Health-Care Reform: Obama, Dems Owed Americans Nothing Less & Delivered

Although I will admit to a few stray moments of doubt, I always believed that a sweeping health-care reform bill would pass, and now that the House is on board with the Senate soon to wrap up loose ends, the end of a morality play that began with Teddy Roosevelt some 98 years ago is in sight.

I understood from the outset, as certainly did President Obama, that the final bill would be far from ideal, and indeed it is. But it also is far from the disaster that lefties and some liberals claimed it is or the socialist takeover that Republicans who suddenly find themselves on the wrong end of history claimed.

Yes, those big, bad insurance companies will be able to further line their deep pockets. And yes, the abortion restriction is offensive. But there is much good about the legislation.

Thirty-one million uninsured Americans (about 95 percent of the legal population, according to the nonpartisan Congressional Budget Office) will now have coverage regardless of income or pre-existing conditions. Although reform will cost a staggering $940 billion over the first 10 years, the CBO says it will reduce the federal deficit by $130 billion during that time and by a whopping $1.3 trillion over 20 years. And no, Sarah, there won't be death panels.

One battle down and one to go, the second one being the November election and whether the Democrats have now signed themselves up for an apocalypse.

They have not, and while the party in power almost always looses seats in mid-term elections, the pundits who predict a sweeping Republican resurgence on the back of reform -- let alone that their vows to repeal reform will resonate with voters -- miss a small point and a huge one: The Democrats were going to lose seats no matter the fate of reform. And while people are turned off by the machinations of the sausage factory that finally disgorged the bill, a majority of people support reform and even more will embrace it when they understand that it is not the end of the republic as we know it but rather the beginning of an age when people no longer have to fear the financial consequences of falling down or falling ill.

Indeed, the Republicans who tried to block reform through lies, demagoguery and fear mongering may see things a little differently come fall. The saner ones will look back and realize that in the absence of providing an alternative plan, the incredibly cool-under-pressure president, with an ample assist from House Speaker Pelosi, was able to outmaneuver them.

Obama also got lucky. His risky bipartisan health-care summit ended up revealing the Republicans as empty vessels, while in an exquisite sense of timing, Anthem, an especially rapacious California insurer, notified policyholders of premium increases of up to 39 percent just as the momentum was shifting to the Democrats and their demonization of the insurance industry was getting traction.

Middle-class and poor Americans will be reminded that were it not for Democrats, health care still would be unaffordable for those who don't have it and a benefit that could evaporate overnight if they lose their jobs.

If the LBJ-backed 1965 Medicare bill is a guide, and I think it is, then the reform initiative will become considerably more popular with time. The same certainly was true of FDR's sweeping New Deal reforms.

Some of the provisions of health-care reform do not kick in for a few years. All 31 million uninsured will not be covered until 2019, while an excise tax on insurers who issue high-cost policies will be put off for several years. But other provisions will take effect immediately, including those to prevent people from losing their insurance just because they get sick, small businesses getting the same discounts for health insurance as do major employers, and allowing young adults to stay on their parents' insurance plans until age 26.

The bill that the Senate will tidy up this week and send to Obama falls short of what I advocated, but it is an historic balancing act that will comprehensively reform a deeply dysfunctional system.

That Democrats were able to pull off that balancing act -- mandating coverage for pre-existing conditions while keeping healthy people in the risk pool so that everyone can afford coverage, which is the glue that holds the whole thing together -- is extraordinary.

But Obama and his congressional majority owed Americans nothing less. We hoped for change, they promised change and we finally got it. My only regret is that another Teddy -- Teddy Kennedy -- did not live to witness it.

Photograph by Brendan Smialowski for The New York Times