Obamacare was sold as a way to help poor people and sick people get health insurance, but, as the D.C. decision shows, the actual intent of the law is the abolition of health insurance. The notion of insuring a preexisting condition is an oxymoron; insurance is by nature concerned with that which may happen in the future rather than with that which already has happened. In very large groups, human health outcomes are predictable with a fair degree of precision: Given 10 million people, actuaries can make pretty accurate predictions about how many people are going to get lung cancer and how many are going to be in car accidents. Some factors are relevant to some conditions: Being 17 years old and getting in a car accident, for example, or smoking and heart disease, emphysema, cancer, etc. Insurance, which places a price on calculated risks, will take some of those factors into account. But you cannot in any meaningful sense insure somebody against cancer when they already have cancer.

Obamacare is designed to destroy the insurance market. Markets do not function without prices, and Obamacare ensures that prices will not be allowed to emerge. There is a medical price associated with smoking, but the District of Columbia has decided to suppress that price by law. Pretending that smoking has no relationship with health-care costs does not make it so — it is only a way to push costs around in a way that is agreeable to the likes of Barack Obama, converting a system that prices risk into a system of entitlements.

That leaves us with a system that is private in name only — which is the point. It is meaningless to say that we have a private system in which private consumers buy insurance from private insurers when the insurers have been forbidden to price their products, and have instead been converted into something somewhere between a public utility company and a government contractor. Sure, you are free to buy any insurance you want — but if what you want is a lower rate for being a non-smoker, the point is moot, because it would be a crime for anybody to sell it to you.

This will get much more complicated in the very near future. Our knowledge of the relationship between genetic factors and serious disease is growing very quickly. One hopes that one of the benefits of that growing knowledge will be better treatments. But what will almost certainly precede those treatments is the knowledge of the brute facts themselves, data about which genetic markers are correlated to what extent with which diseases. If smoking is a preexisting condition, then surely your genome will be a preexisting condition, too. And with the federal government holding a whip hand over medical-research dollars, do you think that it will be eager to fund cutting-edge genetics research, the results of which will most assuredly complicate the politics of health care? Do you think that it will be eager to approve clinical trials that will make political life more complicated? Certainly not. And if you think that these boards will be operated independent of politics, ask yourself why the treasurer of the D.C. board is an SEIU operative “responsible for coordinating SEIU’s national-issue campaign efforts” — not a doctor, not a scientist, but an old-fashioned political hack, one Khalid Pitts of USAction and the Gephardt campaign.

Inhibiting prices is not an unintended consequence of Obamacare: It is the main thing the law is intended to do. A market without prices is by definition a market that will not function. What comes after that is obvious. The argument for Obamacare was “Everybody gets insurance,” but the final product will be something between “Everybody is on Medicaid” and “Everybody has access to the fine health care on offer at the infirmary in the county jail.” And that is happening, one unaccountable decision at a time.