The approval Sunday of a health care reform bill is both an end and a beginning. The vote showed that a majority of Congress members — albeit a slim majority — is serious about tackling the growing health care crisis that hamstrings businesses while leaving too many Americans without the coverage and care they need. Sunday night’s vote does not signal that reform — or the debate surrounding it — is complete; rather an important step was taken but far more work remains.
The months leading up to the vote in the House of Representatives were full of missteps. President Barack Obama never sold the U.S. public on the need for reform. Instead of explaining how rising health care costs were driving jobs to countries with universal coverage while forcing companies to forgo adding employees and new products in order to pay their insurance bills, he focused on small details of the legislation. Meanwhile, businesses dropped coverage for their employees, leaving them vulnerable to a costly illness or accident.
He and Democratic leaders in Congress squandered opportunities to work with Republicans to gain their support for the needed legislation. They then cut distasteful deals with fellow Democrats to ensure their support, something they were forced to do when it became clear that not a single Repub-lican would vote for the measure.
Meanwhile, the public became increasingly distrustful of the bill. Fed by their own fear of job losses and mounting debt — a fear that was deftly whipped into a frenzy by opponents of reform — raucous protests filled the airways. Charges of socialism and a government takeover of medicine were rampant.
Oddly, none of these charges accompanied the recent expansion of Medicare to cover prescription drugs. Medicare Part D extended benefits to about the same number of people as the health reform package. It was estimated to add more to the federal deficit than the reform bill, although the long-term costs of the prescription drug program have been revised downward by the Congressional Budget Office.
Medicare Part D was also passed by reconciliation — a process that requires only 51 votes in the Senate, thereby avoiding a filibuster — when Republicans controlled Congress.
Unlike the Part D debate, which clearly faded from the public’s mind, this reform will remain a political hot potato. Some Democrats will likely lose their re-election bids because of their support for the measure. It could even limit President Obama to one term.
But, health reform is about more than seats in Congress. Although many of the changes won’t take effect until 2014, they are significant improvements. From barring insurance companies from denying coverage to those with existing health problems to tax credits to help small businesses provide coverage to their employees to insurance exchanges that will allow companies and individuals to pool their buying power to secure lower rates, these are steps that should be universally supported.
Certainly, there will be provisions that have unintended consequences. These should be fixed by Congress as it looks for ways to tackle the related problem of rising medical costs.
“While the package that we will vote on tonight is not a cure for every problem plaguing our health care system, it is a huge step in the right direction that we can build on,” Rep. Mike Michaud said before voting for the bill.
That is a good summary of the imperfect, but necessary, legislation that lays the groundwork for additional reform.