Last night, the House of Representatives passed comprehensive healthcare reform after more than a year of fierce debate. The sweeping legislation will extend coverage to 32 million Americans, curb the worst abuses of the private insurance industry and attempt to contain spiraling healthcare costs.

The main bill passed the House by a vote 219 to 212, after which the House approved a package of changes to the Senate bill by a vote of 220 to 211. On Tuesday, President Barack Obama will sign the main bill into law. Then, the Senate will incorporate the House-approved changes through filibuster-proof budget reconciliation, perhaps as early as this week.

Landmark Legislation

Last night’s vote was a resounding victory for the Democrats. John Nichols of The Nation compares the passage of healthcare reform to other great milestones in American legislative history, including the Social Security, Medicare and the Civil Rights Act.

Like all great progressive victories, this one was hard fought. Paul Waldman writes in The American Prospect:

This effort will be remembered as one of the most anguished legislative battles in history, alongside the Civil Rights Act, the Federal Reserve Act, the creation of Medicare, and a few others. The positive outcome is not enough to restore one’s faith in the American political system, because the process did so much to destroy that faith. American politics has never been particularly reasonable or reasoned, but this debate saw a plague of demagoguery, fear-mongering, and outright lies that puts anything most of us can remember to shame.

Tea Partiers Slinging Slurs

Months of inflammatory rhetoric about communism and death panels whipped the right wing into a frenzy. Opposition reached a fever pitch this weekend as tea partiers and other anti-reformers gathered in the capital. On Sunday afternoon, some House Republican legislators further inflamed the angry protesters by shouting encouragement from the balcony of the capitol building, as Suzy Khimm reports for Mother Jones.

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Representative Barney Frank chastised his colleagues for riling up the protesters, saying, "It’s like the Salem witch trials–the health care bill has become their witch. It’s a supernatural force, and we’ve got hysteria."

In separate incidents several antireform protesters hurled racist slurs at Democratic legislators. Brian Beutler relates this shocking incident for TPMDC:

Civil rights hero Rep. John Lewis (D-GA) and fellow Congressional Black Caucus member Andre Carson (D-IN) related a particularly jarring encounter with a large crowd of protesters screaming "kill the bill"…and punctuating their chants with the word "nigger."

Standing next to Lewis, emerging from a Democratic caucus meeting with President Obama, Carson said people in the crowd yelled, "kill the bill and then the N-word" several times, while he and Lewis were exiting the Cannon House office building.

Adele Stan of AlterNet reported that one protester was arrested after spitting on an African-American legislator, Representative Emanuel Cleaver of Missouri.

The racial undercurrent to the antireform movement has been obvious from the beginning. The carefully coded language dropped away this weekend as protesters began to lose hope of killing the bill.

No Public Option… Yet

To the chagrin of progressives, the final bill does not include a public health insurance option. However, going back to Mother Jones, Suzy Khimm reports that Representative Lynne Woolsey, co-chair of the House Progressive Caucus, promised to introduce a bill to create a strong public option as soon as Obama signs healthcare reform into law.

Stupak, Stopped

As tea party protests raged outside, it seemed as if abortion might derail health reform. Representative Bart Stupak insisted that he had the votes to kill the bill. At the last minute, Stupak was placated with an executive order from the president reiterating that the healthcare reform would not fund elective abortions.

The executive order is a red herring. It won’t impose any further restrictions, it just restates the status quo. Mike Lillis posted a copy of the order at the Washington Independent. The president might as well have reiterated a ban on federal funds for vajazzling. Healthcare reform was never going to fund vajazzling or abortion, but if Stupak finds the repetition soothing, so be it.

The chair of the prochoice caucus, Representative Diana DeGette acquiesced to the Stupak compromise, describing the overall bill as a "strong foundation," according to John Tomasic of the Colorado Independent. Prochoice groups will be angry, but realistically, the executive order was the best possible outcome. For a while, it looked like Democrats were going to have to make substantive concessions to Stupak. In the end, he flipped his vote for a presidential proclamation of the status quo.

In a last-ditch effort to derail reform, the Republicans tried to reinsert Stupak’s strict antiabortion language into the reconciliation package. The Republicans were trying to poison the reconciliation bill in order to threaten its chances in the Senate, explains Mike Lillis of the Washington Independent. The gambit failed. When Stupak rose to speak against the motion, he was shouted down by Republican representatives. One unidentified member called Stupak a "baby killer."

Bad With the Good

Healthcare reform is not the progressive panacea that many had hoped for. The private insurance industry remains firmly in control, buttressed by government subsidies and no competition from the public sector. However, real changes are coming.

Within the next six months, children will be allowed to stay on their parents’ health plans until age 26. Lifetime benefit caps are history, and annual caps will be regulated. Insurers will no longer be allowed to dump customers who get sick, or offer coverage to children for everything but their pre-existing conditions.

Going Down in History

Whatever else Obama may accomplish, he will go down in history as the president who put the United States on the path to universal healthcare. Skeptics said it couldn’t be done. Adele Stan observes in AlterNet:

It took the first African-American president and the first woman Speaker of the House to do what generations of politicians had failed to do: create a federally regulated health-care reform program that extends health insurance coverage to the majority of Americans.

Healthcare reform is not an end in itself, it’s a process. Passing this legislation is the first step towards establishing healthcare as a right of all Americans. Like any attempt to expand the rights of the disenfranchised, the struggle will be met with fierce resistance.