novak, supervising producer of "Power Lunch." Follow him on Twitter @jakejakeny.