Victory on healthcare reform

The Senate's vote clears the way for the single biggest expansion to America's social safety net in generations

Sahil Kapur   guardian.co.uk  24 December 2009

The moment the US Senate passed its healthcare reform bill, by a vote of 60-39. Photograph: C-Span/AP

Democrats in the Senate have finally passed historic healthcare reform – the most significant piece of progressive legislation in generations. It's deeply flawed, but for all the compelling arguments against it, the bill's success is far better for America than failure would have been.

This legislation is the single biggest expansion of America's social safety net since Medicare was passed in 1965. It will insure 94% of legal US residents by 2019 and significantly reduce the federal deficit, according to the Congressional Budget Office's estimates [PDF]. It accomplishes this through a combination of federal subsidies, mandates to bring people into the system and a mechanism that bans insurance companies from denying coverage to sick people.

If this bill were to have been struck down, it would have denied coverage to 30 million who will now have it. It would have continued the trend of tens of thousands dying needlessly (and many more going bankrupt) for lack of healthcare. It would have led to a higher federal deficit than we'll have now.

Politically, it would have sucked the wind from the sails of a progressive movement and Democratic party unable to make use of its grip on power. It would also have invigorated a discredited GOP and further inspired its feisty right-wing factions, which have been salivating at the thought of seeing President Obama fail.

One controversial component in the bill – among liberals and conservatives – is the directive to purchase insurance, enforced with penalties for those who don't. On one hand, not everyone may be able to easily afford insurance even with the subsidies and exchanges. Having said that, it's very valuable from an economic standpoint to include as many people as possible in the system – it spreads risk and expands access to primary care.

The legislation unfortunately doesn't fix the core inefficiencies in the insurance market. The inclusion of a public option would have greatly helped by creating competition [PDF] so as to drive down costs and rectify the private insurance monopoly across many states. Its removal, despite being highly popular and an Obama campaign pledge, will leave many progressives wistful for years to come.

The opposition from "centrist" senators like Joe Lieberman and Ben Nelson – who ultimately killed the public plan – has been disingenuous. The biggest grumbles were that it'll be costly and increase the deficit. But CBO scorings have repeatedly shown the public option to be a cost-saver and a deficit-reducer – by way of increasing competition and market efficiency.

The public option's death also reflects a triumph of dirty propaganda from conservatives, which killed its appeal early on among red-state Democrats facing more conservative electorates. The White House's lukewarm embrace of the policy – as various key players have attested – also seems to have contributed to its demise.

It further symbolises the considerable sway that insurance companies and other K Street lobbyists have on both political parties. Republicans placate them with deregulation under the guise of procuring limited government. And this bill suggests Democrats are willing to channel taxpayer money into their pockets for the common good, without asking for much in return.

Even so, this bill's achievements are a remarkable victory for the Democratic party that will likely boost its prospects in the 2010 mid-term elections and beyond. Failure could have been ruinous for the progressive movement. This fact alone explains the GOP's virulent opposition and its admitted strategy to flat-out kill the bill.

It is crushing that even the most progressive American government in a generation was unable to establish public healthcare alternatives. Nevertheless, passage of this legislation represents the willingness – indeed, the ability – of Congress to tackle pressing national issues in a serious manner. These reforms will probably need to be tweaked and improved down the road – but for now this is a crucial leap forward."

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