Time always passes more quickly than you expect so, now, we record the first anniversary of the Affordable Care Act. No matter what you think of this law, it remains a remarkable achievement. Despite all the problems, this is the first major overhaul of our dysfunctional healthcare service. It introduces reforms that have eluded many presidents who have gone before. Perhaps that's why it's picked up the name, Obamacare. Perhaps this law, more than anything else, will be the most remembered feature of this President's term.

The first question, obviously, is whether public opinion has shifted in the last twelve months. You may remember the scenes of anger when the law was being debated and the final votes were taken. The way the media presented these images suggested the Democrats were pushing through laws that offended the majority. In fact, a majority did object to the law, but for two rather different reasons. The GOP was all fired up because of the mandate. The more Liberal wing of the Democrats were upset the law did not go far enough. Now the Kaiser Health Tracking Poll finds 42% in favor and 46% against. Those against seem to focus on the failure of the lawmakers to make any real effort to control costs. As it stands, the pharmaceutical industry and the healthcare service providers have no incentive to offer discounts or reductions. So, as inflation slowly pushes up costs, the savings supposed to flow from reforming the insurance side of the equation will come to nothing. Then comes the problem of the mandate.

In a sense, this should not be an issue. We have had the mandate for auto insurance for decades. The basic economic reality is that, if everyone buys, the price for all falls. But insuring vehicles is not the same as insuring health. No one requires people to drive - although it's fairly necessary - whereas it's impossible to avoid accidents and illnesses. So, the GOP wants to maintain the current system where the uninsured wait until the last possible moment and then go to the emergency room, hoping treatment will be "free". Except no treatment is ever free. Although a poor patient may avoid paying, those of us who pay our insurance premiums or taxes foot the bills. Frankly, it's hard to understand why the GOP are not up in arms that their tax dollars are paying for the freeloading poor. But there's no requirement politics should have anything to do with logic. It's all about emotion.

So, one year on, the world is left a little confused. All states are required to have the exchanges up and running by 2014. If they do not get their planning under way soon, the federal government will step in with a standard package. The Republican politicians seem to be waiting for the Supreme Court to deal with this. Until then, doing nothing is their best strategy. That means no cheap health insurance for now and the number of uninsured rising. Even the middle class still in work are finding the rising health insurance quotes hard to stomach. Yet there are no politicians riding to their rescue. If you cannot afford it, you are uninsured. Hardly the fairest result.