US House passes key healthcare reform.

He was elected on a promise of change, using the slogan, "Yes, we can", and last night he delivered the biggest change to America's healthcare system in decades.

The change which Clinton sought, but was unable to deliver, was brought to America by Obama on the slightest of margins, with the Republicans fighting him every inch of the way and not a single Republican voting for the bill.

After days of manoeuvring by the Democratic party leadership to bring dissident party legislators on board and an impassioned plea on Saturday by Obama, the speaker of the House of Representatives, Nancy Pelosi, confirmed that the votes were in the bag, saying she would not have decided to take the bill to a vote unless she had secured the necessary 216 Democrats to push the move through. As it was, the bill was passed by 219 votes to 212.

The House speaker, Nancy Pelosi, summing up the debate, described the bill as "the great unfinished business of our society".

The bill now goes to Obama to sign into law.

Despite not going as far as many liberals had hoped, the bill will take the US close to universal health coverage and Obama will have achieved the goal that eluded US presidents dating back to Theodore Roosevelt a century ago.

The reform, which will cost an estimated $940bn over 10 years, amounts to a massive change in US health provision, expanding care to 32 million more people, predominantly the poorest, and giving the country 95% coverage.

One could harp about the lack of a public option, and the fact that the bill makes insurance compulsory, and those would be perfectly valid points to make.

But, overall, one has - especially speaking from across the pond - to simply marvel at the fact that Obama has delivered where so very many previous US administrations have failed.

Obama, whose poll ratings slipped amid criticism that he was a "do-nothing" president, needed at least one major policy success after a series of setbacks in the last 15 months. He told Hispanic members of Congress early last week that the fate of his presidency and their own chances in the mid-term congressional elections in November rested on passage of the bill.

In his final rallying call on Saturday, Obama told his Democratic colleagues: "Every once in a while a moment comes where you have a chance to vindicate all those best hopes that you had about yourself, about this country. This is one of those moments." He added: "We have been debating health care for decades. It has now been debated for a year. It is in your hands."

And what he has delivered is change:

1. Adult children may remain as dependents on their parents’ policy until their 27th birthday
2. Children under age 19 may not be excluded for pre-existing conditions
3. No more lifetime or annual caps on coverage
4. Free preventative care for all
5. Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online. While these will not be cheap, they’re still better than total exclusion and get some benefit from a wider pool of insureds.
6. Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50% of what they pay for employees’ health insurance.
7. The “donut hole” closes for Medicare patients, making prescription medications more affordable for seniors.
8. Requirement that all insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.
9. Authorizes early funding of community health centers in all 50 states (Bernie Sanders’ amendment). Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.
10. AND no more rescissions. Effective immediately, you can't lose your insurance because you get sick.

This bill has passed despite the tea party protesters, despite the venom which some on the right had managed to create.

Thousands of protesters gathered outside Congress at the weekend, shouting "kill the bill". Some directed racist and other derogatory remarks at African-American members of Congress, including John Lewis, one of the veterans of the 1960s civil rights movement. One congressman was spat on.

Another protester shouted "faggot" at a Democratic congressman, Barney Frank, who later told the Politico website: "It's like the Salem witch trials, and healthcare is the witches. There is mass hysteria."

It's done now. And Obama has achieved his first great congressional victory and delivered the change to healthcare that has, for so many months now, looked impossible to bring about.

So many people argued that he was wrong to do this so early in his presidency, that it was too divisive, but he has managed to do something which has eluded previous US presidents for decades.

John Boehner, the minority leader in the House of Representatives, called the vote Mr Obama's "political Armageddon".

Other conservatives were less optimistic. David Frum, a former speechwriter for President Bush, called it "the most crushing legislative defeat since the 1960s" for Republicans. He said that conservatives were over-optimistic of big gains in the midterms and warned that while "legislative majorities come and go, this healthcare bill is forever. A win in November is very poor compensation for this debacle now."

Frum is much nearer to reality than Boehner is. Now that the American people have this, no Republican will dare to take it away. That is the bitter reality of what has just occurred here for the Republicans.

Change, as promised, has come to America.

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Tags: Obama, universal healthcare, Democrats, Republicans