The Beginning, Not The End

History in the making. That about sums up the signing ceremony today, when Barack Obama put his name on the health care reform bill—now officially the health care reform law—passed by the House this weekend.

Historic, for sure. But also sure to mean much more lawmaking—and many more bill signings—for Obama and his successors in the years to come.

We are not just talking about the reconciliation “sidecar” bill that Obama will sign shortly (assuming, of course, that the wheels don’t fall off this sidecar in the Senate).

Rather, we mean the legislative tinkering in health care in the years ahead, bills that will tweak, build-on, rethink, fix, undercut or over-engineer the new health care law.

Consider Medicare, the only reasonable model for the current legislative initiative. The law was enacted in 1965, signed by Lyndon Johnson…and amended by every single one of his successors, up to and including Obama, today at the signing ceremony.

Here is the “official” history of Medicare, as recorded by the Centers for Medicare & Medicaid Services. By our count, there are at least 14 pieces of legislation highlighted on the list, or about one every three years (since the "history" ends in 2003 with the Medicare Modernization Act--since amended twice...).

And CMS' list doesn’t include minor changes tacked into little bills each year—nor bigger ideas that generate considerable legislative energy but fail to make it to the President for signature.

That is probably a reasonable marker for how health care reform will continue in the years ahead, with some changes to the new program sure to happen every couple of years or so.

The new law truly is history in the making: it will keep on being made for many decades to come.