Mother Nature contributed to the “happy ending” after 25 days of frazzled manoeuvring. Senators wanted to “be home for Christmas” and not grounded at airports by massive snow storms building up over the country’s mid-west.

The polarized debate reflected a deep and sometimes bitter conflict between two approaches to health care. One is faith-based -- faith in the health care insurance industry. The other is equity-oriented, partly inspired by Senator Kennedy’s career-long effort to turn health care from a privilege of the few into a right of the many.

Not surprisingly, the venerable Senator Robert Byrd of West Virginia, the longest-serving Congressional member, and usually a stickler for propriety, broke with tradition at voting time, saying the customary “aye”, then triumphantly shouting: “This one is for my friend Ted Kennedy.”

CONFERENCE

Shortly after the vote was taken President Obama said at a news briefing: "With today's vote, we are now incredibly close to making health insurance reform a reality in this country."

Separately, he sent a message to nationwide supporters of health care which said, in part: “If we finish the job…..we will have beaten back the special interests who have for so long perpetuated the status quo. We will have enacted the most important piece of social policy since the Social Security Act in the 1930s, and the most important health reform since Medicare in the 1960s.”

For all that to happen, a conference drawn from both Houses will have to create a single version out of the two that exist: the Senate Bill, and another adopted by the House of Representatives in a 220-215 vote last month.

Among several key issues that need reconciliation are provision for a publicly operated institution to run in competition with private insurance companies, payments for abortion and, overall, the costs of reform.

Neither version is perfect. The left flank of Obama’s support, for instance, has already criticized him for not safeguarding provisions that they assumed were part of his core agenda. Yet, the proposed new health care regime will even in its first year of operation make a substantial difference to the uninsured and the under-insured.

Nancy-Ann DeParle, Director, White House Office of Health Reform, points out that the new health care system will:

-- extend coverage to over 30 million uninsured Americans without adding to the federal deficit,

-- provide access to a new insurance marketplace, the Exchange, that will allow the uninsured and small businesses to compare plans and buy insurance at competitive prices,

-- begin covering preventive services, helping to shift health care from only sickness to wellness,

-- provide major relief to seniors in paying for prescription drugs,

-- introduce the largest reduction to the deficit in well over a decade,

-- make it illegal for insurance companies to drop coverage for the insured,

-- reduce premiums for the family, shifting the balance of power to the insured,

-- require insurance companies to report the proportion of premium dollars that are not spent on medical care -- including profits. Companies not spending enough of its premium dollars to provide benefits will have to issue rebate checks to its customers.

Is it conceivable that these conditions do not already exist in the U.S.? It is. “This is the only rich nation where people can die from lack of medical care -- because they can’t afford it or because it’s not available….Only in America can sickness send you to the poorhouse. This cannot be what’s meant by American exceptionalism,” says “Washington Post” columnist Richard Cohen.

DELAYS

The case for health care reform is undeniable. A combination of special interests, deceit, ignorance, racism, and political blackmail bedevilled the legislative process, however, delaying progress at every turn until the Christmas Eve vote.

Some day, says Pulitzer Prize winning author Eugene Robinson, “we will deal with the perversity of having for-profit health insurance companies.” That is the systemic nature of the beast.

The beast was so enraged and terrified at the prospect of losing profits that it attempted to fight back with a massive propaganda campaign whose targets were average Americans fearful of losing what insurance they have.

The catalyst of deceit, meanwhile, was Sarah Palin, ex-governor of Alaska, and the Republican party’s ex-candidate for vice president of the U.S., who said on August 7, 2009 that seniors and the disabled “will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of the ‘level of productivity in society,’ whether they are worthy of health care.”

This was a frightening prospect, particularly to older Americans. And well it should have been, if the claim was true. It was not. It was, instead, obnoxious fiction.

PolitiFact.com, an independent fact-checking group, combed the draft legislation and found nothing, but nothing, to substantiate her claim. The phrase itself had not been in circulation before she used it, said Ian Dowbiggin, professor of medical history.

The phrase and the false allegation acquired lives of their own, with the term “death panels” appearing some 6000 times in news reports during August and September. Even mainstream Republicans tagged along. John Boehnor, the Republican Leader of the House of Representatives, was quoted as saying: “This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law.”

Pressed to explain the lie, Palin repeated it, but added this clarification: “The term I used to describe the panel making these decisions should not be taken literally.” It is “a lot like when President Reagan used to refer to the Soviet Union as the ‘evil empire.’ He got his point across.”

Given the nature of the lie and the havoc it created, PolitiFact selected Palin for its “Lie of the Year (2009)” award. Over 60 percent of readers who were polled endorsed the decision.

Elsewhere, ignorance was to be found among audiences receptive to Palinisms such as the “death panels” lie and who, in any case, did not seem to know the source of their own health insurance. Many insisted that services they received from ‘Medicare’, a wholly government-owned activity, should be defended against government ownership.

These “asides” sullied the atmosphere, making any kind of bipartisanship not even theoretically possible, and lengthened the debate over many more weeks than were actually required.

As for the racism, a single banner made the point. It read: “Keep your hands off my private insurance.” The word “hands” was not written out. Instead two hands were sketched in outline and filled in with dense, black paint.

GAMESMANSHIP

In the Senate, other kinds of games were played on both sides of the aisle, centred on the practice of filibustering, a process by which a substantive vote can be indefinitely held up unless “cloture” is applied by a minimum of 60 Senators. Debate then ends and Senators move on to an up-or-down vote on the Bill under discussion.

On the Democratic side, recalcitrant Senators threatened to engage in a filibuster unless they got special concessions for their constituencies, or secured deletion from or additions to the pending legislation. Political blackmail, said the critics.

Republicans, for their part, while actually engaging in filibustering, also made some quirky appeals for at least one Democrat not to vote for cloture, which would have dropped the cloture vote from the required 60. In the process, Senator Garrasso of Wyoming put on an excruciating show of circular logic.

President Kennedy, he said, had profiled courage, in his famous book. Therefore, a Democrat should have the courage to break ranks and vote against health care. The circle was squared at that point because health care reform was a program very dear to Kennedy. Garrasso has to be either ignorant of history, or a crazy mixed-up Senator, or a vicious mixed Senator, or all of the above.

The most egregious effort to break the solidarity of support for reform came from Republican Senator Tom Coburn of Oklahoma, and it took the form of a proposed appeal to the Almighty.

He urged his colleagues to pray that at least one Democrat would be unable to vote. Given the fact that the 92-year-old Democratic Senator Byrd was ailing and his presence at the Senate for a very late night vote could worsen his condition, the message was crude and clear.

In response, Byrd was wheeled into the chamber at 1.18 a.m., raised his right hand as he voted “yea” for cloture, while pumping his left fist in the air.

FIGHT

Some observers fear that opponents of health reform are now so enraged by their defeat, both procedurally and substantively, that they will wallow in obstructionism.

Senate Republican Leader Mitch McConnell has vowed that the empire will strike back. “This fight isn’t over,” he announced, after the vote was taken. “My colleagues and I will work to stop this Bill from becoming law.”

Other opponents of health care reform have hinted that because of the acrimony over the debate that just ended, it might not be possible to craft climate change legislation. Such an approach would be an affront not only to Americans without access to affordable health care but to the very planet that the human family occupies.

[Source: IDN-InDepthNews | Analysis That Matters]

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The writer has served as Sri Lanka's ambassador to Canada, Cuba, Mexico, and the USA. He was Chairman of the Commonwealth's Select Committee on the media and development.