After what feels like seventeen years and 14 million column inches the Senate passed the healthcare bill 60-39 today (no Republicans voted for it). Assuming they agree on a final version with the House, here's what it will mean.

The public option and expansion of Medicare have been much discussed. They did not make it in the forms many wanted — due partly to the intransigence of Joe Lieberman and Ben Nelson. According to the New York Times, this is the substance of what passed. The bill would:

  • Require that most Americans have health insurance.
  • Add 15 million to Medicaid.
  • Subsidize private coverage for low and middle income people (at a cost of $871bn over 10 years, according to the Congressional Budget Office).
  • Cover 31 million Americans who are not currently covered, but leave 23 million uninsured in 2019, according to the CBO.
  • Prevent insurers denying coverage because of a person's medical condition.
  • Prevent insurers discriminating on the basis of sex or health status.
  • Prevent insurers rescinding care when someone becomes sick or disabled.
  • Force insurers to include a summary of benefits that "does not exceed four pages in length and does not include print smaller than 12-point font."
  • Limit insurance company profits by forcing them to spend between 80 and 85 cents of every dollar on healthcare.
  • Set up healthcare exchanges — a kind of marketplace for insurance shoppers which feature tax credits — that are the last remnants of a public option.

The bottom line seems to be that it's not perfect, but it is something. The thorny issue of abortion — many old men without wombs in both houses would like to deny it to women — will be dealt with when the House and Senate bills are reconciled. Here are some views from Senators, taken from the Times piece:

Senator Sherrod Brown, Democrat of Ohio, said insurance companies were often "just one step ahead of the sheriff."

Senator Dianne Feinstein, Democrat of California, said the industry "lacks a moral compass."

"Premiums are out of hand," Mrs. Feinstein said. "Chief executive salaries are out of hand. Administrative costs are out of hand. My bottom-line belief is that the health insurance industry should be nonprofit."

And Senator Sheldon Whitehouse, Democrat of Rhode Island, said the business model of the health insurance industry deserved to die.

"It deserves a stake through its cold and greedy heart," Mr. Whitehouse said.

The stake seems to have missed its target. But it may have wounded the insurance industry enough to make it more manageable.