This rush of good feeling, to put it mildly, hasn’t yet materialized. But some very clear tradeoffs that were always central to Obamacare have been put on sharp display.
*It is, in many respects, a classic social welfare program. Like other social programs, it involves transferring from haves to have-nots. Healthy people are going to have to pay to help sick people get coverage. People who had skimpy coverage before — and in some cases, not-so-skimpy coverage — will have to upgrade to insurance that covers more things, but costs more. And young people will have to pay so older people don’t face sky-high premiums.
*For some people, the policy changes were always going to be highly disruptive. To rebuild the broken individual health insurance market, the part of the market that has always been riddled with holes, the law eventually has to move people with individual coverage into new plans with stronger rules and benefits. Whether it happens now or later, it has to happen — otherwise the new market falls apart.
*There is no subtle way to control costs. To keep the prices of the new plans from rising even higher, a lot of them have narrower networks of doctors and hospitals than the health plans most Americans are used to. And the cheapest Obamacare plans have high deductibles — so people who go for the lowest monthly premiums may find that they’re stuck with higher out-of-pocket expenses.