God oh god, the Crikey UK office – now established above a karaoke bar in Frith St Soho, staggering distance from the Coach and Horses and the Groucho, should one ever be invited again, which is unlikely – is not the best place to be observing the passage of Barack Obama’s health care bill, but so it is.

Time of writing: the US House of Representatives was meeting on a Sunday evening, and the vote to have the bill proceed to debate had just been passed 224 – 206.

That doesn’t pass the bill of course, but if the votes hadn’t been there, it wouldn’t have got to debate at all. The Democrats have been scurrying around getting votes all day to get the thing over the line.

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Crucial to getting the bill across has been finding a way in which anti-abortion Democrats – both genuine ones, and those who are simply in conservative seats – can reasonably vote for it, without putting in a whole series of explicit anti-abortion funding provisions that left-liberal democrats couldn’t come at.

That has been achieved not by legislation but by the promise of an executive order – similar but not identical to a ‘signing statement’, where the President announces how s/he will interpret the law – the executive order declaring that the President will conform interpretation of the current bill in line with earlier interpretations of congressional votes banning public funding for abortion.

The Right is screaming about it and I don’t blame them, because the executive order can be changed at any time. The promise means nothing, but it is enough for Dem congressman Bart Stupak to go back to his heavily Catholic Michigan district and claim that he protected unborn children from being aborted by the evil socialist government.

Stupak is genuinely anti-abortion, but it seems clear that he wants a fig-leaf to cover his arse, so to speak, as the enormous pressure comes down on Democrats to get the bill across the line.

People half-following the issue may have believed that Congress had already voted through a health care bill. But that was the Senate bill, got through before the Democrats lost their narrow filibuster-proof majority with the loss of Teddy Kennedy’s old Massachusetts senate seat.

The problem for the Obama administration has always been to get the narrower, more conservative Senate bill through a House where the Democrat majority is larger, giving the Admin problems on both right and left.

Thus the use of executive orders etc, to get the damn thing across. In fact, there’s two twinned bills going through – one to the White House for signing and one back to the Senate, that will align the different Senate and House bills. Since that bill is a ‘reconciliation’ bill, it only requires a simple majority, 51 votes, not a filibuster-buster.

Should the bill pass the House – and there will be a vote sometime around 1pm Australian eastern time – and then get reconciled in the Senate (and if they can’t make that happen, they should shoot themselves in the head) then it will be a triumph for Obama, and the first real structural reform of health since the creation of the 65+ Medicare programme in the 1960s.

By any standard of civilised countries with a real public health system, it’s regressive, since there is no universally available public option – indeed the system herds people into private insurance schemes.

But crucially there will be price controls on the insurers, a provision to ban exclusion on the grounds of pre-existing conditions, a carry-over of people’s work-based healthcare when they lose or change jobs, and an extension of work-based healthcare. Within the conditions he had to work with, Obama has – if the bill passes – achieved a vast reduction in unnecessary suffering within the US. (As an added bonus it also reforms the iniquitous student loans scheme that leaves people in debt for decades.)

The Right are going nuts about it of course. If you want to read something really funny, go to the National Review‘s ‘The Corner’ blog, where insanity is in full flight. Quite aside from their fantasy about this being ‘socialism’, their obsessive focus on abortion, not because they care about humans, but because they simply want to control some abstract notion of life, and how it is disciplined and regulated.

Amazing really. They couldn’t care if the poor died in the casualty wards, but they’re pro-life. Dumb f-ckers.

Nevertheless Mark Steyn’s despairing cry has it about spot-on:

“…it’s hard to overestimate the magnitude of what the Democrats have accomplished. Whatever is in the bill is an intermediate stage: as the graph posted earlier shows, the governmentalization of health care will accelerate, private insurers will no longer be free to be “insurers” in any meaningful sense of that term (ie, evaluators of risk), and once that’s clear we’ll be on the fast track to Obama’s desired destination of single payer as a fait accomplis.”

If Barack Obama does nothing else in his term in office, this will make him one of the most consequential presidents in history. It’s a huge transformative event in Americans’ view of themselves and of the role of government.”

And why would that be a bad thing?

“…one of the first things that middle-rank powers abandon once they go down this road is a global military capability …”

That’s right. Extending health-care will make it harder to find the money to go and kill people elsewhere. The Right, ladies and gentlemen…the party of death over life.

They’re still debating the bill, in that curious American way, of two minutes for each speaker, etc. There’s a chance this won’t go through, and that a switcheroo is on the way. But barring that, American society is about to change about as momentously as is possible within the fractured, corrupt system of government they’re saddled with.

And below in the karaoke bar, they’re singing U2’s One. Again. And everyone out there in the street will get whatever care they need, whenever they need it, and no questions asked.

And 15,000 Americans die per year of easily curable conditions they cannot afford to treat…

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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