Despite the complexity and emotion of the long health care debate, the momentous choice facing the U.S. House on Sunday was straightforward.
A "yes" vote on reform endorsed taking steps firmly rooted in the private sector to extend coverage to 32 million people and to start the long process of reining in soaring costs. A "no" vote stood for the unsustainable status quo: insurance company abuses; Medicare's looming insolvency, and millions in the middle class priced out of coverage before the end of the decade.
By late Sunday, the House had passed the Senate health care bill and had approved final changes that will now be considered by the Senate. The reform package is a uniquely American prescription for challenges faced globally as populations age and as medical technology becomes ever more expensive. Reform's passage also hands President Obama an elusive legislative achievement sought since Theodore Roosevelt resided in the White House. Obama, who campaigned on change, is delivering. This bill's historic passage should jump-start his young presidency. Reform's near-death experience after the Massachusetts U.S. Senate election also sends this message to the president: He needs to be in the trenches, not outsourcing policy prerogatives to Congress.
Passage of the U.S. Senate bill was a critical step in the controversial reconciliation process to make reform the law of the land. House Democrats commendably chose a direct vote on the bill vs. the shadowy "deem and pass" strategy weighed earlier last week. The final package is expected to cost $940 billion over the next 10 years and cut the deficit by $130 billion over the same period.
In no way can the result be called a "government takeover" of medicine, as Republicans and those in the Tea Party movement have repeatedly charged. Reform does not institute European-style, state-run health care. It does not wipe from the landscape the private industries that form the foundation of American health care. If anything, it shores them up.
Millions of people will now get subsidies to help them buy policies from private insurers; there is no public option to compete with them, one of the many compromises Democrats made trying to gain Republican support. Exchanges to be set up will unleash the power of the marketplace to drive down premiums and allow Americans to comparison-shop for coverage. Small but important steps will be taken to start rewarding providers who deliver the best care at the most reasonable cost instead of penalizing them; the measures so desperately needed to control costs will come from within the health care industry itself, not from government bureaucrats. This is capitalism, not socialism.
Even the individual coverage mandate, one of the most controversial components of the legislation, embodies American notions of individual responsibility. The uninsured currently do get care, often in the most expensive venue possible -- the emergency room. Their costs are then often passed along to those with insurance, a key reason premiums are increasingly unaffordable. The mandate in the legislation, though weaker than it should be, requires people to have a game plan for care and holds them more accountable for costs. It also should help divert people to less-costly clinics, meaning the dollars spent on care for the poor will go much further.
Former presidential adviser David Gergen correctly summed up where the nation now finds itself as the historic legislation becomes reality. "It's the end of the beginning, not the beginning of the end on health care reform,'' Gergen said Sunday on CNN. The real work has indeed just begun. Consumers, employers, insurers, providers and politicians have a steep learning curve ahead as they negotiate subsidies; new consumer protections; the mandate; reimbursement changes; business tax credits, and expansion of the Medicaid program for the poor, the costs of which could be particularly problematic for states. This will be messy. This will be hard.
But far better to start negotiating this challenging terrain now than wait until the system is in real crisis. Solutions then will be more limited and far more radical than the sensible steps courageously embraced Sunday in the House. Democrats are heading off a problem, not creating one.