Finally, in a nod to the fact that a final bill -- which still has to be worked out by the House and Senate, and then passed again -- will not, as he and his fellow Democrats had hoped, be hitting his desk before the end of this year, Obama said, "For the sake of our citizens, our economy, and our future, let's make 2010 the year we finally reform health care in the United States of America."

Obama's full statement:

In a historic vote that took place this morning, members of the Senate joined their colleagues in the House of Representatives to pass a landmark health-insurance reform package; legislation that brings us toward the end of a nearly century-long struggle to reform America's health-care system.

Every since Teddy Roosevelt first called for reform in 1912, seven presidents -- Democrats and Republicans alike -- have taken up the cause of reform. Time and time again, such efforts have been blocked by special-interest lobbyists who perpetuated a status quo that works better for the insurance industry than it does for the American people.

But with passage of reform bills in both the House and the Senate, we are now finally poised to deliver on the promise of real, meaningful health-insurance reform that will bring additional security and stability to the American people.

The reform bill that passed the Senate this morning, like the House bill, includes the toughest measures ever taken to hold the insurance industry accountable. Insurance companies will no longer be able to deny you coverage on the basis of a pre-existing condition. They will no long be able to drop your coverage when you get sick.

No longer will you have to pay unlimited amounts out of your own pocket for the treatments you need. And you'll be able to appeal unfair decisions by insurance companies to an independent party.

If this legislation becomes law, workers won't have to worry about losing coverage if they lose or change jobs. Families will save on their premiums. Businesses that would see their costs rise if we do not act will save money now and they will save money in the future.

This bill will strengthen Medicare and extend the life of the program. It will make coverage affordable for over 30 million Americans who do not have it -- 30 million Americans.

And because it is paid for and curbs the waste and inefficiency in our health care system, this bill will help reduce our deficit by as much as $1.3 trillion in the coming decades, making it the largest deficit-reduction plan in over a decade.

As I've said before, these are not small reforms; these are big reforms. If passed, this will be the most important piece of social legislation since the Social Security Act passed in the 1930s and the most important reform of our health care system since Medicare passed in the 1960s.

What makes it so important is not just its cost savings or its deficit reductions. It's the impact reform will have on Americans who no longer have to go without a checkup or prescriptions that they need because they can't afford them, on families who no longer have to worry that a single illness will send them into financial ruin, and on businesses that will no longer face exorbitant insurance rates that hamper their competitiveness. It's the difference reform will make in the lives of the American people.

I want to commend Senator Harry Reid, extraordinary work that he did, Speaker Pelosi, for her extraordinary leadership and dedication. Having passed reform bills in both the House and the Senate, we now have to take up the last and most important step and reach an agreement on a final reform bill that I can sign into law.

And I look forward to working with members of Congress in both chambers over the coming weeks to do exactly that. With today's vote, we are now incredibly close to making health insurance reform a reality in this country. Our challenge then is to finish the job.

We can't doom another generation of Americans to soaring costs and eroding coverage and exploding deficits. Instead, we need to do what we were sent here to do and improve the lives of the people we serve.

For the sake of our citizens, our economy, and our future, let's make 2010 the year we finally reform health care in the United States of America.

Dean's reservations have been widely echoed on the left. The healthcare bill's big winners, they complain, are the insurance industry, pharmaceutical companies, hospitals and doctors. Because it lacks both the "public option" (a government-run insurance company competing with private ones to drive down costs) and the Medicare buy-in that was initially highly touted, then quickly shot down by Holy Joe Lieberman, some Democrats fear that the party is both providing inadequate coverage and setting itself up for a voter backlash.

Once the public realizes that the bill mandates everybody to buy private health insurance — pretty much the way everybody has to carry auto insurance — there's sure to be unhappiness not only on the tea-party right, but also among working people who ordinarily lean Democratic. Politics Daily's David Corn saw it coming. "I feel as if I'm watching a cheesy horror flick and some poor unsuspecting person is about to open the wrong door," he wrote last September, "and you want to scream, 'Hey, don't open that door!'"

To be sure, the bill provides generous subsidies for individuals and small businesses currently unable to afford coverage. And it doesn't kick in for a couple of years, when one hopes the current recession will be a bad memory.

© 2009 by Gene Lyons. Distributed by Newspaper Enterprise Association

Even so, Salon's estimable Glenn Greenwald sees it as a sellout: "The healthcare bill," he writes, "is one of the most flagrant advancements of ... corporatism yet, as it bizarrely forces millions of people to buy extremely inadequate products from the private health insurance industry — regardless of whether they want it or, worse, whether they can afford it," even with some subsidies.

MSNBC's self-dramatizing Keith Olbermann goes further, vowing to become what the Russians used to call a "refusenik." "I hereby pledge," he announced, "that I will not buy this perversion of healthcare reform. Pass this at your peril, senators. And sign it at yours, Mr. President. I will not buy this insurance. Brand me a lawbreaker if you choose. Fine me if you will. Jail me if you must."

As diverting a spectacle as that might be, for Democrats to heed such overheated rhetoric would be catastrophically foolish. Olbermann and others spent the 2008 primaries charging that Democrats skeptical of Barack Obama had racist motives. Now that he's poised to sign the most far-reaching enhancement of the American social contract since Lyndon Johnson, President Obama has now been rendered impure in their eyes.

Here are a few truths: First, we've been living in a one-dollar, one-vote corporatized democracy for a long time. If this is news to you, then you're probably also shocked to learn that the U.S. Constitution, by awarding two senators to each of what H.L. Mencken called "the cow states" — no insult to the cows in my own barn — was deliberately crafted to make fundamental change difficult. Who made "moderates" like Blanche Lincoln of Arkansas, Ben Nelson of Nebraska and Joe Lieberman of Aetna mini-presidents? Alas, the founding fathers did.

Living in such a polity, anybody who thought entrenched interests like the insurance, pharmaceutical and hospital industries weren't going to find ways to make money off healthcare reform probably wasn't paying attention back at the beginning, when Obama said that despite the abstract appeal of a Canadian-style single-payer system, it was a political non-starter. As Greenwald points out, that told you right there that the White House was going to settle for the best corporate compromise it could get.

Sure, there's a risk of backlash. The problem is no universal or near-universal health-insurance plan — public or private — can be voluntary. Mandates are, well, mandatory to prevent opportunists from gaming the system: Buying insurance only after they get sick. Nobody can insure "previously existing conditions" if clients come and go at will.

Insurers forbidden by law from canceling policies also need a base of healthy rate payers. Public or private, it's a two-way street; costs can't be cut without a bigger risk pool.

Indeed, a gradual counter-backlash seems likelier, as all but the most perfervid tea partiers gradually recognize that their families are more secure, and that none of the GOP scare stories — "death panels," rationing, etc. — have any basis in reality. Retreat now is unthinkable. Imperfections notwithstanding, once universal coverage is established in principle, there'll be no going back.

The ad's going to be running in Washington, D.C., as well as in Wisconsin -- the latter is an attempt to change liberal Sen. Russ Feingold's vote, Sam Stein reports. Notably, it goes right at the heart of Obama's appeal during the presidential campaign, saying at the end, "A bill without a public option is not change we can believe in."