Health care reform? I can’t do better than Dickens. It is the best of times, even though — on the merits — this is the worst possible bill. But it is a bill, which means it’s a start. Paul Krugman, who likes it, is exactly right. So is Firedog Lake, where they hate it and tell us everything we must do now to fix it.

I go back to the Kennedy for President campaign. Ted Kennedy, that is, in 1980. He lost. No HCR. In 1991, running on an all-out platform of universal health care/HCR, Democrat Harris Wofford won a special election for U.S. Senate in Pennsylvania against the popular former Governor and U.S. Attorney General Richard Thornburgh (and Wofford won it easily). Bill Clinton was elected president the following year promising to introduce HCR on “day one” of his administration. He didn’t, and long story of Hillaryycare short, no HCR. You will note, perhaps, that in between and following these episodes, long periods of Republican ascendance occurred, producing — no surprise — no HCR.

Which brought me to last year, when I rode to Washington with the ’09 crop of HCR’ers and, once again, breathed deeply the air of freedom. HCR. With a public option. Yes, We Can! That’s when I met Rhonda Robinson, the Durham woman who was out of a job and, because of that fact, off the insurance rolls and living in fear with her epilepsy.

I’ve never forgotten that, whatever else HCR was about, it was about the Rhonda Robinsons whose lives were literally in peril because the United States, alone in the industrialized world, links health care to earnings. Good earnings, good health care. Bad earnings, or none? Your health care line is around the back.

Of all the ways we could’ve chosen to reform health care, we’ve chosen the worst. Control remains firmly in the hands of the medical-pharmaceutical industrial complex, which overcharges for everything it does in the manner of the military-industrial complex of Dwight Eisenhower fame. On top of that, we not only didn’t put a nick in the health care insurance industry, we’re now going to require that everybody buy access to the overpriced health care system through the monopolistic and overpriced health insurance industry, adding 20 percent or so to our otherwise out-of-control health care spending. Oh, I know, every good idea for controlling health care costs is in the HCR legislature. Yeah, right.

And yet.

The reality is, this is all we could do. It was the worst, or nothing at all. From the get-go, the Republican Party made the decision to obstruct, oppose and attempt to destroy the Obama presidency by defeating whatever version of HCR that it brought forward. The fact that Obama brought forward a Republican version of HCR, the same kind that Mitt Romney enacted in Massachusetts, was irrelevant.

And on the Democratic side, there was no appetite, in 2009 or now, for using reconciliation to enact a bill with 51 Senate votes, avoiding the need to deal with the likes of Joe Lieberman, Blanche Lincoln, Ben Nelson et al. There were, I believe, 53 votes in the Senate for a progressive version of HCR with a public option. But there were not 53 votes, or 50, for putting an end to the ridiculous Senate system of requiring 60 votes to end fake filibusters or the equally absurd system of letting every senator blackball, anonymously if so desired, any provision of any bill. (So to this day, a certifiably unbalanced senator like the gentleman from Kentucky, Jim Bunning, can stop a major bill extending unemployment benefits all by himself.)

So, short of Obama calling them out and staking his presidency on the Senate’s willingness to reform itself, the Liebermans and the Nelson retained their vetoes, and HCR needed to be reduced to the least common denominator they would accept, which was — is — this bill.

And yet.

And yet this bill does establish, for the first time in American history, that everyone has a right to good health care, and that taxes will be used to assure that everyone gets it. Expensively. Crazily, even. Yes, Obama cut a deal and the pharmaceutical industry was paid off. Yes, Obama cut another deal and the AMA was paid off. Yes, Obama cut yet another deal, and the health insurance industry was paid off. (And do read Glenn Greenwald on all this: He, too, is exactly right that it’s a dream bill for the lobbyists and special interests.)

I hate it that Obama, right here in Raleigh, lied about being for the public option. Lied, that is, unless being for it meant that it was a nice idea he had no intention of trying to get.

What an awful way to enact universal health care. And yet, it was the only way possible.

For 30 years in my experience, and many more years before that I mercifully don’t remember, HCR was impossible because we had no platform of universal health care from which to proceed.

This legislation is the worst possible platform. But it is a platform. From here, progress is possible. Until last night, it wasn’t. And until last night, the Rhonda Robinsons of the world were in terrible peril. This morning — or, at least, no more than six months from now when the first provisions of the bill check in — their world is better. That’s reason to cheer.