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Atul Gawande: Obamacare and Obstructionism : The New Yorker

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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, 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.


So far, the health-care-reform law has allowed more than three million people under the age of twenty-six to stay on their parents’ insurance policy. The seventeen million children with preëxisting medical conditions cannot be excluded from insurance eligibility or forced to pay inflated rates. And more than twenty million uninsured will gain protection they didn’t have. It won’t be the thirty-two million hoped for, and it’s becoming clear that the meaning of the plan’s legacy will be fought over not for a few months but for years. Still, state by state, a new norm is coming into being: if you’re a freelancer, or between jobs, or want to start your own business but have a family member with a serious health issue, or if you become injured or ill, you are entitled to basic protection.

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