Just a few hours ago Barack Obama became the first Democratic President to succeed on getting comprehensive health care reform through the House of Representatives.

This has been a cherished goal of the American Democrats since Harry Truman's administration over a half-century ago. Finally, almost all Americans (including, for the first time, the very poorest) will be able to access health care, something that has been a given in places like New Zealand, Britain and Western Europe for most of the past century.

I still believe though that Obama's health care legislation is somewhat flawed in that it hasn't gone for a  universal, single-payer model where government funds all of the health care required by its population. This approach has never sat well in laissez-faire America where a supposedly ingrained distrust of government has been manipulated by private health care providers and insurers in their continuous propaganda campaigns against any form of publicly funded health care provision. But this new law is a positive first step in that direction.

After all, progressive social and economic policy is not an alien concept in the US. Franklin Delano Roosevelt's administration strengthened the role of the federal government within the economy by introducing Keynesian economic policies during the Great Depression. Roosevelt also oversaw the introduction of social security (albeit in a more limited form than in New Zealand or elsewhere) for the unemployed and those with disabilities and long-term illnesses. These policies greatly expanded the role of the federal government in America. Far from being unpopular, Roosevelt was returned to office in three sucessive presidential elections after his initial 1932 victory with substantial popular vote majorities.

The other great socially reforming president of the last half-century was Lyndon Johnson. In 1964, he initiated his 'Great Society' programmes which sought to relieve the poverty experienced by many Americans. While he didn't succeed in cutting poverty levels in the way that he and his administration had hoped (thanks to Vietnam), his programmes which included the introduction of free school lunches and the launching of Medicare and Medicaid to provide limited health coverage for the oldest and most poorest Americans saw the federal government become more involved in social policy.

Since the mid-1960s, progressive social policy advances have been few and far between. Due to the Republicans exercising a near stranglehold on the occupancy of the White House between 1968 and 1992 under the respective presidencies of  Richard Nixon, Gerald Ford, Ronald Reagan, and George Bush Senior, no major social policy advances of note were recorded. While the Democrats controlled the Congress for this whole period, there was little hope seen of moving towards universal health coverage in America unless there was also a Democrat in the Oval Office. This was the case as the presidency of Democrat Jimmy Carter (1977-1981) only proved to be a brief interregnum in the Republicans hold over the White House.

However, the election of Bill Clinton to the presidency in 1992 spawned new hope that health care reform could succeed. Clinton and then first lady Hillary Clinton drove the health care reform effort into a storm of Republican and private health sector opposition during 1993/94. Health corporation lobbyists trumpeted that universal health care (with private insurers still being guaranteed to control the market, albeit under stricter regulation and cost controls) would mean the beginning of the end for liberty and freedom in America and a wholesale turn towards Communism. This level of hysteria was reflected in what turned out to be a very successful public relations scare campaign waged by the corporate lobby. This smear campaign doomed the effort and cost the Democrats control of Congress at the 1994 midterm elections. It also saw the Clinton Administration turn further to the political right in an effort to attract moderate Republicans.

With the victory of Barack Obama in 2008, the new administration vowed to learn the lessons of Clinton's health care debacle of a decade earlier and succeed this time. The new president was swept to office on a tide of popular disillusionment with unfettered capitalism following the global financial crisis of September/October 2008. Changing attitudes towards health care reform had been detected somewhat earlier as was evidenced by the public reaction to American left-wing film maker Michael Moore's documentary Sicko which detailed the shortcomings of America's health system for all to see. The sight of even ordinary middle class Americans not being able to afford cover or knowing of people with pre-existing conditions being denied cover finally convinced the majority of Americans (as shown in polls) to favour health care reform.

Now, with all the political stars in perfect alignment Obama has made his move and succeeded. While the Republicans and the corporate health lobby managed to scare most Americans into believing the worst, Congressional Democrats have defied the odds and voted yes to reform. Obama and his Congressional allies well know that, beyond the opinion polls, many Americans deep down favour reform so that more of their fellow citizens can access care. To say that these reforms will be tantamount to turning America into a Communist state (as Fox News, the Republicans, Tea Party activists and some corporate health advocates will continue to scream) are nonsense. If anything, the American system will continue to be vastly dominated by private health insurers with the only difference being that they will be required to cover previously ineligible groups, accept public subsidies and reduce some of their heinous premiums. In fact, to most of us on the left in New Zealand, the type of health care system that America will have post-reform is close to that advocated by the most right-wing, free market party in this country, the Act Party. Due to our social democratic heritage, we would regard even Obama's health reforms to be anathemnic but, in American terms, this is progress.

Despite these reservations, I say congratulations to President Obama and House Democrats for this victory. May I say to any American readers of this blog that you need not fear public health care and social provision. While imperfect in many ways, it is still worlds better than the American free market health system where whether you live or die has (until now) been determined on the size of your income.