Before we get to ObamaCare, let’s recall the rationales for government imposing top-down control over one-sixth of the nation’s economy. First, we had to end the issue of the uninsured, which had spiked as a percentage of the population after the Great Recession, mainly from unemployment. Second, costs were spiraling out of control, and the argument was that government control was needed to “bend the cost curve downward.” Third, Democrats argued that only a comprehensive federal system could apply the expertise and consistency needed to resolve both of these issues.

Five years after the passage of the Affordable Care Act, and almost two years after opening the ObamaCare exchanges, the results are consistent and almost entirely bad. The cost curve is bending upward even more rapidly than before, as Slate reminded everyone last week. Access to providers keeps narrowing as well, especially under ObamaCare’s exchanges:

Insurance plans sold on government-run Obamacare exchanges on average have 34 percent fewer hospitals and doctors—including specialists—in their provider networks than health policies sold outside those exchanges or offered by employers, a new analysis finds.

The gap in health providers covered by plans is particularly wide when it comes to cancer and cardiac specialists, according to research by the Avalere Health consultancy.

Obamacare policies on average had 42 percent fewer oncology and cardiology specialists available to patients in their networks than private plans sold outside the government marketplaces. …

For its report, Avalere Health examined the largest rating region—an area where a group of health plans are sold—of Florida, California, Texas, Georgia and North Carolina—the top five states for Obamacare enrollment this year.

Even the one area of supposed success, the reduction of the uninsured by percentage, comes with some drastic caveats, as I note in my column for The Fiscal Times — and the government turns out to be even more inept at running the market than its critics first warned:

At the same time, deductibles have also skyrocketed, leaving people with higher monthly payments and even less ability to access the insurance that those premiums provide. Slate’s Helaine Olen heaps scorn on Obamacare opponents and fails to admit that their predictions of spiraling costs have come true, but she does admit that the system does not work at controlling costs – the most significant reason to have government overhaul the health-insurance system in the first place.

What have we accomplished in the last five years since the passage of Obamacare? We still have roughly the same number of uninsured, estimated to be roughly 30 million people, although the rate of uninsured has dropped significantly. Costs for the insured are skyrocketing, however, and many of the newly insured will find that high deductibles mean they will still have to fund their routine care out of pocket. Provider networks have narrowed considerably, making access even more difficult than before. Emergency room visits for routine care have actually increased. The bureaucracy that runs all of this cannot fix its fraud problem, not even after having it specifically pointed out to them by the GAO and given a year to resolve. …

Furthermore, HHS still does not require its contractors to detect fraud – a year after the GAO exposed the ease in which it takes place. “We found that the CMS document-processing contractor is not required to seek to detect fraud,” the report states. The executives at contracting agencies told GAO that all they are required to do is “determine if the document image is legible and appears unaltered by visually inspecting it.”

Sen. Orrin Hatch pronounced himself “appalled” at the easy way the GAO defrauded HHS, in amounts of approximately $30,000 a year per account. “Bad actors can game the system,” Hatch told ABC News. “It’s an example of gross mismanagement.”

It’s more an example of the unfitness of government to run private-sector industries. F. A. Hayek could have easily explained the built-in failure of central command control of economies, and in fact did explain it in The Road to Serfdom, but unfortunately too many people are enamored of the elitism that allows them to dictate life choices to others.

We now have a much worse cost spiral, almost the same number of uninsured Americans, fewer and fewer options for care for those in the middle and working classes, and a massive subsidy system with no built-in way to prevent fraud. ObamaCare has been an utter disaster from start to present thanks to the flaws in its very top-down structure. It’s not fixable; it is only fit for dismantling, and replacing with reforms that eliminate third-party payers for all but unforeseen and costly life events, which is what insurance is designed to indemnify against.