With rising premiums and the departure of major insurers, there’s been plenty of pessimism towards the Affordable Care Act’s health insurance exchanges, but Princeton University health economist Uwe Reinhardt, PhD, has an even harsher assessment on their future.

“We all know about the death spiral that actuaries worry about, and I think what you’re seeing now is a mild version of that,” Reinhardt said in an interview with Vox’s Sarah Kliff. “These things accelerate, as premiums keep rising.”

Reinhardt bases his doom and gloom prediction on how the U.S. health care system differs from those of Switzerland and Germany, where he says the insurance mandate is “brutally” enforced and benefits packages offered by private insurers are standardized.

Such a system would be hard to establish in the U.S., Reinhardt says, consider the fierce opposition generated against the ACA’s existing mandate. But he’s clearly not enthusiastic about the future of the exchanges and the ACA in general.

“I always joke about it like this: If you got a bunch of Princeton undergrads to design a health care system, maybe they would come up with an arrangement like the marketplaces,” he said.

It’s a far different assessment than UCLA Center for Health Policy Research Director Gerald Kominski, PhD, had for HealthExec earlier in the year, when he said the insurers’ exits weren’t a death spiral, but a “political game of brinkmanship” to get insurer subsidies extended.

To read the full interview with Reinhardt, click on the link below: