The time has come - Updated [Bryan]

Tonight the House of Representatives will be voting on the Senate's version of the health care reform bill and its related amendments. This is a big deal to me. A really big deal. Readers of this blog know that health care has been something I've long been concerned about. We have a health care system in which up to 45,000 people die each year because they lack insurance. Meanwhile, current health care spending is growing rapidly and will bankrupt the country within a few decades. These are problems we need to address; if we can't, our country is indeed broken.

If you haven't been following this debate closely, here is a quick run down of what the current bill looks like.

The conservative side of me is happy for the substantial cost control. The current bill is projected by the non-partisan Congressional Budget Office to cut the deficit by $130 billion in the first decade, and $1.2 trillion in the second, although many health care experts believe it may actually be much more than this. This is the most ambitious attempt to slow medical spending ever undertaken. Harvard health economist David Cutler recently argued, "What is on the table is the most significant action on medical spending ever proposed in the United States. Should we really walk away from that?" (Cutler's important article can be found here). The conservative in me also likes harnessing the free market through the new health insurance "exchanges." These exchanges will help consumers and small businesses navigate the health insurance market and make insurers compete, in a more clear and transparent way, for their business. Markets can be cool things.

The more liberal part of me is happy about several things. The bill helps 32 million people get health insurance, mostly buy giving them "vouchers" to help them purchase insurance (more precisely, tax subsidies based on income). People with preexisting conditions will be able to buy insurance at a reasonable cost, and insurance companies won't be able to rescind your coverage once they have given it to you. The bill finally closes the Medicare Prescription Drug Benefit's notorious "doughnut hole" thus making medicine more affordable for grandma and grandpa. It will invest in new funding for community health centers to serve up to 20 million patients by 2015. It will increase the number of primary care providers in underserved communities, with new funding for the National Health Service Corps. This will fund scholarships and loan repayment to entice more doctors into primary care medicine.

The final bill has been endorsed by a wide variety of groups like the American Medical Association, the American Association of Retired Persons, the American Nurses Association, the American Association of Pediatrics, the Catholic Health Association, the American Hospital Association, the National Council of Churches, the Consortium of Jesuit Bioethics Programs, the American Heart Association, the Federation of American Hospitals, the American Diabetes Association, the American Cancer Society, and many, many others.

Of course, there is some medicine to take, also, and it is not all fun and games. Expensive insurance plans will be taxed at a higher rate within the decade (which will probably affect me), and everyone will now have to buy insurance or face a fine (Mitt Romney called this a "personal responsibility" provision in his Massachusetts bill, which is very similar to the current bill). There will also be a 3.8 percent tax on investment income for families making more than $250,000 per year (which would definitely not affect me). Nobody likes these things, but they are necessary to pay for the bill and to allow for the insurance companies to cover preexisting conditions.

So, this is a good bill, even a great one. We need it for moral reasons. We need it for our fiscal health and to reduce the deficit. We need it so that business can be more competitive internationally. If this bill passes tonight it will be the most important piece of legislation that has passed in my lifetime. It is time to do the right thing and pass the bill.

UPDATE: Well, they did it! History has been made.