I think what we won is enormous, we won a national commitment
to getting everybody affordable health care
and the bill is not all we want it to be in delivering on that commitment
but the structure is there, we now for the first time
have national responsibility for making the health care system work and I think
that's huge
and I think that's an institutional change and an
achievment of a shift in where the responsibility lies can enable us
to move forward
so that's what I think of from an institutional perspective
but
to me the biggest victory is
in an immediate way for
people over the next
few years, until two thousand
fourteen
covering better than thirty million people
is amazing
it is an amazing achievement for us to do that, to do it with a
medicaid program, that we
have an expanded finally a medicaid program
so that it's no longer covering
only low-income people who are considered deserving poor and leaving out
working age adults who aren't parents of dependent children, we've finally
gotten rid of those welfare
categories and have
a floor of coverage for everybody below one
hundred and thirty three percent of the federal
poverty level or
incomes below that level
with the subsidies built on top of it I think that
that's huge
I think in terms of
our ability to
manage
the private health insurance industry
with which we are stuck
I think that we have considerable tools there
to bring an end to the health insurance that really isn't there for us
when we're sick, all the practices particularly in the non-group market
that undermine meaningful protection so I think that the
authorities to
hold the insurance industry accountable which I hope we will use to the hilt
are there in this law
When it comes to containing costs I think containing
costs is
probably the hardest thing to do and it's the ballgame, because if we
don't do something to slow the growth of health care costs
then the subsidies in this law
as well as the medicare program and existing medicaid are going to hell in a handbasket
so we really
have got to do something about controlling health care costs and
contrary to
much of the commentary I think short of putting a lid on the system which
people are not willing to do
that the authorities in this law for
medicare to become a more efficient, effective pair
and to start rewarding providers of all kinds for delivering
quality care efficiently, those authorities are now there and medicare
where medicare leads when they do so effectively
the private sector follows, and then we have a commission with the
capacity to fast track things through congress which is important in
this respect because
taking care and bailing out providers is a bipartisan
proposition that
every delegation takes care of its
providers at the expense of affordable
and sometimes quality health care so I think all those tools are there and I
would then add
one more
when talking to John McDonough, is often missed in the
discussion of what this bill achieved and that is truly a miracle because we
have
in this law
established a public insurance program for long term services and
support s
and you're talking about a miracle, advocate that I am for
that initiative and Steve McConnell and I have,
some of us had more hair, some of us had browner
hair at that time working long-term care and
and if I had known that the ticket to success was to achieve
seventy billion dollars in deficit reduction
by pre-funding those benefits we'd have had it long time ago but it
truly is a miracle, it too is going to take
real effort to make successful and stable but we've got it
and that's huge.