THE BLOG

The Big Change Moment

05/22/2010 05:12 am ET | Updated May 25, 2011

I meant to get something posted first thing this morning, but after working 30 years for universal health care, I decided to sleep in a little this morning.

You know, for all the ups and downs of this process, for all the compromises we had to make to get here, when you see the tens of millions of dollars insurance companies were pouring into lies to defeat this bill, and see John Lewis called a nigger, and Barney Frank called a fag, and see all supporters of this bill called Stalinist, it makes you pretty confident you're on the right side of history.

Is this the change we have been looking for? Only partly. Insurers and other big corporations remain far too powerful, and we will have to keep working hard to improve health care policy in America. We need a public option to provide Americans better choice in their health care system; we need for the federal government to be able to negotiate with the big pharmaceutical companies; we need the insurance anti-trust exemption to get repealed, and for the federal government to do more to regulate insurance rate increases; we need to repeal the Hyde Amendment. Many other changes and improvements will be important to keep fighting for in the years to come.

Yet for all those things we still need, we have won an enormous amount in this bill. You know the list of things we accomplished- universal coverage, an end to pre-existing condition clauses and lifetime caps, more people eligible for Medicaid, more young people able to stay on their parents' insurance policies, an end to the Medicare drug donut hole, and more. These are bigger changes than we have seen in health care policy since the passage of Medicare and Medicaid, and maybe even bigger that them, since this means almost every American will have insurance. Most importantly, health care will be a right instead of a privilege.

That is progressive change, and big change. That builds the narrative in this country that we are all in this together, that we are our brothers' and sisters' keepers, that we are a beloved community. Flawed as this bill is, as many improvements as will be needed, this is a very big deal. It gets us over this massive hurdle that nothing big can be done to change health care, or in general. It sets the stage of another of those Big Change Moments I wrote about in my book, The Progressive Revolution: those eras where big change was possible and really happened. It gives us hope again that this era may join the 1860s, early 1900s, 1930s and 1960s as a time when the country truly was able to move forward more than just a little bit at a time.

The politics of this remain complicated. Many of the best and most popular features of health care reform were bargained away, and many of the best things in the bill won't kick in until 2014. Until jobs start being created and the big banks' power over our economy knocked down a peg or two, Democratic political fortunes remain uncertain. But maybe this bill can help build hope and courage for doing the next things that need to be done. We still have millions of new jobs to create, big banks to be better regulated and broken up, climate change and immigration reform and the Employee Free Choice act to pass. We have a very big and very important agenda in front of us, and with health care done, that gives some momentum to moving forward.

I am still in awe that this actually got done. After seeing the Nixon/Kennedy compromise fall apart, and Carter walk away from the battle entirely, in my youth; after watching the successful demonization of all things government by Reagan in the 1980s; after being a part of the most painful political failure of my life in the Clinton health care war room; and after seeing Rahm Emanuel and others continually advise Obama to scale back his ambitions for health care reforms over the past year, I didn't know I would ever live to see this happen. Having seen what happened in 1994, I was pretty sure that no one would have the courage to take this up again for at least a generation if we failed. But the President hung tough. Readers of mine know I have been very critical of Obama at times on how he managed this health care fight, but I am enormously grateful that he brushed past all the advice to give up, and that he hung tough. And Speaker Pelosi, who argued passionately to keep pushing for comprehensive reform, and then delivered the votes twice in tough, tough circumstances, gets enormous credit as well.

To not walk away, to stand and fight for big change even when the going gets very tough and the politics are dicey (at best): that is the measure of great leadership. Hopefully, this result gives everyone in the Democratic Party the courage to keep going to give us another Big Change Moment.