The Affordable Care Act (also known as "Obamacare"), like all legislation, indeed all things created by humans, is not perfect or ideal, but it has the potential to represent a big improvement over the status quo. As it happens, my personal preference would have been something more like the Canadian model of Medicare for all ages, but that is not on the table here (and also not perfect either), so I am hopeful that the Affordable Care Act will succeed as well nationally as it did in Massachusetts.
As it happens, the textbook I have been using in my public finance class since the first edition came out in 2005, Public Finance & Public Policy, is written by MIT Professor Jon Gruber, who also happens to be the author of both RomneyCare and ObamaCare.
There is an intriguing PBS interview with him in which he describes how it was that he came to invent this model.
Prof. Gruber, of course, hails from MIT, which is a school full of brilliant problem solvers with an engineering mindset. Back in the late 1990s, when the government actually had a fiscal surplus rather than a deficit, the government decided to spend some of it on grants to help the state come up with plans for health care reform. Prof. Gruber received some of that money and did a study in 2000, which--as he puts it--sat on the shelf gathering dust (as many studies do) for a few years. After Mitt Romney became governor of Massachusetts, he apparently pulled the study off the shelf--because Mitt Romney (a Harvard B-School graduate) is also a kind of policy wonk too. (By the way, even though I certainly don't see eye to eye with Mitt Romney, that phrase "policy wonk" is meant affectionately. I am a Democrat and would consider myself a policy wonk also! Prof. Gruber is also a Democrat and would probably be comfortable being described as a policy wonk too, I think.) Anyway, Mitt really liked the plan because the numbers worked out (and so did his green-eyeshade guys, his financial advisers, even though his political advisers were leery.)
Prof. Gruber gives a vivid description of his encounter with Mitt Romney and his advisors:
I truly hope we can come together as a country the way Massachusetts problem solvers came together as a state almost a decade ago.
A personal note epilogue: By the way, I bought an Affordable Care Act policy for myself and my young adult daughter this weekend. Even without subsidies, it is a great deal better than our current coverage. Because we are in good health and fortunate to be able to cover small routine expenses easily, I chose a high deductible bronze policy from a top-ranked local HMO we have known and used for many years. (The health plan organization was #1 in the state rankings in Consumer Reports and in the top 20 out of 600 nationally ranked plans.) The premium is less than half the best price currently available to us on the open market for individuals in New York State, and it is also a much better deal than COBRA coverage under my late husband's large group policy from his employer. There was an array of great choices for us from several different providers that were ranked high in the lists published by Consumer Reports, based on the National Council on Quality Assurance, a nonprofit health plan accreditation organization.
If plenty of people in good health (like my daughter and myself) sign on to buy plans on the exchange, it will succeed and be viable. I hope that it will create value for our family and many other families in the future.