A vote for history

President Obama, Vice President Biden at his side , makes a televised address after the final House vote on the bill to overhaul the health-care system. He said the vote proved "we are still a people capable of doing big things."

The historic vote in the House Sunday night is a victory in establishing the long overdue principle that affordable health care is a basic right.

Reforming the nation’s health-insurance system couldn’t wait. Soaring premiums have eroded the availability of employer-based health benefits. About 32 million Americans can now get coverage, the bulk of them working poor.

As business leaders understand, the burden of rising costs on employers, individuals, and the government cannot be sustained. This bill should start the nation on a path to more affordable, accessible health care with nearly universal coverage.

Speaker Nancy Pelosi (D., Calif.) and President Obama deserve credit for persevering on this goal, despite universal and sometimes vulgar opposition by Republicans. When opponents saw they couldn’t win this debate, a few of them outside the Capitol resorted to hurling homophobic and racial slurs (and spitting) at Democratic lawmakers. They demeaned themselves.

It was a tough “yes” vote especially for Democrats in swing districts, such as Pennsylvania Reps. Patrick Murphy and Chris Carney. Their votes were courageous, and on the right side of history.

The legislation will prohibit insurers from excluding children with preexisting conditions. In 2014, this prohibition will be extended to adults. Insurers will be barred from canceling policies when a policyholder becomes ill.

For the first time, nearly everyone without insurance will be required to purchase it by 2014 or pay a fine. The federalgovernment will subsidize insurance premiums for families earning up to four times the poverty level ($88,000 for a family of four). Insurance “exchanges” will be created to offer affordable plans.

Medicaid will be expanded to cover the lowest-income uninsured. Adult children could stay on their parents’ plans through age 26. The bill would gradually reduce seniors’ out-of-pocket expenses that fall into the Medicare prescription-drug “doughnut hole.”

All of this cannot be achieved without costs. The nonpartisan Congressional Budget Office calculated that this legislation will cost $940 billion over 10 years. It will be financed partly by expanded Medicare payroll taxes, roughly half of which is to be paid by families earning more than $250,000.

But the CBO forecasts that the bill will actually reduce the deficit $143 billion in the first decade, and by $1.2 trillion in the decade thereafter. Policymakers will need to keep a careful watch on whether these projections come to pass; more tinkering with this legislation will be needed in coming years.

Rep. Frank Pallone (D., N.J.) said the CBO cannot predict the additional savings that will result from prevention — people seeing a doctor before they become seriously ill. “I think that saves so much more money,” he said.
Without fixes to the system, costs of employer-based health care could triple in the next decade. That would result in more uninsured citizens, more people dying from delayed treatment, and higher costs for a government that increasingly can’t afford it.

The course of this legislation over the past year produced some unsavory deal-making and some legalized bribery for lawmakers’ votes. But such deals don’t diminish the overall achievement that Congress has reached.
The wealthiest nation in the world can’t afford not to provide its citizens access to decent health care.