Landmark health reform will be national defining moment

In the end, after all the votes had been counted, when the last word had been said, after Rep. John "Hell No" Boehner had called the process a disgrace, after Speaker Nancy Pelosi had praised President Barack Obama to mixed reviews from the House floor, one thing would remain: The bill would be signed into law, meaning universal health care would finally be coming to America.

It's not a small thing. In fact, it's an enormous thing.

And the way to bet is that a generation from now, your children or grandchildren will ask if there really was a time in America when not everyone had reasonable access to health care.

You'll shake your head and say it's hard to explain -- but, yeah, people actually said things like health care is a privilege, not a right. And you'll recall, not so fondly, that that was actually one of the nicer things said during the year-long debate.

It's no surprise that the debate got ugly or that it was drawn out. What's surprising is that the bill got done at all. It looked dead once Republican Scott Brown changed everything by winning, of all things, Ted Kennedy's Senate seat -- a clear message that people weren't exactly sold on reform.

Pelosi successfully pushed Obama to push the bill anyway. And it took Obama's intervention in the end -- with his promise to Michigan's Bart Stupak on abortion -- to get the bill passed.

But, of course, it would be hard. Recall that Bill Clinton's try at health care reform never got out of committee. There are large philosophical differences between the two sides. There are large political differences. And it's not easy to tell where one begins and the other ends.

What is clear is that the bill's opponents understood that once it passed, there would be no turning back. Whatever you hear in the postmortems, there will be no repeal.

Republicans will run against big government in November. You'll hear the Congressional Budget Office estimates of debt reduction mocked and the idea of insurance mandates called un-American. But whether or not Republicans win, this phase of the battle is almost certainly over.

History tells the story here. Health care reform likely will become popular, just as Medicare and Social Security did. The cries of socialized medicine and, worse, of creeping socialism, and, worse yet, of dead grannies littering the streets will look like what they were -- political rhetoric.

Everyone agrees something needs to be done to mend Medicare and Medicaid. There's little agreement on what. Everyone agrees that costs have to be further controlled. There's no agreement on how. These are big problems needing big solutions. If there's a lesson from debate, it's that big problems can be faced, if only occasionally.

One writer said the health care bill would launch the mother of all culture wars. He's probably right, but you have to look at the bill itself -- much of which doesn't go into effect until 2014 -- to see what it will bring. According to the budget office, 32 million people who are not now insured would be insured by the end of the decade -- accounting for 95 percent of nonelderly legal residents.

The end of discrimination against those with pre-existing conditions doesn't simply promote fairness, it also allows people to change jobs -- or lose them -- without fear of losing their health care. And, in a related note, insurance companies won't be able to dump you because you have a chronic illness.

These are big changes. Getting a subsidy if you can't afford health care is a big change. And my guess is the scare tactics on other changes won't seem so scary. Medicare recipients won't see their benefits cut. They will see the so-called prescription doughnut hole filled. Small businesses will get tax credits for extending health care to workers. Parents can keep children up to age 26 on their health care. And I'll be interested to see how hard Republicans fight reconciliation in the Senate. There's only so much to be gained by fighting when it starts to look like obstructionism.

There's only so much to be gained when somebody yells "baby killer" at Rep. Stupak, the same anti-abortion Democrat who held up the bill to the end. But no one will remember this night for name-calling. It will be remembered for the 219-212 vote to pass a bill that, for once, can be rightfully called a landmark bill.

At the end of the long night, Obama gave a speech from the East Room of the White House. He said of the bill that this was what change looked like, knowing that "change" has become a punch line, trusting that this time it won't be.