There's No Stopping Obamacare

By Atul Gawande, The New Yorker

29 September 13

urs can be an unforgiving country. Paul Sullivan was in his fifties, college-educated, and ran a successful small business in the Houston area. He owned a house and three cars. Then the local economy fell apart. Business dried up. He had savings, but, like more than a million people today in Harris County, Texas, he didn't have health insurance. "I should have known better," he says. When an illness put him in the hospital and his doctor found a precancerous lesion that required treatment, the unaffordable medical bills arrived. He had to sell his cars and, eventually, his house. To his shock, he had to move into a homeless shelter, carrying his belongings in a suitcase wherever he went.

This week, the centerpiece of the Affordable Care Act, which provides health-insurance coverage to millions of people like Sullivan, is slated to go into effect. Republican leaders have described the event in apocalyptic terms, as Republican leaders have described proposals to expand health coverage for three-quarters of a century. In 1946, Senator Robert Taft denounced President Harry Truman's plan for national health insurance as "the most socialistic measure this Congress has ever had before it." Fifteen years later, Ronald Reagan argued that, if Medicare were to be enacted, "one of these days you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free." And now comes Senate Minority Leader Mitch McConnell describing the Affordable Care Act as a "monstrosity," "a disaster," and the "single worst piece of legislation passed in the last fifty years." Lacking the votes to repeal the law, Republican hard-liners want to shut down the federal government unless Democrats agree to halt its implementation.

The law's actual manifestation, however, is rather anodyne: as of October 1st, healthcare.gov is scheduled to open for business. A Web site where people who don't have health coverage through an employer or the government can find a range of health plans available to them, it resembles nothing more sinister than an eBay for insurance. Because it's a marketplace, prices keep falling lower than the Congressional Budget Office predicted, by more than sixteen per cent on average. Federal subsidies trim costs even further, and more people living near the poverty level will qualify for free Medicaid coverage.

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