Now the fighting will really begin

It's over. A landmark health care bill has passed. Now let the fighting really begin.

President Obama got his wish, a health care bill, though the bill that survived the U.S. House Sunday was not what he and many of his supporters had originally envisioned. The fight is hardly over. Eight months from now, Round 2 of this fight will be decided as voters cast their ballots on this issue.

If the past few months are any indication, it will be a down-and-dirty fight with blows below the belt, a lot of eye-gouging and ear-biting and plenty of disingenuous prevarications. The debate (which is too mild a term for the fight over this bill) started out early with blatantly (and knowingly) false claims that the bill contained "death panels" that would impose euthanasia on America's senior citizens. The public was treated to the comic sight of people holding up placards reading "Keep the government's hands off my Medicare." It got much worse. Over the weekend, some opponents of health care reform angrily shouted racial epithets at members of Congress.

Many Americans were turned off by the political maneuverings that squeaked this bill through Congress, but most Americans also agreed that the health care system was in need of reform. American workers were sick of exorbitant increases in their monthly health care premiums and the capricious manner in which insurance companies picked what procedures they would cover and what they would not. More seriously, many Americans found their coverage restricted by "pre-existing conditions" or found their coverage canceled when they became ill. To the extent that this bill will correct those abuses, most Americans will support it.

For supporters of the bill, however, the danger lurks not only in the disingenuous falsehoods being shouted by critics but in the fact that most provisions of the bill won't become effective until well after this year's election. Coverage of the uninsured and the requirement for employers to provide health coverage for most workers will not be effective for years. It will be hard for supporters to proclaim reform when much of that reform is still a promise of the future.

This bill is a modest step, perhaps too modest. There is nothing logical about the American system of having employers provide health care insurance, but that link will be difficult to break. Likewise, health insurers absorb health-care dollars in a system that benefits only the insurers while frustrating patients and physicians. But the political clout of insurers make it difficult to break that chain.

The 2010 bill is a first step toward a more logical and effective health care system, but its first test will come in November when voters will have decide whether all this fighting was worth it.