That theory forms the foundation of Mass-Care, Massachusetts' universal health care system, passed in 2006. Unfor- tunately, Mass-Care and its mandate haven't stopped spiraling health care costs. From 2007 to 2009 in the Bay State, the median annual premium for family plans jumped 10 percent to $14,300 a year. For small business, the increase was even higher, at 12 percent. What's worse, Massachusetts already had the highest health care costs in the nation before Mass-Care became law.

Nor does the counterintuition stop there. The Obamacare debate often has focused on the $43 billion in uncompensated care bills racked up in 2008 by those without insurance (a number that represents less than 2 percent of the $2.5 trillion Americans spend on health care annually).

These costs have been attributed mostly to avoidable emergency room (ER) visits made by those without insurance. Make insurance mandatory, goes the explanation, and the ER onslaught will end. Fast-forward to a Boston Globe story this month:

"The number of people visiting hospital emergency rooms has climbed in Massachusetts, despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use. ... According to state data ... emergency room visits rose by 9 percent from 2004 to 2008, to about 3 million visits a year."

Mandatory insurance, it turns out, is not the same as access to a primary care physician. So even with the mandate, ER overcrowding has continued and costs have continued to rise. Call it one more unintended consequence in the world of insurance made mandatory.

Not that everything is uncertain with this new law: America, you can rest assured, is badly in need of a new cliche. Now the only things certain in life are death and taxes - and the need to buy an insurance policy.

by Dr. Eric Novack