Thursday's New York Times features a story about a Kansas couple, Joe and Mary Thompson, who agreed to adopt a girl named Emily before she was born and without knowing that she suffered from an illness called spina bifida. Then the very same year they took her in, their business went under, leaving them unemployed for a spell. They got new jobs, eventually, but the quirk of timing meant that when it came time to obtain a new family insurance policy, their daughter was uninsurable. She had a "pre-existing condition," you see, that made it inevitable that her health-care costs would be above average. Nobody wants to sell an insurance policy to someone under those circumstances, so she had to go uninsured.
Just another story about the perverse way American health care is financed. If you're old, you're taken care of by Medicare. If you're very poor, you're taken care of by Medicaid. If you're middle class, however, you're stuck with a system that works great—unless you get sick or lose your job. It's a system that makes a joke of the idea of insurance, which is precisely that it's supposed to come rescue people who suffer bad luck.
But not any more.
Many provisions of the Patient Protection and Affordable Care Act of 2009 won't be implemented until 2014, but much of the low-hanging fruit started Thursday. One such juicy apple is that insurers will no longer be allowed to deny coverage to children on the basis of pre-existing conditions. That means Emily will be covered, as will the Thompson family's son Andrew, who's been diagnosed with Attention Deficit Hyperactive Disorder. It's true that covering Emily will mean slightly higher costs for everyone whose kids don't get sick. But this is how insurance is supposed to work. Small payments by the healthy majority allow the sick minority to avoid financial calamity. That saves lives, keeps families together, and gives peace of mind to everyone.
And as Joe Biden memorably observed on the day the bill was signed into law, it's a big fucking deal.
There's a lot to complain about with regard to the Obama administration's record. And the Affordable Care Act has shortcomings. Most of those shortcomings are due to the obstructionism of congressional Republicans and the shortsightedness of "moderate" congressional Democrats, but it's not wrong to say that the administration's approach to the issue did not achieve a standard of pristine flawlessness. But then again, nobody's perfect. Fundamentally, this week we are beginning a process of ending a series of monstrous social injustices driven by a completely irrational approach to a critical issue. This week we're also watching the unveiling of a new Republican "Pledge to America" that promises to repeal the ACA, kick Emily off her health insurance, and speed the unraveling of the current system so as to ensure more uninsurable Emilys in the future.
And perversely, nobody on the left seems to know or care.
To review: As of this week, insurers will be unable to refuse to do business with children. Insurers will also be unable to impose arbitrary lifetime caps on benefits. And insured parents will be able to keep adult children on their plans up to the age of 26. This is a downpayment on the eventual transition to a system in which nobody will be denied coverage on the basis of a pre-existing condition. Which is to say that the system of health insurance for people under the age of 65 will at last do what Medicare has done for seniors for decades—actually guarantee that if you get sick you won't need to shoulder the entire financial burden yourself.
Existing insurance policies are supposed to do this, but not only do many people lack insurance, many who are insured find that when disaster strikes suddenly, the insurance vanishes. That's a business model that's made insurance executives loathed, but it's inherent to the economic logic of the current system, a logic that the ACA will upend with its system of subsidies, regulations, and—yes—the dread individual mandate to make everyone buy health care.
This week we are beginning a process of ending a series of monstrous social injustices driven by a completely irrational approach to a critical issue.
The system is, however, under grave threat. It's unlikely that a new congressional majority will literally repeal the law in one fell stroke. Their plan instead is to fatally wound it. The law is a fairly intricate quilt of popular ideas, and not-so-popular ideas that are necessary to make the popular ones work. By picking away at the unpopular planks in an unprincipled way while pretending not to realize the consequences of these actions, a GOP Congress could ensure that by the time the full ship launches in 2014 it won't be very seaworthy. Then they can ride the ensuing backlash to victory and be in a position to finish off repeal.
• Kirsten Powers: The Dems Aren’t ToastThe result would be a disaster for the American people. Conversely, if the political position of President Obama and his congressional allies remains strong enough through the next several Congresses to get the thing off the ground, it will become politically unassailable. There's no country on earth that's moved to national health insurance and then moved back. And the U.S.A. will be no exception. But only if the move actually happens.
And for that to happen, progressives need to recognize the stakes. It's completely true that the Obama administration hasn't given the left's activist base the care and feeding it needs and deserves. But at the end of the day, it has in fact given health care to sick kids. Its opponents want to take that away. A little less whining and a little more cheerleading from the left would make that less likely. Under the circumstances, more enthusiasm and a less self-pity and self-indulgence would be very welcome, not least by families hoping to be able to pay the bills next time someone falls ill.
Matthew Yglesias is a fellow at the Center for American Progress Action Fund. He is the author of Heads in the Sand: How the Republicans Screw Up Foreign Policy and Foreign Policy Screws Up the Democrats.