Obamacare: Still stupid after all these years

 Slipping on a banana peel
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There's something about Obamacare that really shines a light on the stupid. And by that I mean stupid politicians, stupid "experts," and even regular – but stupid - Americans. And in case you missed it, the last few weeks have presented us, and the presidential candidates, with more solid evidence of ACA-related stupidity than usual. Let's look at the top three contenders on the Obamacare Stupid Bowl '16:

First, we now know that Obamacare enrollment has fallen short by 24 million people. The real number of enrolled Americans in ACA plans is 11.1 million. Making matters worse is the fact that a major chunk of the people not signing up are the younger and healthier Americans the ACA's architects were foolishly relying on to help absorb the costs from older and sicker enrollees. This is the continuing development that many call the "Obamacare Death Spiral."

Second, so many Insurance companies are curtailing their participation in Obamacare exchanges that 31 percent of U.S. counties are likely to have just one insurance company option for health coverage by next year. That's what we call a monopoly. And in case you don't know how dangerous monopolies can be in health care, Google the words "Mylan" and "EpiPen" when you get a chance.

Third, and getting back to the weak enrollment numbers, this summer we learned that one of the biggest reasons people are refusing to sign up for Obamacare is… they want to keep smoking. The higher surcharges and premiums for smokers are discouraging people, especially young people, from enrolling in ACA plans. And, it turns out that these higher costs aren't encouraging them to quit smoking either. Oh, and there's also still evidence that a decent percentage of people who do sign up for Obamacare who say they're not smokers are lying. This last one is a triple dose of stupid all on its own.

The stupid response from our two leading presidential candidates has been predictable and constant. Donald Trump keeps promising to repeal Obamacare, but he offers no further specifics. This is stupid, especially for a candidate who's otherwise been pretty good at focusing on one single aspect of a policy he doesn't like and also making clear, (if questionable), promises about what he'd do to change them. Hillary Clinton is barely talking about Obamacare at all.

"This summer we learned that one of the biggest reasons people are refusing to sign up for Obamacare is… they want to keep smoking."

The ACA's continuing inability to attain even a 50 percent approval rating in the polls is likely the reason, along with an intense Clinton campaign fear of even appearing to criticize President Obama. But it's simply stupid for Clinton not to point out that Obamacare has failed to live up to some of its most crucial promises. Her unwillingness to do so leaves the door wide open for Trump to score major points on this issue if he ever hones his message on the ACA.

All of these emerging issues are fruit of the same stupid source tree a lot of people saw from a mile away well before Obamacare went into effect in the first place. As many who worked in the health care industry tried to tell the politicians who wouldn't listen, we know that a lot of people just won't do the right thing for themselves when it comes to their health care.

They won't eat right, they won't stop smoking, they won't exercise, they won't visit a doctor regularly, and they sure as heck aren't going to sign up for health insurance coverage unless they need it right away. In short, the ACA was set up to rely the most on the most tragically unreliable people in the country. Some of those people are rich, some of those people are poor.

More of them are younger, but a decent number of them are over 30. Do they have a right not to sign up for government-mandated health insurance? Absolutely they do. But let's pretend we all agree that health care is a human right. If that is the case, then why should Americans who want their health care rights be held hostage by those who don't?

So, what about all those poor and middle class people who couldn't get health insurance before Obamacare? Was it "stupid" to try to help them too? Of course not. Setting up a system that helps poor or even middle class people who want and need cheaper health insurance coverage wasn't stupid. But setting up a system that relied way too much on people who don't want and will not sign up for health insurance no matter what was epically stupid, and now we're all paying for it.

And don't forget that it's not rich people, or even young and healthy people, who will suffer because of this stupidity. With reduced carrier options for coverage, which means a reduced number of doctors who will accept enrollee insurance plans, and rising costs, it's the people who can least afford to pay for their own coverage who are suffering and will suffer more as current trends continue.

And before you yell "single payer!" remember that a completely government-administered health system would only exacerbate this problem as we wouldn't even be able to penalize those who don't sign up and won't otherwise take care of themselves. Single payer makes all of them the responsibility of the taxpayers forever. And the answer to a growing number of cases of crony capitalism and virtual monopolies in American health care won't be solved by folding them into the biggest and most powerful monopoly of them all: the U.S. government.

A non-stupid alternative would be to keep the best part of Obamacare, which is the idea that you can have the freedom to shop online from a real number of competing choices of health plans. But that would require allowing insurers to cross state lines and that's still not allowed.

It would also be great to offer more of those bare-boned major medical plans that used to be much more popular among the young and healthy. But the ACA basically banned them. With real competition and real affordability, at least the less stupid among the uninsured would finally sign up.

There was a brief time in American politics when candidates could score points by promising to stand up for those who worked the hardest and were the most responsible with their finances, their families, and their personal health. The ACA and Trump and Clinton tell us that we now have, and are likely will continue to have, a national health insurance policy given to us by a government of the stupid, by the stupid, and for the stupid.

Commentary by Jake Novak, a senior columnist for CNBC.com. Follow him on Twitter @jakejakeny.

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