That he gave us what a reasonable observer should have expected from him is a different point.

And, it's all well and good to be centrist and bipartisan, but there still have to be principles at the core, things that are deal-breakers.  There was a remarkable and deafening silence from Obama in the area of women's health; he chose to be a mere spectator in an area that I, at least, think required some leadership.  If he could twist arms and threaten members of Congress if they did not get on board and pass his war funding bill, one can only conclude that Obama did not get involved in this area because he agreed with it.  Agreed that women could be thrown under the bus, agreed that the public option was unnecessary, agreed that reform could wait for another four years, agreed that we should not reimport drugs from Canada - not right now.  Agreed, agreed, agreed.

I think what we may discover is that "purple" is the color of apoplexy.

If I get seriously ill, the pre-existing conditions waiver is going to help me buy insurance (RIIIGHT?).  So I'll just buy the insurance when it's needed.

If I have an emergency like a heart attack, I'll just file bankruptcy.  Fvck them.  Fvck everyone who supported this crap.

At present, I carry high enough deductible insurance that I pay most of my medical care out of pocket.  When I drop insurance, I'll pay all of it.  And again, barring extreme sickness, it'll be cheaper to do this than it is now to carry insurance, and definitely less expensive once we're getting even further railroaded by insurance via Obama's bill.

And the moment Obama signs this bill I vow NEVER to vote for a Democrat again.  Because guess what? Democrats are NOT better than Republicans.  Maybe they once were, not now.  I'm glad Jane at FireDogLake has figured that out well enough that she's actually working with Grover Norquist.  People at DailyKOS are screaming about that.  But maybe they'll someday figure out that Obama no more has our interests at heart than Norquist does.  And anything that kills this bill no matter who you have to work with to do it, is a good thing.

So, you see, Obama likes to have it both ways.  He uses flowery progressive rhetoric even when the "change" achieved is actually strictly compromise and may well be regressive, not progressive.  Whatever else may be said, this is insurance company welfare if nothing else.

Reagan was a transformative political figure because he was able to get Democrats to vote against their economic interests to form a majority to push through their agenda

yet I tend to think it's very hard to understand anything that obama States.

Look at teh absurdity of the Nobel prize Speech/Venue/Afghan context.

Look at his attacks on Mandates in the primary wars.

You can see different results for policies purchased through the "exchange" for House and Senate bills as they now stand.

Pretty interesting.  I note that both bills come out with lower premiums (including subsidies) for me than the very good VT system.

In his 2008 online platform (link to PDF), Obama promises that "any American will have the opportunity to enroll in new public [health care] plan."

On the other hand, during his presidential debates Obama never mentioned a public option, and throughout his 2008 campaign, most of Obama's speeches talked about the desirability of a public option but did not specifically promise to create one.

So the evidence seems mixed. Obama made campaign promises in his platform, but as we all know, a campaign platform represents a set of aspirations and it's not fair to hold a candidate to account if s/he fails to enact every single one of the elements in the party platform. In America, the president's ability to act (outside of war-making, and a handful of executive orders governing national parks, etc.) remains limited by congress's ability to legislate.

In a general sense, Obama promised to push for health care reform and he did that. He never promised a single-payer system, and he never pushed that plan, so no one can blame him for not enacting single-payer. Obama talked about public exchanges from the git-go, and the HCR bill contains public exchanges. The problem remains that with single-payer off the table, Obama had no big stick to compel insurance monopolies to change their behavior, and the current system has no real incentive to change without the threat of fundamental change to a non-profit system hanging over their heads.

At this point the big question remains: will this health care bill merely involve a return to business as usual for our broken health care system (as the TARP bailout represented just a speed bump for the U.S. banking system and has now returned to business as usual with no reform and every prospect of a much bigger systemic breakdown sometime soon)?  Or will this health care bill mark the start of incremental change leading to genuine reform (as in the individual state legalization measures for marijuana, which appears to raise the prospect of a genuine change in the failed and futile "war on drugs")?

Briefly, our overriding question now is whether this health care reform bill will be a compromise that turns into a trainweck like the No Child Left Behind bill of 2001, or a compromise that contains only a few progressive provisions like the Civil Rights act of 1964 but which subsequently gets expanded and amended to produce genuine lasting change, as the subsequent civil rights legislation did in 1966 and 1968.

At present, the HCR bill requires insurance companies to create public exchanges which in effect compete with the for-profit insurance sold by the companies themselves. The stick to force for-profit insurance companies to do this is the threat of a trigger which creates a full public option if the insurance companies drag their heels.

The devil's in the details, though. What happens if the insurance cartel simply bribes congress to look the other way as the insurance exchange fills up with uninsurable sick people and insurance premiums for the public exchange rise to, say, $20,000 per month?  

We also don't know what will come out of reconciliation. The senate has passed HCR but the house and senate bills still need to get reconciled, and only 50 votes are needed to pass the reconciliation bill. Lieberman and the other  sociopaths will play little part in a 50-vote reconciliation bill.

The HCR bill consists mostly of experiments design to cut costs. The insurance exchanges and other highly-touted provisions only amount to a few pages; most of the HCR bill involves various experimental cost-cutting plans. Some commentators have argued that over the long run these provisions will dramatically reduce America's health care costs and produce a massive reform in our health care system, as FDR's patchwork reforms succeeded in dramatically boosting farm productivity from the late 1930s on.

But will they?  The No Child Left Behind legislation did not result in fundamental reform of our broken educational system -- American teens score below all other developed nations on math and science, despite the No Child Left Behind legislation. Will this health care reform bill be a failure like the NCLB, serving only to make things worse?  It's easy to see how things could get worse -- if you're one of the working poor who can't afford private insurance but you have to pay a fine because of the mandates, now you'll have even less money than you did before and you'll still have no insurance. Meanwhile, if the insurance companies bribe congress into letting them using the public exchanges as dumping grounds for uninsurable sick people, the premiums for the public exchange insurance could easily wind up being much higher than the unaffordable regular insurance offered by for-profit companies. So if you're a recent college graduate working part-time at UPS for minimum wage or a single mom with two kids working at Wal*Mart, this HCR could reduce your income with fines without providing you insurance. That's worse than the current system.

With for-profit insurers left in charge of a gross inefficient fragmented health care system, why would they change?  How can reform occur?  

One of the fundamental drivers behind the high cost of U.S. health remains the profit motive which induces doctors to act as businessmen, start their own storefront labs, and sell wildly overpriced medical tests to hospitals (see this New Yorker article for evidence). Where doctors act as businessmen in a fee-for-service system, costs explode...and not merely by 10% or 20%, but bya factor of 5x or 7x (500% to 700% more expensive than medical services in other countries), with typical fees for common services like a routine office visit running $151 in America but $22 in countries like Germany. What does the HCR bill do to discourage doctors from setting themselves up as businessmen and raking in vast amounts of cash on insanely overpriced imaging scans and medical tests?