U.S. President Barack Obama delivers a statement about passage of health-care legislation as Vice-President Joe Biden listens in the White House in Washington.JASON REED
The United States is now well on its way to a health-care system that is not like Canada's, but one that builds sensibly upon the prevalence of employment-based insurance, to which many Americans have grown accustomed. It is more or less based on a Massachusetts health-care statute enacted in 2006, making health insurance compulsory, which was the initiative of the Republican governor at the time, Mitt Romney.
The new U.S. system will be much more complicated than the Canadian single-payer system, but the Obama administration and the Democrats in Congress would have been imprudent to sweep away existing institutions, as if starting from scratch - or to have expropriated a large health-insurance industry.
Indeed, predominantly employer-sponsored health insurance in the United States is older than Canadian medicare; it took root because during the wage controls of the Second World War as an incentive to employees, and was firmly established when premiums were made tax-deductible by companies in 1954.
President Barack Obama was right to persist, despite recent discouragements, in refusing to accept the status quo, which has made the possibility of serious illness a constant threat of pauperization to earners of modest incomes and particularly to employees of small businesses. North American society believes in equality of opportunity, not equality of condition, but the existing state of affairs carried a danger of extreme social polarization. It was, moreover, a clog on labour mobility, making employees afraid to leave their jobs and look elsewhere.
The health-care bill is an eight-year plan. Some of its most important elements - the actual obligation to hold health insurance, the coverage of adults who are already ill before they apply for insurance, new taxes to help pay for the new regime, and "exchanges" where people who lack employer-sponsored plans can buy health insurance - come into effect in 2013 and 2014, after the end of Mr. Obama's first term.
This gradual approach accommodates - or defers - the fiscal consequences of the health-care bill, on both the spending and taxing sides.
Even so, some significant provisions will already have impact this year: some initial subsidies to encourage small businesses to set up insurance plans for their employees, and a prohibition against the denial of coverage for children with "pre-existing conditions."
The willingness of Democrats in the House of Representatives to pass the Senate's bill, which is more moderate than their own, is evidence of the renewed health of the American political system. Above all, Barack Obama has accomplished a historic health-care reform, but not a revolution, because he has respected American health insurance as it has evolved.