Elmer Smith: Senate bill is most far-reaching attempt at health-care reform

YOU WOULD have thought that the demonstrators from Healthcare for America Now had missed the latest dispatch from the battle front.

A couple of dozen sign-wielding stalwarts gathered in the City Council Caucus room yesterday to prod Congress to pass the kind of far-reaching reform that this group has been demanding for the last 18 months.

Their leaflets and signs called on Congress to include abortion coverage and a public option in the health-reform proposal winding its way through the legislative process in Washington. Their signs must have been left over from a time when it still seemed possible to include those things in the reform.

What the Senate passed Sunday in one of the most contentious compromises ever fashioned falls far short of their wish list. It barely bends the inflationary curve that has seen health-care costs skyrocket more than 100 percent since 2000. It leaves as many as 10 million Americans uninsured and, in its present form, could end up taxing millions of middle-class policy holders.

But despite those and a few dozen other glaring flaws, it is the most far-reaching and game-changing attempt at health-care reform since Medicare survived an equally contentious process 44 years ago. Only the tong war that ended when Social Security passed 75 years ago left more blood on the floor of Congress.

This was the civics lesson from hell. The GOP was unified in its resolve to block anything that could be construed as a victory for President Obama and the Democrats, even if those things are good for America. Across the aisle, Senate Democrat Ben Nelson and so-called Independent Joe Lieberman threatened to hold their breaths until we were all blue in the face.

They squeezed out something that is as unsatisfying for liberal groups like Healthcare For America Now as it is for conservatives who distrust anything that looks like an expansion of government.

What has passed in both houses is a principle. It's the principle that no American should work all his life only to go broke trying to pay for medical care. No American should face the loss of life-sustaining care because he lost his job or because his employer can't afford his coverage.

As a matter of principle, the richest country in the history of man should not accept the fact that 47 million people are without health insurance, including nine million of our children. And only a people without principle could countenance a report by the National Academy of Sciences Institute of Medicine that at least 18,000 Americans die each year for a lack of insurance.

Even those who exalt pragmatism over principle are left without a leg to stand on. The argument that this is merely a way for the rest of us to subsidize people who can't afford health care doesn't hold water.

People who are insured will no longer bear the threat of being dropped because of a pre-existing condition or be left uncovered when they change jobs. Medical debt is the principal cause of bankruptcy in America. Having a job doesn't insulate you from that.

There is something here for almost everyone. But there's not enough to completely satisfy anyone.

"It looks like we may not get everything we want," said Marc Stier who organized the Health Care for America Now coalition 18 months ago.

But no one was conceding defeat.

"This is a step forward," U.S. Rep. Joe Sestak, D-Pa., said of the Senate bill. He told the demonstrators that it would be "extremely difficult" but not impossible for him to vote for a bill with no public option.

Reconciling the Senate bill with a House version that includes a public option may be the toughest part of this battle. But they will get it done.

They will pass a bill that is as flawed as the process that spawned it and as unwieldy as democracy itself.

But, like democracy, its imperfections will be outweighed by its promise.

Send e-mail to smithel@phillynews.com or call 215-854-2512. For recent columns: http://go.philly.com/smith