When Congress passed Medicare in 1965, it went into effect one year later. In contrast, the major provisions of the health-care reforms now before Congress would not go into effect for three years (January 1, 2013, under the House bill) or four years (January 1, 2014, under the bill being voted on by the Senate).

The House's timetable is bad enough, but the Senate's timetable is, to put it bluntly, nuts. A four-year delay in delivering benefits from reform would give rise to widespread disappointment and confusion during the intervening years, and it would expose the entire program to the risk of being overturned in the 2012 election, if not in 2010.

When I worked at the White House in 1993 on the Clinton health plan, one of my responsibilities was to think through the "phase-in"--the series of steps that would be required to put the legislation into effect. I haven't been involved this time, but I don't think it's a deep mystery as to what is motivating the decision to delay the program, though it seems to me to invite more problems than it avoids.

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The other participants in our dialog have already made a series of mainly overlapping cases for passing either the current senate bill or the senate bill plus some minor improvements in conference that look likely to be the only changes that will be possible. But there's another point that Theda alludes to that I'd like to take a moment to discuss.

The big thing that scares me about this current bill is 2014 -- the year when a lot of the key reforms actually go into effect. Assuming this bill works at least something like it's supporters anticipate, once it fully takes affect it should be pretty hard to undo, because people will see in tangible ways how it improves their access to and the security of their health care coverage. People's own real world experience should trump all the crazy that's getting pumped out of the Fox-o-sphere about death panels and needing to get your mammogram at the Post Office and all the rest of it.

But until there's any real world experience to have, there's no reason to think the lying will be any less effective.

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The 2009 health reform end game -- yes, the end of the beginning is in sight -- has been excruciating for progressives. Reforming health care in the real world in which we live means paying to include millions more Americans while fending off all of the tricks America's privileged, left and right, use to resist paying taxes; and it means finding ways to use public regulations and subsidies to put health delivery and finance on a more sustainable path for us all, while watching key mechanisms like the public option shrink and disappear to buy the votes of a few weasly "Democrats" in Congress who want to guarantee profits for private insurers.

Understandably, some progressives see what's left at the end of these struggles as not worth their support. But history tells us this is mistaken. We should take the many big steps forward that are on the table now -- above all the expanded entitlement, the regulations of private insurance, and the increased subsidies for the less fortunate -- and accept that true "health care reform" remains a multi-year, multi-election struggle. Social Security took several decades to become universal and adequate; Medicare did not include cost controls or key benefits for many years. Both programs moreover, had to be improved and defended at the same time, because conservatives attacked and tried to dismantle, even as liberals fought to improve and expand. The same will happen here.

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Here's my position. In these final days of the health care fight, progressives should work hard to improve the health reform bill in the Senate and in the conference with the (better) House bill. But we should support the passage of the best bill we can get - and then keep fighting for more and better reform.

We always knew that winning health care for all Americans would not be easy. Yes, the health care crisis is hitting more and more Americans, but the special interests that now control America's health-industrial complex would fight fiercely to stop reform (as they did against Bill Clinton) or to shape change to their own ends.

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Bob Reich agrees we should pass health care reform. But, like a lot of our fellow travelers on the left, he's not at all happy about it, given the way it's likely to work out. Insurers will win. Drug and device makers will win. Doctors and hospitals will win. Basically, everybody will win except the public.

Broadly speaking, I agree with his list of winners. Almost every group in the health care industry complaints that reform will squeeze them and, in fact, some members of each group will be squeezed. (Small insurers will have probably have trouble surviving once they have to compete in the exchanges, inefficient hospitals will struggle with more scrutiny from Medicare, etc.) But overall, I think, there's no question these industries stand to benefit on the whole. All of them will benefit from millions of new customers. They may have to change the way they do business. But, once they do, they should make out well. In some cases very, very well.

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When I proposed an alternative to the individual mandate last week in The American Prospect, I mainly thought of it as a means of averting a backlash by conservatives and by people who would be so poorly informed about the subsidies in health-care reform that conservatives could scare them into a revolt. Little did I realize that once the Senate dropped the public option, there would be a revolt against the mandate by some progressives who are doing their best to sound like Tea Party right-wingers.

Let's go over the reasoning behind the mandate. If you eliminate pre-existing condition exclusions but don't have a mandate, the rational thing for healthy people to do is not to pay for insurance until they get sick. But if healthy people don't participate, the whole insurance system breaks down. And this would be true if all insurance was governmental.

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"Don't make the perfect the enemy of the better," says the President and congressional insiders when confronted with the sorry spectacle of a health-care bill whose scope and ambition continue to shrink, and whose long-term costs to typical Americans continue to grow. They're right, of course. But by the same logic, neither the White House nor congressional Democrats will be able to celebrate the emerging legislation as a "major overhaul" or "fundamental reform." At best, it's likely to be a small overhaul containing incremental reforms.

Real reform has moved from a Medicare-like public option open to all, to a public option open to 6 million without employer coverage (still in the House bill), to a public option open only to those same people in states that opt for it, or about 4 million (the original Harry Reid version of the Senate bill), to no public option but expanded Medicare (the Senate compromise) to no expanded Medicare at all (the deal with Joe "I love all the attention" Lieberman).

In other words, the private insurers are winning and the public is losing.

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The health-care reform legislation pending in Congress would be the largest program on behalf of low- to moderate-income people in the United States since the 1960s. Besides subsidizing coverage, it would create a new mechanism for purchasing insurance that would give greater buying power to people who now purchase policies individually and through small employers. It would eliminate pre-existing condition exclusions. It would enable people to buy policies at the same price regardless of their health (albeit with some allowance for differences in age). It would raise the standards of coverage for millions of people who are underinsured. It would represent a commitment by the federal government to make health insurance affordable to every American. And by making that commitment, the government would effectively commit itself to controlling both public and private health-care costs.

Oh, and by the way, according to the Congressional Budget Office, it would reduce the deficit and, according to the Medicare actuary, it would extend the life of the Medicare trust fund.

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Like a lot of people I don't have a firm grasp of the details of health care policy. So I've found it difficult to untangle for myself just what to think about the different iterations of the health care reform bill as it's evolved over the summer and fall. So I've pulled together a group of journalists and health care policy experts to try to help me hash these questions out.

My general take on this is that many people are overstating the centrality and significance of the Public Option, especially in the very constricted form it took in all versions on the Hill this year. At the same time, I'm wary of the political impact of the mandates -- even though I suspect they're necessary in any private-sector based plan because you have to broaden the risk pools.

Here's my question. What is in this bill (to the extent we can take the commonalities of the House and Senate versions) that makes it significant, meaningful reform -- assuming Public Options, Medicare Buy-Ins etc. are stripped out of it? Or is it?

Not only did Barack Obama's Cairo speech amply vindicate his election and inauguration as Barack Hussein Obama against the scare-mongering of 2008; it flushed out disingenuous ideologues on both sides of the Israel-Palestine conflict.

And -- stunningly, though so far not widely remarked - Obama made arguments against violence very much like those made here in April, thanks to the Israeli writer Gershom Gorenberg and the American writer Jonathan Schell, on the indispensability of coercive non-violence to struggles for liberation.

Obama's truths and arguments made believers in the armed-struggle, people's-liberation left squirm. But they made believers in the "This land is our land," Israel-Lobby right squirm, too. It's worth noting how.

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I don't think I could improve upon M.J. Rosenberg's summary of what the meaning of the Obama speech would be to the Mid East. Clearly it was directed at that audience and its reception (except perhaps in the Likud and other expansionist parties in Israel) was very good. What struck me was how a similar speech might be addressed to an American audience, perhaps at one of the Think Tanks that is at the heart of the American Military Industrial Complex. This is a speech that Americans may not be ready for, but some time in the next three years, Obama should make it.

Obama seeks a new beginning with the Arab World. Part of that is the acknowledgement of what can only be described as the Imperial history of American intervention in the Arab world. There are hints in the Cairo speech that he understands this legacy.

The relationship between Islam and the West includes centuries of co-existence and cooperation, but also conflict and religious wars. More recently, tension has been fed by colonialism that denied rights and opportunities to many Muslims, and a Cold War in which Muslim-majority countries were too often treated as proxies without regard to their own aspirations...

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The Obama team's remarkable wordsmithery and the president's unparalleled capacity for delivery were exquisitely on display again today in Cairo. But this speech should perhaps be remembered as much for what was not said. Gone was the arrogance and lecturing: there was no lavishing of praise on Egypt's undemocratic leader - the word 'Mubarak' was not even mentioned once. Out too was the purple finger version of democratization and even the traditional American condescension toward the Palestinian narrative. But perhaps most remarkably of all, the words 'terror' or 'terrorism' did not pass the president's lips. Here was a leader and a team around him smart enough to acknowledge that certain words have become too tainted, too laden with baggage, their use has become counter-productive, today the Global War on Terror framing was truly laid to rest.

Particularly striking was that President Obama almost certainly has emerged from the Cairo speech having accumulated additional capital rather than expending it, with greater popularity, traction, and respect among not only his ostensible target audience, the Muslim world, but also globally, including at home in America and even in Israel and with the world's Jewish community. His future leverage across a range of issues has been enhanced.

It's true that whenever the speech descended from the lofty heights of 30,000 feet to the 100-feet resolution of policy specifics and details, the magic dust seemed to dissipate as it emerged from the clouds, and those details were too often more autopilot than reset. But this was a big picture speech, and there is room later to make those course corrections on policy detail.

Here then are ten quick thoughts:

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The attacks on September 11, 2001 sent shock waves throughout the world. This act of terrorism, despite its horrific brutality, created a global period of solidarity and mourning. It also presented an unprecedented crossroad where the world could choose a new era of engagement.

Today, in Cairo, President Obama began to work toward exactly that. He gave the speech that should have been given after the events of 9/11 setting the stage for a more abundant, prosperous and secure world not by demeaning others, but by asking them to join in creating a secure and affluent future for all. A feat that can only be accomplished by nations working together.

Make no mistake, changing the dynamics of the global propensity toward fear and mistrust will take time. Further, altering embedded systems that have been around for centuries is no easy task.

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President Obama didn't disappoint all those in the Middle East and America who care about enlightened progress. He continued with his relentless push to end Israeli settlement activity and he spoke as an American leader reaching out to the Arab world that can be, to a Middle East that can be.

As one of Israel's Knesset members, Haim Oron of Meretz, put it: "The speech was the feat of enlightenment." For Israel, this is precisely the choice--will it be a country of the 21st century or a country of the shtetl?

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Myself I was impressed by Obama's offering himself to the Muslim world as a leader, the supple use of the Koran and of Islamic teaching, the embrace of his own Muslim background, and the willingness to dive into women's freedom. The students here were wild for him on this basis too, many of them say the speech was "amazing," a word I heard again and again from them. Several have told me how moved they were by his appreciation for Islamic prophets.

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Mission accomplished. For the first time in memory, an American President spoke to Muslims and Arabs not as antagonists who need to take certain actions before achieving US acceptance but as equals. Not only did the speech specifically reject western (and American) colonialism, its entire tone was the antithesis of colonial. This is a profoundly different American voice, one that will do much to advance American goals rather than to sabotage them.

Arab leaders who were listening to this speech might want to consider a similar speech of their own to their people. That is not going to happen. But they have to realize that this speech will significantly raise expectations among their own people. This is the kind of speech they have never heard before, and they will expect something like it, but from their own potentates next time.

The President conveyed eight distinct messages.

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"To those who cling to power through corruption and deceit and the silencing of dissent, know that you are on the wrong side of history; but that we will extend a hand if you are willing to unclench your fist." President Obama could hardly improve on this line, from his inaugural address, during his forthcoming much-heralded major speech to the Muslim world on June 4th. Better yet, he has already further reinforced this position when he announced--after an extensive strategic review--that the United States' goal in Afghanistan was "to disrupt, dismantle and defeat al Qaeda," full stop. To further this message, we have outlined here points we hope the President will include in his scheduled speech.

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Peniel Joseph's insightful post last week on equality smartly notes that on January 20th, "the very aesthetics of American democracy changed, both symbolically and substantively, through the ascension of a black man to the nation's highest office." It is the power of that image, and that ideal, that infused the week of inaugural activities from President Obama's address, to the first dance at each inaugural ball to the signing of each new executive order. This was a moment that much of America saw itself reflected back to itself from its leaders, a break from a history of white, primarily Protestant, Brahmin men, a triumph of meritocracy as well as the civil rights movement and perhaps the biggest push towards embracing a nation-wide movement of service to volunteerism in our history. A government by the people and for the people was finally of the people.

And yet amidst those cautious words of hope, I couldn't help but think of the continued economic, social, and tax marginalization of a group of Americans who were cast aside - particularly by this election and the presidential one before it. If we are to address community and equality in the Obama era, the legacy of this election's homophobic statewide ballot initiatives must be redressed through both legislative means and the President's bully pulpit. In the glow of our embryonic racial stabilization, it seems almost churlish to mention, and yet to not do so would be to undermine our communal path towards equality.

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There's little I disagree with in Michael Waldman's post or in his article on democracy for Democracy, and yet if it were a box of ideas, I would be unable to resist the temptation to dump it out and repack it differently.

The article brought to mind a concept one often hears in discussions of education or community development: We tend to focus on deficits - children's behavior problems or a community's problems with crime or poverty - and instead we should look for the child's or the community's strengths and build on those strengths.

It's a cliché in other fields, but the concept hasn't penetrated our discussions of democracy and the political process. The standard paradigm for talking about American democracy still always follows the deficit model: Identify a bunch of problems - big money, low participation, obstacles to voting -- and a set of procedural solutions to fix each one. The result is a list of reforms as long as your arm, not one of which is inspiring or has enough of an enthusiastic constituency to move it forward. For the last ten years, I've sat through countless meetings where democracy-reform activists insist that people "should" be more interested in these issues and then argue among themselves about which of the dozen or more complex, bloodless, over-hyped process reforms should be given priority, when and if the masses actually become interested.

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I just want to add a couple of points to the discussion on opportunity, one relating to progressives' tendency to get distracted by inequality when thinking about opportunity, and one relating to the evidence that is brought to bear when assessing how much opportunity there is.

When most progressives think of opportunity, they have in mind something like Amartya Sen's concept of capability - the chance to pursue whatever personal aims a person holds dear. As numerous political philosophers have recognized, there must be limits to what individuals can legitimately claim from their fellow citizens in pursuit of their aims. For instance, no amount of money might suffice to give the severely disabled "equal" opportunity. And I would expect that asking you all to subsidize me so I can go to Paris with my girlfriend would go over like flatulence in church. Nevertheless, the basic progressive conceptualization of opportunity is much less muddled than the idea among some conservatives that so long as there is a chance--any chance--at success in life, then there is equal opportunity.

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It's hard to disagree with much of Michael Waldman's lovely post. It is inviting at the level of principle (who, after all, is against creating a robust participatory democracy?). And he's right at the level of practice - matching funds and universal voter registration are entirely sensible policy proposals What Waldman doesn't say, however, is precisely why the proposals he offers will lead more people to engage with politics, and the why is far less idealistic than the happy notions of grassroots organizing and civic engagement that typically spring to the mind of progressives when they think about election reform. Political elites (parties, campaign organizations, political professionals, and candidates - all of the actors that progressives tend to disdain) are all but essential for generating the type of participatory energy and engagement that Waldman seeks.

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Theda Skocpol rightly draws attention to President Obama's focus in his inaugural address on promoting more broadly shared prosperity: "The success of our economy has always depended not just on the size of our Gross Domestic Product, but on the reach of our prosperity," he said.

Indeed, to date, too many Americans have failed to benefit from our nation's economic growth. Between 1947 and 1973, productivity and real median family income both grew by 2.8 percent a year. Since 1973, however, productivity has grown by 1.8 percent a year while real median family income has risen by less than half of that. The disconnect between aggregate economic growth and the income of typical families is accompanied by a large increase in inequality. Since 1979 the share of income going to the top 1 percent has risen by 8 percentage points while the share of income going to the bottom 80 percent has fallen by the same amount. The problem has been particularly acute in recent years, with the gains of economic growth accruing largely to those at the very top; the tax cuts enacted since 2001 have reinforced this long-term trend, increasing after-tax incomes for high-income families substantially more than for the rest.

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President Barack Obama's inaugural address may well be remembered as one of the rare moments in history where substance matched symbolism. On January 20, 2009 the very aesthetics of American democracy changed, both symbolically and substantively, through the acension of a black man to the nation's highest office.

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