Paul Holmes: Yes he did - Obama gets hands dirty

If you are fascinated by the machinations, twistings and turnings of American politics, you could not have had a better afternoon and evening than last Monday, watching American television coverage of that historic Sunday session of the House of Representatives in Washington, in which President Barack Obama and the Democrats, led by that formidably groomed arm-twister, Speaker Nancy Pelosi, ground out a victory for Obama's Health Care Bill.

It went right to the wire - 219 members for, 216 against.

A squeakily narrow but famous victory.

Then, at midnight, the cameras were waiting in the East Room of the White House and out walked the President to sing the glory of the night and its historic stature, Obama as fresh and as tidy as if standing there at midnight was his first duty of the day.

Suddenly, all of the talk about Obama being another one-term Democrat president has disappeared.

As the veteran New York Times columnist, Maureen Dowd, wrote, "The lofty President and the wily speaker suddenly steered them off the Jimmy Carter Highway and on to FDR Drive".

Suddenly Obama is once more widely acclaimed. Suddenly his approval ratings are heading north.

American presidents since Theodore Roosevelt have been trying to reform health care. Obama had done what seemed to be impossible.

Even the wily, deal-making Bill Clinton tried and died on the issue. Obama may already be a great reforming president.

So what has he done? It is difficult for us in this country, which has a clear and simple state-funded health service, to work out.

The United States is the only developed country not to have a national health service. Their system is private. You pay, you get. That alone makes it difficult to figure.

And what made it more difficult was the hysterical opposition and predictions thrown up by the Republicans.

To listen to the ranting Republican commentators you would think that Obama was turning the United States into a socialist nightmare.

He is creating a national health system, like those of Canada and Britain, declared beady-eyed Charles Krauthammer on Fox News.

Essentially the Bill tries to ensure that every American will have access to good health care, that they will be covered by health insurance.

In 2008, 48 million Americans had no access to paid health care. These are not only the poor and the unemployed, but the struggling bottom end of the middle classes.

Obama seems to have set up an insurance system parallel to the big private insurance giants which will embrace the poor, the unemployed and those already ill.

Anyone is eligible. No one will be rejected for cover because they are already sick.

People will be eligible for a comprehensive range of benefits and Obama says the premiums will be affordable.

At present, most Americans pay their health insurance through their employer.

Their employer offers health insurance as part of the employment deal. In big firms, the boss will have been able to negotiate a good deal from one of the rapacious major insurers.

But in the financial and economic carnage of the past 18 months, health insurance has become a terrific burden to many employers.

Many have had to decide whether to keep paying the health insurance or to lay off staff. And if you leave your job or lose it, you lose the health insurance cover.

Finding yourself in that situation meant you had to buy your family's health insurance on the "individual" market where you did not have either the bargaining power or the protections of employer-based schemes.

As the Des Moines Register clearly explains, nearly 20 million Americans buy their health insurance policies this way. "They are the people who are unemployed or self-employed or work for a business that doesn't offer insurance. They are on their own shopping for coverage. And they frequently pay a small fortune for it ...

"The truth is there is no scarier place to get health care coverage than in the individual health insurance market. Insurers review your health history. If there's even a hint of a health problem, they may charge you higher premiums. If you have heart problems, cancer or diabetes they may not sell you coverage at all. Companies may cancel your policy if you get sick."

You may also be confused, or misled, about how much coverage you have. There have been bankruptcies because people were simply not covered for the care they got.

The New York Times reported the case last year of 21-year-old Jake, who had been undergoing cancer treatment for three years.

During that time his mother, Danna, had a job with good medical coverage. Last year she lost that job, and with it she lost her coverage.

She and her husband, the proprietor of a struggling small business, had to sell their home to pay for Jake's continued treatment.

In this ferocious battle for reform, the giant health insurance companies did not help themselves. In February, Anthem Blue Cross, one of the biggies, told 800,000 of its individually insured Californian clients - strugglers and poor people - that premiums would go up 39 per cent this year.

They advised their clients of this after reporting a US$2.7 billion ($3.8b) profit for the previous quarter.

So what did Obama do the day he signed the bill into law? He went to Iowa, where his historic journey started when he so famously won the Iowa caucuses.

An adoring crowd shouted, "Yes, we did! Yes, we did! Yes, we did!" It must have been a glorious moment for him.

For long months it looked as if Obama's dream was over and his health reforms were dead. He looked like a president unprepared to deal or get his hands dirty or twist arms, like a president who seemed to want to govern, as one commentator put it, with "a noble fastidiousness".

This was never going to work. He got down and dirty and squeezed those votes out. He has pulled off what no other president has managed to do.

It was a great night to be watching Washington. And to be watching Fox News where they were spitting. Armageddon was about to happen.

But there was nothing they could do. There remained, in that shining city of history, something still more powerful than they.