A historic first step

The House vote Sunday to send a comprehensive healthcare reform bill to President Obama’s desk put the United States on a path toward universal health insurance, a goal that had eluded reformers since then-presidential candidate Teddy Roosevelt called for all workers to have coverage in 1912. It may prove to be the signal accomplishment of Obama’s administration, even though the controversy surrounding it threatens to end his party’s majority in Congress. Rarely has such a good thing for Americans been perceived by so many as a threat to their livelihood and liberty.

There’s wide agreement in the healthcare industry and across the political spectrum that the system is in dire need of repair. But while liberals called for government to eliminate the insurance middleman and act as the single source of coverage, conservatives sought to reduce the government’s presence in the market and give consumers more responsibility.

The measure that emerged from the Senate, HR 3590, pursues a course between those two extremes. It augments the existing system with a new marketplace for individuals and small groups to shop for insurance, a mandate that everyone buy coverage, insurance subsidies for the working class and rules limiting insurers’ freedom to design, price and market their policies. It won’t bring coverage to everyone -- the Congressional Budget Office estimated that HR 3590 would leave about 6% of Americans uninsured in 10 years. But that’s a significant improvement over the situation today, when an estimated 17% have no insurance and thousands lose their coverage daily.

Nevertheless, the notion of creating a new entitlement at a time of record-setting federal deficits infuriated opponents, whose relentless, hyperbolic attacks would have scuttled it had Obama not kept up the pressure to pass it. And the fight isn’t over; it’s just changed venue. This week, the Senate is expected to battle over the reconciliation bill, HR 4872, that the House passed to improve HR 3590. After that, the campaign against the overhaul will continue in the courts and at the ballot box.

We hope Congress keeps the reform moving forward, not backward. Although the measure attempts to improve the efficiency and quality of care, lawmakers will need to do more to restrain costs and provide more options for low-priced coverage. Nevertheless, the bill takes a big step toward solving the problems threatening the U.S. healthcare system. The path to a sustainable healthcare system is long and complex; Sunday’s vote was a good start.