Globe Editorial

After landmark health vote, a thorny new phase of reform

March 23, 2010

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PASSAGE OF health-insurance reform creates two new beginnings. The first is for the health-care debate, so long mired in how to provide coverage to the uninsured, that can now turn relentlessly to cost containment, the great challenge of the next few decades. The second is for Barack Obama, who dedicated his first year in office to letting Congress work its way through a single issue, albeit a complex one.

In the two months since Scott Brown’s surprise Senate victory seemed to portend political doom for Obama, the president has answered his critics. His willingness to take responsibility both for the process of health reform, and for the substance of the bill, was instrumental in its passage. He showed he could be both resolute and politically dexterous.

Now Obama must decide where next to turn. Climate change legislation has been bubbling on the back burner while health care consumed most of the heat, and it’s almost as ideologically charged and subject to misrepresentation. Almost immediately, Obama will have to decide whether to push ahead on a modified “cap and trade’’ plan, creating incentives for power plants to reduce carbon emissions, before the mid-term elections. The House has already passed a bill; the Senate, with its filibuster rule, presents an enormous obstacle. The administration must assess quickly whether it has enough Senate support to move quickly on climate change.

More likely — and perhaps necessarily — the president will move to enact financial reforms, including strong consumer protections, that will prevent banks from jeopardizing their solvency by expanding into risky businesses.

Though such legislation won’t create jobs by itself, it should safeguard the credit markets enough to allow more lending. As part of his enhanced economic focus, Obama could also address jobs-producing issues such as trade with China.

But no one should believe that health care reform is complete. As Massachusetts well knows, the extension of health insurance to almost all citizens is just the precursor for equally thorny disputes over reimbursements. Structural weaknesses remain in the health system, and the pace of medical advances guarantees that costs will rise even in the leanest of systems.

There are competing theories about the implications of Sunday’s health vote. One group believes the reforms will become so popular they will buoy the Democratic Party for a generation, and another that they will be so unpopular that the Democrats will suffer grievous losses in November. Neither is likely to happen. Health care is now so deeply embedded in the economy, the government, and social issues that it will continue to consume an equivalent space on the political stage. Far from ending, the health care debate will go on and on.

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