The Senate's "Starter Home" Health Reform

Last week, when Senate Democrats passed the Patient Protection and Affordable Care Act, the right wing's quest to kill President Obama's No. 1 domestic priority ended. Santa has delivered a lump of coal to Senator Jim DeMint, who gleefully predicted that defeat of health reform "will be [Obama's] Waterloo; it will break him."

Progressives in the Senate have reached a momentous crossroads, just as our predecessors did in 1935, when they passed the Social Security Act, and in 1965, when they passed the Medicare Act. Both of those bills were giant steps forward for the health and economic security of the American people. Both were bitterly opposed by conservatives, who waged strident campaigns of fear and loathing, warning that the bills would lead to "socialism."

Make no mistake, the Patient Protection and Affordable Care Act is a profoundly progressive bill. As Ezra Klein wrote in the Washington Post, "The bill is the most important social policy achievement since the Great Society." It will usher in three truly historic reforms.

First, we are going to extend access to quality, affordable health care coverage to nearly every American. An estimated 30 million Americans who do not have coverage will get it thanks to this bill. By itself, this is an historic achievement every bit on par with passage of Social Security and Medicare.

A second great reform in this bill is an array of provisions cracking down on abuses by health insurance companies - abuses that currently leave most Americans just one serious illness away from bankruptcy. Among other things, this bill will extend coverage to people with preexisting conditions, and it will eventually ban the practice of denying coverage due to preexisting condition. It will stop insurers from canceling the policies of people who get sick. And it will stop discrimination against women, who now pay premiums up to 48 percent higher than premiums for men.

A third great reform is something I have championed for many years. Our bill includes a whole array of provisions designed to jumpstart America's transformation into a genuine wellness society. For example, we are going to require reimbursement for recommended preventive services such as mammograms without deductibles or other cost-sharing requirements. We expand Community Health Centers, and help businesses to create workplace wellness programs. This bill will begin to transition our current sick care system into a true health care system - one focused on preventing chronic disease and keeping people out of the hospital in the first place.

By passing this legislation, we will achieve a progressive prize that has eluded Congresses and Presidents going back to Teddy Roosevelt. And we now know why those earlier efforts failed: Because the special interests defending the broken - but highly profitable - status quo are extraordinarily powerful. At long last, we are going to break their stranglehold.

To be sure, the path to securing 60 votes was paved with painful compromises. That's also the way our predecessors were able to get the votes to pass Social Security and Medicare, both of which had big gaps in coverage when they were first enacted. They passed bills that were less than a full loaf, and then they came back for more in later years.

Instead of that "partial loaf" analogy, I like to think of this bill as like a starter home. It is not the mansion of our dreams. But it has a solid foundation, giving every American access to quality, affordable coverage. It has an excellent, protective roof, which will shelter Americans from the worst abuses of health insurance companies. And this starter home has plenty of room for additions and improvements.

The reforms in the Patient Protection and Affordable Care Act are extraordinary achievements. That's exactly why the right wing has pulled out the stops to try to kill it. But let's be clear: This bill is the beginning of health reform, not the end.