US health care reform: I know it's over (and it never really began)

So, US legislators have finally passed health care reform. Or, at least, extensive health care tinkering. Whilst Washington recovered from Snowmageddon^TM, elements of the Congressional and Senate bills were being spliced together in a gruesome hybridization ritual conducted on Capitol Hill. Following a final bile-disgorging ceremony, a majority of both houses then agreed to tolerate this unlovely chimaera. Although Republicans swore they would haul it out and shoot it at the earliest opportunity.

The week of passage happily coincided with St Patrick’s day, and there was an appropriate air of inebriation in Washington. Democrats shuttled between votes, all champagne smiles and bonhomie, whilst Republicans propped themselves up against Fox news anchors, raging impotently against the death of democracy. Before the final vote the parties summoned their high priests for one last sermon, less to convert any vacillators and more to establish which party loves The Constitution more.  This is standard procedure in Washington, where legislators are incapable of asking one another the time without referencing the founding fathers. For the Republicans John Boehner – immaculate, incandescent, orange – invoked everyone from Thomas Jefferson to Moses, stopping just short of claiming that reform went against God and that a rain of fire was imminent. His anger was understandable, given that Democrats had proposed, in an apparent personal attack on him, a tax on the use of tanning-beds. For the Democrats speaker Nancy Pelosi strode into the building wielding, Excalibur-like, the gavel used in the enactment of Medicare in 1965 . Giddy and grinning like Skeletor – confident the day was hers – she could barely get her sentences out. Having secured victory in the vote, she paraded from the chamber – Democrat patricians trailing in her wake – to deliver a series of Oscar-style acceptance speeches to waiting journalists.

And so on to The Signing. Rather than drop the bill in the President’s in-box for him to scribble on over breakfast, this apparently simple act is accorded a full ceremony, complete with fanfares and chanting. By custom, the president presents the pen used for the deed to the person deemed most influential in crafting the legislation. As this inevitably offends the pen-less, Franklin Roosevelt started a tradition of using multiple pens, employing the trick of dividing his signature into bite-size chunks. For health care reform Obama used no fewer than 22 pens, each barely contributing a curlicue. Future generations may conclude that twenty first century America was governed by a football squad. Or a six-year-old child . Republicans spent most of the day sulking in sackcloth, but they did enjoy one minor victory: Obama betrayed himself as left-handed, and therefore a witch.

Most – but not all – Americans now know that if they can just cling-on to their health until 2014 they’ll get the opportunity to become the lucky customers of a health insurance industry that will hopefully be behaving itself by then. And even covering the sick. The crippling cost of the system will either be drastically reduced or catastrophically inflated as a result of the legislation, depending on which oracle you consult. The Republicans, taking the latter view and having lost in Washington, are taking the fight out to the provinces, seizing on the mandate – the requirement for everyone to buy health care insurance. At least thirteen states are preparing to sue the federal government on the grounds that compelling citizens to buy anything – however essential – is unconstitutional. Which illustrates the country’s mental block when it comes to health care – it is still seen by too many as a commodity and not a right. Within that context, the Sisyphean struggle to reform health care has finally achieved some measure of success this year. More fundamental change – equity, universality, sanity – will have to wait until the context changes.