By CBO estimates, the Act commits US taxpayers to spending over one trillion dollars over the next ten years. Through the magic of a projection that would be fraudulent if done by a publicly traded company subject to Sarbanes Oxley, the law was deemed to be a revenue enhancer because it collects taxes beginning in 2011, while only providing benefits beginning in stages in 2013, one year after the Presidential elections. Deficits in the years beyond 2019 have been ignored by Congressmen touting the Bill. Among other major economic drags in the bill is the requirement that we all purchase insurance directly if our employers no longer provide it because they are paying a cheaper payroll tax to shuck us off to the government pool, a tax on so-called gold-plated insurance plans, new taxes on pharmaceutical and medical device companies, and a 5.4% income tax surcharge. Including state income tax rates, many successful United States entrepreneurs will now face over 50% marginal tax rates, which will sharply reduce their incentive to start new small businesses that are the backbone of job creation. In their talking points, the Republicans plausibly claim the bill may cost 5 million additional jobs.

There is not the slightest chance that the assumptions underlying the bill will be reflected in reality once people have the chance to game the system. In the same way the government could not keep up with the acceleration of demand created by the cash-for-clunker law, healthcare insurers and providers will not be able to keep up with the distortion in demand created by not having use of the system tied to a cost. Many employers will opt to pay an 8% payroll tax rather than provide private insurance. Millions of employees, knowing they can wait until they are sick, will pay the penalties associated with not having insurance, or ignore them altogether, only seeking insurance once they feel they need serious coverage. The penalties range up to a misdemeanor failure to insure (up to $25,000 and one year in jail) and to felony failure to insure (up to $250,000 and five years in jail). Representative Camp (R-MI) put it well when he said, "This is the ultimate example of the Democrats' command-and-control style of governing — buy what we tell you or go to jail." These penalties are so severe and so unjust and so unconstitutional that they will never be uniformly enforced, if they are enforced at all.

These facts, coupled with how invincible we feel when we are young, will result in many millions of people delaying coverage for years knowing they cannot be denied government coverage for any pre-existing condition. In a Fitch forensic survey of a 2007 mortgage pool that went bust, 47 out of 47 mortgage applicants lied to get their loans. Similarly, this law will encourage many U.S. citizens to work off the books now that they have coverage. As a result, as an unintended consequence of this Act, fewer people are likely to actually be insured. While the poor may gain in coverage, the middle class will lose coverage. And our smartest students will veer away from medicine.

With new healthcare industry taxes, the destruction of private insurers, and the likelihood of more arbitrary reimbursements, the pharmaceutical and medical device industries will stop innovating in the United States at the level that brought them to the top of the world in knowledge competitiveness. The large international companies will do more and more of their drug innovation elsewhere.

There will be a migration away from innovation in the United States towards a focus on process. Did you get to see a doctor? Did you get to see a nurse practitioner? Not, did you get well? The vibrant healthcare industry, with its equity in public companies alone valued at $1.9 trillion in today's dollars, will likely be cut roughly half in value over the next five to ten years as the same forces that made Amtrak unprofitable are brought to bear in healthcare. For those families fortunate enough to own some stocks in a pension or a retirement or private account, the average losses attributable to the wipeout of healthcare could be on the order of $15,000 to $20,000 per household in today's dollars. The losses are likely to be unequally distributed, with health insurers losing the most.

This is above and beyond the annual burden that will be imposed by forcing everyone to buy non-economic government-based insurance. To the extent the dollar collapses, it may well be that in dollar terms, the industry does not lose as much value. But in real terms, there will be a clear loss of value. For example, all sorts of drugs, operations and procedures that are considered routine today will be considered unnecessary and unreimbursable tomorrow.

Congress acts as if we can borrow and borrow and never have to worry about repaying. We have issued $12 Trillion in debt, and the new law would add another $1 Trillion at a minimum. This is in an economy that only has $14 Trillion of nominal GDP. As the total United States debt begins to climb over 100% of our GDP, other nations will increasingly move away from the dollar.