Average premiums for the benchmark Obamacare plan rose 8 percent in 2016 and 21 percent in 2017, according to Kaiser Family Foundation data, while deductibles were up by about 15 percent. For some markets and plans, the premium increases were considerably higher: 67 percent in Oklahoma City; 71 percent in Birmingham, Ala.; 145 percent in Phoenix.

Same deal for employer-sponsored plans. While Sen. Obama promised during his campaign in 2008 that the average family would see health insurance premiums drop by $2,500 per year, the average family premium for employer-sponsored coverage has risen by $3,671, noted Maureen Buff and Timothy Terrell in the Journal of American Physicians and Surgeons. That was back in 2014, and premiums continue to rise.

Meanwhile, insurers keep walking away from Obamacares unprofitable exchanges. Anthem and MDWise announced last month that they were withdrawing from Indiana, which will leave 76,000 Hoosiers in need of a new insurer. Anthem said it would be pulling out of the exchange in Ohio. Aetna warned it was pulling out of Virginia in May and Iowa in April. Humana did as much in Tennessee in February. More than 1,000 counties in the United States a third of the total are down to just one insurer, according to a Bloomberg analysis.

This was predictable. Obamacare was sold using the language of choice and competition, but it is actually reducing both, a Wall Street Journal editorial warned back in 2010, when the law was months old. Health insurance doesnt work when it isnt allowed to operate as insurance: when it cannot tailor its products to the preferences and budgets of consumers, and when it cannot make business decisions based on considerations of risk.

You do not get to insure your house after its on fire. Why should Americans have the unalienable right to wait till they get sick (at least during open enrollment) before buying health insurance?

Here, however, is where the philippic against the Affordable Care Act ends. Barack Obama inherited a broken health care model and made it worse, unless you count shunting millions of people into Medicaid as a triumph. For all the liberal angst about the Republican House and Senate bills, they are only tinkering with the same unfixable formula.

The only genuinely promising reform in the Republican health bills are proposals to nearly double contribution limits for heath savings accounts and allow them to be used to pay for premiums. Enrollment in tax-deductible, investable H.S.A.s has roughly doubled since Obamacare took effect, to about 20 million, because they help cover out-of-pocket costs for low-premium, high-deductible plans.

But as Peter Ubel of Duke pointed out last year, theyre mainly attractive to wealthier people with income to spare. Government subsidies of H.S.A.s for low-income people, Ubel writes, could turn H.S.A.s into something other than another tax break for the wealthy and make our health care system more responsive to consumer needs. This is what Singapore does, along with mandates for employees to set aside a portion of their income for H.S.A.s, and for employers to match it.

H.S.A.s can restore sanity to a market in which prices are invisible and costs keep rising, and in which the concept of insurance has lost its meaning. Republicans who want to salvage a conservative policy victory from their health care fracas would be wise to leave Obamacare alone, so that its authors can pay the price for its failure, just as the G.O.P. restores price to the rest of the health care system.

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A Price for the GOP's Health Care Insanity - New York Times