Well the Democrats managed to pass comprehensive health care reform, and I have to say I am pleasantly surprised. I basically figured they were going to screw it up somehow, but they managed to snatch victory from the jaws of the defeat which had been previously snatched from victory's jaws. Or something like that.
Anyway, I'm glad to see Congress take a few baby steps toward a truly workable health care system. The truly important thing here is that Congress established the principle that everyone should have access to affordable health insurance. That is the new status quo and once people learn about it they won't want to give it up. The moving parts will be tinkered with and strengthened by politicians of both parties for years to come, but I don't think that core principle will ever be revoked.
I would personally prefer a more comprehensive "Medicare-for-all" system, but this is a decent step forward. My rough understanding is that the health insurance industry is a kind of natural monopoly, making it hard for small mom-and-pop companies to enter the market. Insurance companies don't really compete on the basis of service or quality of product so much as on the respective magnitude of the medical "risk" they carry. Without proper regulation, this leads to inhumane practices where the sick are excluded up front or dropped after paying premiums for years.
But once you make those practices illegal (as this law does) it makes more sense to pool medical risk as broadly as possible, to have everyone pay into the system when we're healthy and pay out when we (inevitably) get sick. And that starts to look at lot like Medicare-for-all. And perhaps we will evolve toward that system over sooner rather than later -- a public option would certainly speed up that process.
Beyond the policy, yesterday's vote signaled that Washington can actually do things and address big problems that seem impossible. People are already talking about how the HCR vote may actually revive the climate change discussions. If it had gone the other way the media narrative of failure, gridlock and impotence would have become a self-fulfilling prophecy.