The Importance of Obama's Health Care Bill

So Obama has finally done what every American president since Lyndon Johnson has failed to do - expand health care coverage to more Americans.

The bill that has passed congress isn't a radical reform - it is not a single payer universal health care system, and it does not include a public option. It also doesn't allow people to buy into medicare, except for those at the very bottom.

However the changes in the bill do more tightly regulate the health insurance industry in terms of what it is and isn't allowed to do. The expansion of coverage relies on individual mandates, tax breaks and direct subsidies, to be phased in over four years. All of this stuff is still significant reform and most democrats would see it as an essential first step.

The victory he secured in congress was significant not just for the reforms themselves, but how they were passed. Much of the credit must go to Obama and Nancy Pelosi, who refused to see the entire health care bill go down in flames. Obama understood that his success on getting a health bill passed would greatly impact on his credibility to deal with other issues. No member of congress would want to side with what they saw as a "losing" president on tight votes about major reform. So instead of giving up the game when he couldn't get everything he wanted, he pushed on, twisted arms and did some heavy lifting.

Now, regardless of how effective the bill itself is, he will now be known as someone who refuses to give up until he can squeeze something - anything - in the direction of reform out of a conservative, stubborn and corrupt congress. This bill passed with only 4 votes in hand, many in his party defected, but still he pushed on anyway.

The impact on the rest of his agenda will be immense - he can start the work of other things like the Employee Free Choice Act, Emissions Trading, Financial Reform and a jobs bill.

This bill was as much about sending a message about the proper role of government as Obama sees it. Obama is a pragmatic liberal who is prepared to accept weak, incremental change if that's all he can muscle through congress. There is only one thing he refuses to accept, and that's the status quo.

It's as much about the direction of government and Obama's agenda than it is about the policies. Obama is trying to push back 30 years of ideologiical orthodoxy in government which said it should butt out of economic affairs - this ship of state is taking a long time to turn around. But his hope will be that by turning it around, step by step, he can set the tone for progressive government through the next decades. Obama once described Reagan as a "transformational president" - someone who changed the terms of the political debate. Obama wants to be the liberal version.

He has already taken a gigantic step forward. Political pundits have already come out and said this could cost democrats seats. This is complete crap. If the democrats had failed to pass a health care bill, the base that propelled them to victory would have stayed home, and independents would have thought of them as a waste of time. Now, Obama has a concrete achievement to stand on. Many of the measures in this bill will start before the election. Republicans may kick and scream, but once Democrats and Independent voters start seeing change flow directly to their families, they will not appreciate calls to get rid of it. The republicans are on the wrong side of the issue and are only playing to their crazy conservative base. Indeed, ten years ago this might have been a health care bill the republicans could have supported. Now Obama gets to gift wrap it for himself.

If anything, the democrats have shored up their political coalition by passing this. I think their majority is headed nowhere - not forwards or backwards. With a few more bills through congress, they will definitely be back for more. For 30 years, the democrats have been looking for their soul and their spine. Obama has given it back to them, and if he keeps demonstrating that same tenacity, he will win himself a second term and the democrats will win many more congressional elections.

Keep in mind that this is just policy number one - more is to come. Much of FDR's most sweeping legislation came in the second half of his first term - after the 1934 congressional elections. THe Social Security Act was passed in 1935. Obama has more to do.