When Paul Ryan proposed Medicare entitlement reform, there were advertisements showing him dumping an elderly woman out of a wheelchair over a cliff. These were run by the Democratic National Committee to demonize the efforts of the Republicans to salvage the Medicare program by modifying age eligibility in the future for someone under the current age of 55. When the Affordable Care Act, known as "Obamacare" was proposed, most honest analyses of the bill concluded it was unaffordable. Most of us, this author included, were ridiculed for coming to that conclusion. Our concern was that it would limit access to care especially for seniors, thereby "Culling the Herd".               "You have to pass this bill so we can find out whats in it."– Nancy Pelosi said about the ACA, which was deemed to have passed without a vote.               Now that the funding mechanisms for the affordable care act have failed catastrophically and it is obvious that the cost is 3-5 times the original White House projections, there is a desperate push to speed implementation of the law. This effort will insinuate the law’s concepts into the fabric of our government and accelerate the end of Medicare Advantage and private health insurance in general.               By the fall of 2011 Secretary Kathleen Sebelius had completely canceled the long-term care insurance program which was designed to put $300 billion into the ACA because no one bought the insurance. Now Secretary Sebelius has pulled back the government purchase subsidies to Medicare Advantage programs which will mean most of these programs will cease to be offered by independent health insurance companies. This pullback is so dramatic that such firebrand "progressives" as Chuck Schumer and Kirsten Gillibrand have now come out against this action from the Center for Medicaid and Medicare services (CMS). Over a quarter of current seniors have these plans, and closer to 40% in NY and Fla. There goes Granny, cliff diving.               As a consequence, the congressional oversight committee reversed Sebelius and CMS April first and reinstated the subsidies to the Advantage programs, for one year for 2014.               One by one the funding mechanisms for the program have collapsed. The states have been unable thus far to set up exchanges in a timely manner or fund the expansion of the Medicaid system to increase access to health insurance. The Federal exchanges required by the law if the States fail to set them up are even farther behind and appear to be beyond the capability of the government to accomplish. Proposed taxes on medical devices was most recently rejected by Congress by an overwhelming majority. Six out of seven people thought to be uninsurable because of pre-existing conditions continue to be without health insurance.               Unbelievably, the individual health care costs for patients with pre-existing conditions, on average, have exceeded $4.6 million per patient. This has drained the insurance system to the tune of almost $400 billion compared to the $5 billion that was set aside to buy the uninsurable coverage for the next 8 years. Obviously, this fund is already depleted. Those excess costs were paid by the private insurance industry and will be passed on to the consumer in the form of increased premiums. This will make private health insurance too expensive for most Americans to afford and will effectively end private health insurance.               The number of uninsured people has risen. The cost of health insurance has risen dramatically as opposed to the promise of a decrease. Access to medical services such as total hip and knee replacements has been significantly restricted starting in October 2011. Access to private health insurance will likely end by the end of 2017. Since this past February payments to doctors and hospitals has decreased across-the-board, leading many to reconsider their practice and to consider retirement from medical services. Make no mistake: these efforts are successfully limiting the access to care, which is the desired outcome the government intended from the beginning.               There is no amount of obfuscation or spin that can reasonably deny the failure of "Obamacare". On no single point have the core objections to the ACA been proven untrue, while the promises of those pushing the act have all proven false. "If you like your health insurance you could keep it", but only if you can afford it and if it is being offered anymore by any carrier. "If you like your doctors you can keep them", but only if your doctors have not retired or will still accept your plan or Medicaid or Medicare.               The colossal irony is the arrogance of those who are true believers in the single-payer system or socialized medicine.  They are now doubling down, accelerating the effort to get the program firmly in place even as it collapses around them, They are hoping against hope they can first eliminate the existing healthcare delivery system leaving in its void this disaster of Obamacare as the only choice.               My error in writing "Culling the Herd" in 2009 was that I was not cynical enough to believe the actual goal was not only to destroy the current healthcare delivery system and insurance system but to also destroy Medicare as we know it. I apologize for being so naive.   Chris Casscells, MD Director, Center for of Health Policy Caesar Rodney Institute