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ACA: Not perfect, but a big step

SIXTEEN million Americans who haven't access to medical care are eagerly awaiting the Oct. 1 start of the Affordable Care Act.

SIXTEEN million Americans who haven't access to medical care are eagerly awaiting the Oct. 1 start of the Affordable Care Act, and now Republicans and a few willy-nilly Democrats are saying, "No, it's not perfect, let's defund it and start over."

What unprincipled malarkey. Of course it's not perfect!

No piece of legislation that wends its way through the sausage factory on Capitol Hill ever deserves a Grade A stamp, but implementing the legislation as it stands and making needed fixes later is a far better choice than dumping it into the waste stream whole hog.

Barring the unlikely event that Congress should suddenly follow the world's other progressive industrialized nations and enact single-payer health care, the ACA is as good as it gets as a starter bill.

Indeed, the administration's implementation team, under the wise leadership of Health and Human Services chief Kathleen Sebelius, is in the process of hiring several thousand "navigators" to fan out across America and guide people through the bill's most confusing labyrinths.

And the Internal Revenue Service is set to hire more than 10,000 agents who will be specially trained to collect reasonable tax penalties from those who choose to opt out of the federal program. It is hoped that the numbers of young people and small businesses who decide to unwind themselves from the nation's social fabric will be much, much smaller than many right-wing critics are projecting.

This is the one thing that the president and Sebelius are confident of - that Americans who actually try the health-care law will like it and find it the answer to their long-term medical needs.

After all, what's not to like when you consider its outstanding features, including:

* The elimination of pre-existing conditions that big insurance companies have used unmercifully over the decades to rake in some of the largest profits on earth.

* The requirement that at least 85 percent of large-group premiums and 80 percent of small-group and individual premiums be spent directly on clinical services and improving the quality of health care. Forcing Big Insurance to spend most of the dollars they take in on actual health care for patients is almost revolutionary. Insurers whose actual spending is below those levels will have to refund the difference. Government estimates suggest that 12.8 million Americans will get rebates totaling $1.1 billion - or an average of about $151 per household.

* Opponents of the law have been warning that not enough young Americans will be civic-minded enough to enroll in the program and instead pay the relatively low opt fee of $95. Such cynicism likely is misplaced, but it should be noted that the law allows an estimated 3.1 million young Americans who would have lacked health coverage to remain on their parents' health insurance up to age 26.

There have been some glitches and delays along the way, but Sebelius and other administration officials are confident that things will go smoothly when consumers and businesses begin to sign up for benefits.

"We know we have a lot of work to do," she told reporters recently, "but we'll be ready for whatever comes up."

That's good news not just for millions of uninsured citizens, but more for America's reputation as a beacon for the rest of the world. At long last it puts our country on the path of social justice already taken by so many other nations.

The trip along that path may be bumpy at times, but the result will be a healthier United States - one that is able to meet all the economic challenges of what looks to be an increasingly turbulent and eventful 21st century.