Obamacare begins – and the right is terrified that it will work

Out of America: While all the talk is of shutdown, schemes for those without health cover open for business

Static states: Federal workers protest at the shutdown, at the Capitol (AFP/Getty)

In a week in which all the talk was of shutdown, the most notable development here in Washington was something that opened up. I refer to the launch of the online federal and state health exchanges that are a key feature of Obamacare, allowing those without health insurance to shop around for the best plan.

Readers who have managed to keep up with the latest antics of what passes as the United States Congress will be aware that the reason Republican hardliners shut down the government was to force the President to delay – or to put it less politely, dismantle – his signature legislative achievement. Yet in a splendid two-finger gesture by fate, on the very day that veterans' services, national parks and a host of other government functions were closing, the health exchanges, symbol of everything those Republicans detest about Obamacare, were opening for business.

True, the moment was pretty shambolic. Overwhelmed by visitors, the websites virtually seized up on day one, though things seemed to improve slightly as the week wore on. But it was a start, and let it never be forgotten what Obamacare is attempting: to bring the US in line with every other advanced industrial country and provide healthcare for all its citizens, irrespective of their means.

Others had tried it before. Harry Truman called for universal health insurance in the late 1940s, only to be described by Republican adversaries as a crypto-communist. Two decades later, Lyndon Johnson did push through Medicare and Medicaid for elderly and poor Americans. Not, however, before a certain aspiring conservative politician named Ronald Reagan predicted that Medicare would see Americans "spending their sunset years telling our children and our children's children what it was like when men were free".

Then came Bill Clinton. Alas, he created the impression that a coterie of White House officials, led by his wife, Hillary, was trying to foist its pet ideas upon a suspicious country and he, too, failed. But in 2010, after a monumental fight, Obama's plan was finally approved by Congress.

Yet still Republicans continue their Canute-like refusal to accept the rules of democracy. No matter that the measure was signed by the President and ratified by the Supreme Court, or that Republicans resoundingly lost the 2012 presidential election in which Obamacare was a prime issue. The law, their leaders say, is a "monstrosity," a "trainwreck" that must be fought by every means, even if that means closing down the government.

Now, no one would argue that the reform is perfect. Even without the distortions and abuse peddled by the right- and left-wing media alike, it is extremely hard to understand. Nor will it cover absolutely everyone. If you started from scratch, you would almost certainly go for some form of single-payer system, a universal, government-funded scheme of the sort that Truman advocated.

Determined not to make the Clintons' mistake, Obama consulted with every interested party: Democrats and Republicans, hospitals, private insurers, doctors and the pharmaceutical companies. He bent over backwards to retain the existing structure of employer-based coverage, even dropping proposals for a "public option" favoured by the left as a way of keeping the private insurers honest. In doing so, he bowed, in effect, to the conservatives' argument that an alternative state-run insurance scheme would pave the way for a single-payer system.

But, as Obama has painfully discovered, offer Republicans an olive branch and they'll use it to whip you. Since 2010, the Republican-controlled House has passed no fewer than 42 resolutions seeking to overturn Obamacare (albeit knowing that the Senate would reject every one.) Now it has shut down the government, even though 70 per cent of the US public disapproves of the tactic, and even right-wing commentators argue that the way to get rid of Obamacare is via the ballot box, not blackmail. Elect a Republican president and a Republican Congress, they say, then repeal the thing.

At state level, where Republicans dominate, the sabotage of Obamacare is endless. Many states have failed to set up health exchanges. Citizens are being urged to flout the law and pay a fine rather than obey the individual mandate that requires them to buy insurance. Most inexcusable of all, a swathe of red states is refusing to expand Medicaid, which helps the poor. That will be critical for the success of Obamacare – even though the federal government is picking up 100 per cent of the cost for the first three years, and 90 per cent thereafter.

Why this scorched-earth opposition? After all, the mandate was originally a Republican idea, put forward by the impeccably conservative Heritage Foundation some two decades ago. Obamacare, moreover, is based on the healthcare reform enacted in Massachusetts in 2006 under the state's then governor, Mitt Romney – the Republicans' White House candidate in 2012. And at a simple human level, why oppose a law providing cover for 28 million people who don't have it?

One reason is Republicans' visceral dislike of Obama, on political, personal or racist grounds – or a blend of all three. Ideologically, they are terrified not that healthcare reform will fail, with the dire consequences they predict, but that it will succeed.

Success would strike at the very core of Republican belief, that government is bad for you and should be reduced to the bare minimum to sustain a functioning state. Despite public wariness of the law as a whole, several of its main provisions are extremely popular (as the once reviled Medicare now is.) If Obamacare works, Americans would feel better about government in general; the terrible monster erected by Republican demonology would be seen to be benign, after all. What price the party's electoral prospects then?