You are so over the top with the death spiral thing. One thing I have learned early on life, don't replace something unless you have something better to replace it with, but the argument of "well it sucked before so we revamped the whole damn system, so it has to better" is ridiculous. What the system is going to create is an even bigger tug on the government rope than before. Now that a lot of small businesses are probably going to be forced out, and people being forced into the health care exchanges, in which then the government will have control over personal behavior such as what you eat, what you drink, BMI index, and God knows what else. Now you might say that private insurance already was doing some of those things, and that would be right, but you could drop your health insurance if it got unaffordable, you wanted to take a chance, or you could shop around a little a bit. You can't do that under Obamacare. There is no opting out, no competition (which they have made illegal for private businesses to do), and no recourse because when they decide to penalize, it will be from the IRS. They'll control what you owe through your taxes or tax refund if you have one coming back. Which brings me to a point I have made some time ago, that it would be a matter of time before they start implementing ways to keep more and more of your tax return until they get it all.