On the eve of Senate passage of once-in-a-generation health care reform, it's clear that Congress won't fulfill every wish on reformers' Christmas lists.
But the broad health legislation that's likely to emerge after differences are worked out with a House-approved version will be a historic step toward providing care for all Americans.
That's a worthy goal befitting the world's wealthiest nation, even if the process to get to this point has been littered with sleazy political deals and partisan policy disputes.
The fragile compromise that Senate Majority Leader Harry M. Reid (D., Nev.) crafted to gain the required 60 votes from Democrats and two independents produced a bill that is far from perfect, and relies too heavily on pilot efforts to tame health costs.
Among the most distasteful elements were essentially the payoffs used to secure votes from senators in Nebraska, Florida and Louisiana. The side deals provide extra funding for Medicaid and Medicare patients in these states, as well as unnecessary limits on abortion coverage demanded by Sen. Ben Nelson (D., Neb.)
To hold his caucus together, Reid also had to jettison the core concept of establishing a Medicare-like health plan for working-age adults. It's no panacea, but the so-called public option would have provided a competitive counterpoint to ever-rising premiums and private insurers' at-times capricious changes in coverage.
When Senate moderates came up with a seeming breakthrough compromise to permit a Medicare buy-in for Americans over 55, even that was shot down by a few senators. In drawing this line in the sand for his support, Sen. Joe Lieberman (I., Conn.) — a lackey for the influential insurance industry located in his state — needlessly denied the nation's 47 million uninsured yet another reasonable choice for coverage.
That said, the Senate proposal is remarkable for what it contains — much the same as the House legislation approved last month.
For the first time in four decades, it tackles reform of the nation's $2.5 trillion health care system and establishes the principle that all Americans should have access to affordable care.
Over a 10-year period, more than 30 million of the uninsured are expected to gain access to health insurance coverage. Some coverage will come through an expansion of Medicaid, the government-run health program for the poor. Low- and moderate-income families will receive subsidies — accounting for the greatest portion of the $871 billion cost — to help them purchase private coverage on new insurance exchanges.
While workplace insurance coverage is said to remain largely unchanged — a good thing — people with insurance will be protected by new rules that bar insurers from refusing coverage based on medical conditions. Federal oversight of at least two new national health plans run by private insurers will reinforce those consumer safeguards. In effect, these provisions represent a long-sought patients' bill of rights.
There's plenty of work yet for congressional leaders following the Senate vote, including getting the right mix of taxes and assuring that the abortion issue doesn't derail the progress toward achieving this landmark reform.