Lost in this analysis is any sense of what the Affordable Care Act does and why, much less any link to the reality of what insurance is and what it does. Exhibit A in the latter case is the set of charges about the rank unfairness of forcing people to pay for coverage they do not need. My wife and I are a couple in their 60s—and we pay for maternity coverage, as we have for decades after we needed it, as part of our group insurance via my employer. When I was in my 20s, I paid—as part of my group insurance at a university—for all kinds of coverage for ailments that hit those in their 60s but were not at all relevant for me. That is what insurance offered to groups of people does.

That reality has always been true for those of us, the vast majority of Americans, who get their coverage through their employers. It is also true that for some very healthy individuals who have not had the ability to secure insurance through an employer or group, they could tailor their coverage to exclude items they would not need, or could gamble that they would not need. But for most—including many of those so privileged—the individual market has been a jungle.

Whether unemployed, working for an employer who does not provide insurance, or between jobs and no longer eligible for COBRA, individuals seeking insurance have faced a market where preexisting conditions—even as trivial as acne—might be enough to deny coverage, or to have coverage suspended when the insured gets seriously ill. Finding insurance on the market was its own nightmare even for sophisticated individuals, as I discovered some years ago when I was shopping for insurance for my able-bodied son, whose Ivy League degree did not bring with it a job that offered health insurance. I went on ehealthinsurance.com and found an impressive array of plans available to him at different price points. But once I got past the initial paragraph describing the basics, discerning what each policy actually covered and didn’t cover was virtually impossible. Comparison shopping to buy individual insurance was like buying a mattress, and there was no assurance, after purchasing a plan, that it would actually pay for all the costs that might result from a terrible accident or a devastating illness.

For every unfortunate story now of an individual losing his or her existing plan—each of whom will get replacement coverage, albeit some with higher costs—there are stories of those who discovered after it was too late that the coverage was not there when they needed it, or was canceled because of a real or imagined preexisting condition. Creating a base of coverage to protect those from disaster, to ensure that basics of insurance routinely made available to those of us in groups are there for those not in groups, is not some horror of big government run rampant but a rational and humane way to create basic national standards. Expanding the risk pool by adding the sick or potentially sick, who are now screwed, and those who have not bothered to get insurance despite the risk of accident or catastrophe, has a cost, but it is one worth paying.