Since about WWII, the most ordinary model for Americans to receive healthcare coverage (ie, insurance) has been through the workplace. It's my understanding that this was deliberate industrial policy at the time, presumably to stabilize the workforce and countervail the pressures of unionization. Everyone in the workforce today entered the workforce under that assumption. You get a (decent enough) job, you get health insurance.
That bargain started to fall apart in the 1980s with the increasing use of part-timers in blue collar jobs and contractors in white collar jobs. That, of course, was all about reducing the cost of benefits for the employer. Companies like Wal-Mart and McDonald's build their entire cost-of-labor around such measures, as do many high tech companies. Part of the reason for so many millions of uninsured and underinsured today is the erosion of benefits in the non-unionized workforce.
(I am neither a healthcare historian or a labor historian, so take all of the above with a grain of salt.)
The profit-driven nature of market-based insurance has introduced so many restrictions that for a lot of workers, myself included, the only access to health insurance is through non-qualifying employer-sponsored groups. In my case, one of my dependent insureds has a chronic illness that barred me from the private market for years before my own cancer made me uninsurable, so this has long been an issue in my professional life.
The full terror of unemployment for someone like me isn't loss of income, it's loss of healthcare coverage. The last time I was unemployed, 2002-2003, my COBRA costs were $1,400 per month. Which was more than my unemployment compensation.
How many millions of Americans with insurance are tied to their jobs by similar issues?
If HCR delivers what it's said to deliver (assuming the Republican ideologues in the Senate don't find some last-minute way to halt the reconciliation bill), those millions of Americans will no longer be tied to their benefits package. Yes, most of us need an income. (And fortunate are you who do not.) But incomes don't have to be paychecks from statutory employment.
I predict a sharp increase in labor mobility in this country, along with a parallel sharp increase in new small businesses as well as independent innovation. Because what we've just done is unchain people from their workplaces. There's a lot more ways to make money than there are to find health insurance. Obama, Pelosi and Reid have just freed us to explore those ways. Which would seem to me to be a conservative ideal, would it not?
What will the social consequences of this be? I don't know, but I'm guessing some pretty fundamental changes are in store for American society over the next years, if the GOP doesn't freeze all of us out. Increased economic prosperity and personal opportunity, reduced unemployment, and better treatment of employees by employers as competitive options open up for the workforce.
Optimism? Sure. But think about it. Take this idea right down to the personal. How many people do you know who are trapped in jobs for the healthcare?