The final version of this reform passed the house 220-207 this evening, completing a momentous change in the American social safety net.
The reform embodies the principle that all American citizens should have an opportunity to purchase health care insurance policies that are comprehensive, regardless of existing health problems or level of income.
Democrats have plenty of reason to smile.
Americans have plenty of reason to smile, though some may not realize this for years due to getting their news and information from ideological sources.
Republicans transported through time from the 1970s or the 1990s would feel largely satisfied with this reform. There is good reason for celebration among those who know small businesses and startups are the engine of America.
Americans need no longer fear losing their job means losing health care, or that striking out on their own to start a new business means losing health care.
Starting in 2014, all income levels will be able to afford to purchase health insurance of good quality, with subsidies for those of modest incomes.
This reform establishes several mechanisms to test out and implement changes to improve quality and value so as to make Medicare and American health care in general more sustainable. To see these efforts succeed we must see Medicare actually implementing real changes, but the means will be in place to allow the search for delivery reforms that work.
Count me satisfied with this reform, this current version. This reform will test most of the ideas I consider the most promising to improve American health care sustainability and quality.
There is good reason to be optimistic.
Success in finding better models of health care won't remove all health questions from our lives. Americans will still face deep questions about how much health care we want, as do peoples in all nations -- questions such as just how far to go to extend life, as technology makes more and more treatments possible.
But when reform is in full flower, such questions will no longer be decided solely by income, by personal wealth, or by an insurance company seeking to cut costs.
Instead, under reform, these questions will be decided by doctors who will have more information than before, and by patients with good insurance the enables them to receive the care that most others receive.