After all the scare tactics, death panel lies, racial epithets, homophobic epithets, threats of violence, predictions of “the end” of the country and/or freedom, a shout of “baby killer” from one Republican at pro-life Democrat Bart Stupak, and horserace reporting that ignores the substance of health care reform, the Democrats came through with a very imperfect but worthwhile starting point.  The passed it through a Congress with nothing but Republican obstructionism and poll numbers that were declining as Republican hysteria created uncertainty in the public.

President Obama signed it into law this afternoon.

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A bill without a public option has been made acceptable by political reality.  I do not mean to diminish the facts that the bill subsidizes health insurance purchases, grants tax credits to small businesses that provide health insurance, covers 32 million more people, ensures that people will not be discriminated against based on pre-existing conditions, guarantees that people will keep their health care when they get sick, fills the Medicare prescription drug doughnut hole, reduces the deficit, allows people up to 26 stay on their parents’ policies as they get their starts in life, and ends lifetime and annual limits on benefits.  However, we will not have an optimally effective and efficient system until we replace subsidies for price-gouging insurance companies with Medicare for all or at least a public option open to all.

Though some members should be credited for exercising political courage by doing what was right despite the fact that they appear to be losing the spin war, polls suggesting the bill is unpopular have been somewhat misinterpreted.  People generally support individual elements of the bill and CNN’s recent poll (while on the surface showing disapproval of the bill) indicates that while only 39% support the bill, enough of those who oppose the bill do so on the basis that it is not liberal enough such that the two groups combined constitute a majority of people who have by definition rejected the Republican position on health care.

Real Republican voters on health care (i.e., those who oppose the bill as being too liberal) constitute only 43%.  That will decrease now that a single straightforward law is on the books and people will start to see benefits.

Furthermore, at least one major poll shows support outweighing opposition to the bill outright (not even considering the liberal segment of the opposition).

But the best reason for supporting reform is that it provides a foundation for improvement and expansion.  Once people in self-governing countries get health care, they don’t lose it or reject it.  Tony Blair owed part of his re-election victories to public reaction to conservative attempts to cut the national health system, and Britain’s is neither the most generous nor most efficient system in the world.

If the bill had failed, health care reform would have been off the table for years to come and more people would have been denied coverage, seen it rescinded, gone bankrupt due to medical bills (the cause of most bankruptcies), or been underinsured.  Now, we can take the next step toward creating the best health care system in the world, instead of the most expensive, least inclusive, and one of the more glaring underperforming systems (whether ranked by infant mortality, life expectancy or international standards set by the World Health Organization) among developed nations.

The first fixes start with the Senate’s repeal of the special deals for Louisiana, Florida, and Nebraska and its increase of funding for community health centers.  Hopefully, there’s much more to come.

More on “The Republican Waterloo” and its fallout by conservative David Frum (who opposes the new law) here.  The great Paul Krugman’s take is here.

*** UPDATE *** According to a new Gallup/USA Today poll,  49% of Americans think the passage of the Patient Protection Act was a “good thing” and only 40% think it was a “bad thing”…