“The bill I’m signing will set in motion reforms that generations of Americans have fought for and marched for and hungered to see,” declared Barack Obama on Tuesday as he signed into law the most comprehensive piece of social legislation in his country in almost half a century. Using 22 pens in the cumbersome process which has become standard for such ceremonies, the US president attached his signature to the Patient Protection and Affordable Care Act, which was narrowly adopted by the House of Representatives in Washington late on Sunday night.

It is the end result of more than a year’s worth of processing rather like that used to produce sausages, and the bill is something of a sausage itself. That’s because it consists of a good deal of substance, a little bit of seasoning, a fair amount of filler, a few drops of colouring and a dash of flavouring to make it palatable.

From the outset Obama extended a conciliatory hand to his political opponents in the Congress, inviting them to work with him to fix the most glaring of the problems affecting their country. All he met at every turn was negativity, obstinacy, stonewalling and obstruction. The sullen Republicans just could not bring themselves to accept that they had lost the elections, both for the executive and the legislature, and they did everything they could to stymie the Democrats and their president.

Cheering them on from the sidelines were the braying troglodytes of the right-wing media who epitomised what Spiro Agnew, a Republican vicepresident of a generation ago described as “nattering nabobs of negativism”. The graceless loudmouths spouted a steady stream of bile, trash talk, misrepresentation, personal attacks, bigotry and outright racism.

The first big problem Obama had to tackle was the unprecedented economic collapse resulting from the shameful shenanigans of the mob on Wall Street who used the money they were entrusted with as if it were chits in a giant Monopoly game. Their efforts wiped out the investments of countless people, not all of them wealthy, and threw many on to the streets when their places of employment had to close.

Although the collapse didn’t happen on his watch, he had to take responsibility for cleaning it up, and did so by throwing unbelievable amounts of money at the problem. People generally don’t like taxes – Americans most of all – and the right wing were able to exploit this to the full. The most radical among them formed what they call the Tea Party movement, taking their cue from the early settlers who objected to being taxed by the British king without having any say in how they were governed and staged what passed into history as the Boston Tea Party.

Obama and his cohorts allowed these miscreants to gain the initiative and consequently saw his huge public support plummet. The health reform bill itself went back and forth between the two houses of Congress like a shuttlecock over a badminton net, each time changing shape and form as this piece was whittled off because a set of people didn’t like it; that part was altered to suit another constituency; yet another portion jettisoned and something else substituted.

No one was sure what would emerge – the House of Representatives had one version which included, for instance, a publicly financed and publicly run insurance plan, while the Senate had a much more timid blueprint. The elephant in the room – and outside as well – was the enormous lobby mounted by the powerful, influential and very well financed lobby of the health insurance companies and the drug manufacturers. They flooded Washington with hundreds of lobbyists and have pumped hundreds of millions of dollars into the election campaigns of many members of Congress, both Republican and Democrat.

Credit for the eventual outcome must go to the Speaker of the House, Nancy Pelosi, a Democrat who represents a congressional district in San Francisco. She is from a very political family: her father was also a congressman who used to keep stacks of the record of proceedings of the House under the bed where she slept as a girl. A long-time member of the Democratic Party, she has held many party posts in California and worked in a string of campaigns before she herself ran for office. She is a firstrate tactician and worked her caucus tirelessly to achieve the positive vote.

Unlike politicians in a parliamentary system, members of the US Congress are far less bound by party lines and generally vote in keeping with their own beliefs (prejudices even) as well as the dictates of their own constituencies. So on Sunday, as the Republicans voted in a bloc against the bill, Pelosi still could not persuade 34 conservative Democrats to support the measure, and Obama had to buy off anti-abortion members of his party with a promise to sign an executive order affirming that federal funds would not be used to subsidise abortions.

The new law will extend insurance coverage to more than 30 million Americans who now have no coverage, and will outlaw some of the most egregious practices of the health insurance industry, such as ending coverage when insured people get sick, eliminating annual and lifetime caps on the number of benefits an individual can obtain, and no longer refusing coverage to people who already have health problems. The law will require Americans to buy health insurance or pay a fine and extend provisions of existing government programmes for the very poor and seniors.

Obama and his people appear to have learnt an important lesson from the bashing of the past year, and have launched a campaign to sell the law. No sooner had he signed the bill than Obama sped over to the biggest auditorium his staff could find — at the Department of the Interior — and spoke to some 500 enthusiastic doctors, nurses, patients and federal employees. It was the first in a series of campaign-style visits he’ll make across his sprawling country.

It’s a task he has to undertake, since the Republicans are still fighting the law. The Senate went through the bill with a magnifying glass and has sent it back to the House to fix some minor glitches they found. Fourteen states are suing on the ground that the law is unconstitutional. And looming in the not-too-distant future in what the Americans call the mid-term elections, when the entire House of Representatives, one-third of Senators along with assorted governors, state and local officials are up for re-election.

The Republicans already have a campaign theme – to attack the Democrats for bringing in “socialist” legislation along with a pledge to repeal the law. But they’ll have to contend with the genuine sense of fatigue most people feel about the whole issue, and by the fact that the economy will most likely improve. Most important, some positive effects of the new legislation will begin to emerge and many people – rock-ribbed, bred-in-the-bone Republicans included – will be able to care for a child with chronic conditions like leukaemia or cystic fibrosis without facing bankruptcy.

keeble.mack@sympatico.ca