Amid the general gloom of this 21st-century, there is some good news. Today, October 1, 2013, the next phase in the evolving implementation of the Affordable Care Act kicks in. Starting today, most uninsured Americans will be able to purchase health insurance through state-run or federal-run "exchanges" - bringing our country that much closer to the goal of affordable health coverage for all.
Sadly, some still remain without access to insurance. The Undocumented are ineligible. And the original plan for addressing the needs of the very poor by expanding Medicaid coverage is being frustrated in certain "red" states. This was simply not anticipated at the time the law was passed, but such mischief became feasible as a consequence of last year's Supreme Court decision.
Still, slowly, the law is taking effect, and the U.S. is finally joining the ranks of modern societies in regard to meeting the health care needs of its citizens.
Like most Americans, I have health insurance already and so am not directly impacted by these health insurance "exchanges." But I could easily imagine being unable to access adequate health insurance whether due to age, a pre-existing condition, or insufficient income. So I can appreciate what this means for those who today - perhaps for the first time in years or maybe for the first time ever - can go online to purchase insurance.
The system certainly seems more complicated than necessary. A "single-payer" plan would almost certainly have been more efficient. Back in 1973 Richard Nixon supposedly toyed with the idea of simply extending Medicare to everyone. If only we had gone that route then!
Ironically, it was the right-wing's phobia about "socialized medicine" that led conservatives to come up with the market-oriented approaches and the famous "individual mandate" that were eventually incorporated into the Affordable Care Act. Given the way the issue has played out, such compromises seem hardly to have been worth the effort. A "single-payer" plan - e.g., Medicare for all - would certainly have been better. But, if we are stuck with a system based on private insurance, then certainly making insurance available to (almost) all is a great accomplishment.
Back in the first year of the Kennedy Administration, my high school Freshman Religion teacher warned us against "socialized medicine." By my senior year, with Medicare finally about to be passed in Congress, that same teacher told us we were getting socialized medicine "and rightly so." Eventually, "Obamacare" will be like Social Security and Medicare - programs once opposed by the right but now widely popular. I suppose that explains the intense fanaticism of those willing to shut down the government to register the intensity of their anger at "Obamacare." My guess is that they must realize that, once people get used to having adequate health insurance coverage they will want to keep it and will insist upon it, and then it will really be impossible for its opponents to get rid of it!