Barack Obama’s health bill is the biggest welfare reform in the US since the 1960s. Another 32 million people will have health insurance.
This is a step forward – and it’s good to see the Republicans defeated – but what is really shocking is how modest the changes are.
The Medicare scheme which offers health care to retired people was introduced in 1965 on the back of a wave of social discontent. But Obama’s reforms are a compromise designed to avoid upsetting the medical insurance companies.
About 23 million Americans will still have no health cover. Ordinary people will continue to pay crippling insurance premiums.
Insurers will no longer be allowed to exclude people for pre-existing medical conditions, but care will depend on what you can afford.
The scheme will subsidise insurance premiums for people who can’t pay. When they come in during 2014 the reforms will cost $940 billion (£624 billion).
So the government will fund the profits of the profiteering insurance companies, and the Republicans will blame reform for the increased costs.
The reforms will not set up any publicly run health scheme – even one that competes with the private companies. Any talk of change that would make the system efficient is dismissed as extremism.
Its frightening that the political consensus in Britain is to make our system ever more like the US.