It's no coincidence that the federal shutdown began the same day the Affordable Care Act marketplaces opened for business.
Alas, a political pandemic broke out.
Many government offices closed yesterday and political discourse came to an ideological standstill. Yet the act's exchanges were swamped with tens of millions of visitors seeking information about health insurance.
How did we get here?
Republicans have vilified the act since the day it became law three years ago. They say it's a job-killer. An unaffordable entitlement. Useless in controlling costs. And, they worry that the individual mandate is the latest and biggest stride yet toward a government takeover of health care.
Defending the law are the Democrats: It will extend coverage to about 27 million of the uninsured, eliminate "free riders" who pay nothing for their own care, help contain costs, and institute important insurance reforms, including eliminating annual and lifetime coverage limits and exclusions for pre-existing conditions.
These are the fears and hopes of the nation about what has come to be known as Obamacare.
It's a complicated law, poorly drafted and poorly sold by proponents, including President Barack Obama and congressional Democrats, whose messaging has been abysmal. But the nation's previous course on health care was unsustainable.
Insurance premiums and health care costs have soared for decades, far outstripping wage increases and inflation. Medical expenses are a leading cause of personal bankruptcies. Taxpayers and policyholders have been paying for care for the nation's 47 million uninsured, often delivered in emergency rooms and hospitals, the most expensive, inefficient way imaginable.
That has to change and Republicans, who have voted more than 40 times in the House to repeal Obamacare, have offered no real alternative.
Obamacare is a risk, a big one, but it's one the nation has taken. The rollout will be bumpy; that's the case with any big new program. The law will have to be revised as problems surface, also the case with any big new program. But the GOP's scorched-earth battle to malign and scrap the law, and Democrats' defensive crouch, will make rational course corrections politically difficult. That could be disastrous.
The nation is in uncharted territory on health care and change can be frightening. The best hope is that the Affordable Care Act will create a robust, competitive new insurance market. In New York, 17 insurers have signed up to offer policies via the state's health benefits exchange, including eight new entrants to the market.
The biggest fear is that the act's subsidy for middle-income families will become a costly entitlement program. People with annual incomes below $45,960, for individuals, and $94,200, for a family of four, could qualify for the financial assistance. More than 1 million of New York's 2.7 million uninsured residents are expected to access coverage via the exchange.
The cost of health care and the way it is delivered are changing fast -- with or without Obamacare. The nation needs to make this program work.