I do hope what has been accomplished so far is simply the beginning - that we'll be able to enact new and better reforms quickly. But, quite frankly, I'm not hugely optimistic. The insurance and pharmaceutical companies are just too powerful and the Democrats are too intimidated.
Obama and the Democrats have no real vision for a transformed health care system, so they’ve gone for a slightly modified version of business as usual. They’ve cut backroom deals that win a few meager concessions toward the public good, while at the same time ensuring the profits of the insurance companies, Big Pharma, and other health care profiteers by maintaining their basic control of the health care system and rewarding them with bigger assured markets and more and more money. (To make matters worse, at the last minute they also cut a deal with anti-choice members of their own party that will further undermine women’s access what was, when I last checked, still a legal medical procedure.) In other words, they’re doing what Democrats have done since at least the Clinton years–acting like kinder, gentler Republicans, rather than like the defenders of the common people.
A whole lot of Americans don’t like the current health care system, and a whole lot more hate insurance companies. The Democrats might have been able to translate that into some sort of populist support for real change. Instead, they dithered and compromised, and failed to invoke any compelling ideology. Health care ought to have nothing to do with profits. It should be a basic human right in a civilized society. But that’s precisely the kind of statement the Democrats are unwilling to make—so they end up saying nothing at all.