President Obama was re-elected last night with an impressive margin in the electoral college. The popular vote margin was much narrower, but it looks like he’ll be over 50% with roughly a 2 point margin.

I’ll have much more to say about this, but most of us will acknowledge that this was a very important election. The pundits liked to mock both campaigns for not discussing big issues, but that truly missed the point. Both sides offered very different paths for our future, and most voters understood the profound differences.

With an Obama victory, his signature accomplishment from his first term, health care reform, will now be fully implemented. Mitt Romney would have either repealed or gutted Obamacare, but now the notion of universal health care will be cemented as part of the social compact. We’ll all have to wait and see how Republicans react to Obama’s victory, but hopefully on health care we’ll see a shift away from a reflexive attempt to overturn Obamacare to constructive negotiations to improve it and cut medical costs in general. We’ve heard Republicans pontificate for years about malpractice reform. Perhaps now we’ll actually get some constructive proposals.

We may have a continuation of the political wars, but now we know that any deal will have to be more balanced than the GOP plan of just hacking away at spending on the elderly and the poor. We’ll see how that plays out.

It will also be interesting to see if some conservatives will break out of the right wing media bubble. Conservatives were told to ignore the poll numbers that pointed to an Obama victory, and that the “real” numbers would lead to a Romney landslide. These projections were pure fantasy, just like the Romney/GOP budget numbers that claimed you could miraculously balance the budget by slashing taxes. We live in a divided country and many on both sides are guilty of just listening to their own partisan news sources, but the dogma and partisanship on the right has become absurd. Even respectable pundits like George Will and Micheal Barone drank the Cool Aid and ended up looking just as clueless as partisan hacks like Dick Morris with their predictions of the Romney landslide.

Finally, conservatives and Republicans need to stand up to the lunatic fringe. You can’t encourage the crazies on your side, and then lament when idiot candidates like Richard Mourdock and Todd Akin say stupid things about rape and abortion. You can’t cater to the haters who demonize illegal immigrants and then complain that you got crushed by the Latino vote. We’ll see if there’s anyone in the GOP who has a spine. Chris Christie is an obvious candidate as he’s called out the crazies before, but now he’s on serious probation with the right for saying something nice about President Obama. Perhaps Marco Rubio can help on that front. We can expect serious fireworks within the GOP as they hash out these issues. If they don’t work it out, I’ll be happy to see them forfeit the Latino, African American, Asian and much of the female vote in future elections.

Here’s a fascinating video of Mitt Romney’s Power Point presentation he made to the Heritage Foundation in 2006. Romney explains the conservative position that any individual mandate should be called the Personal Responsibility Principle.

This is yet another example of how Mitt Romney’s positions are mostly governed by political expediency. The man seems to have no principles whatsoever, except for his consistency when it comes to cutting taxes for the wealthy.

As usual, the Republicans are going to over-interpret their “mandate.” This fact about the public’s opinion on the health care reform law in instructive.

A majority of Americans want Congress to keep the new health care law or actually expand it, despite Republican claims that they have a mandate from the people to kill it, according to a new McClatchy Newspapers-Marist poll.

The post-election survey showed that 51 percent of registered voters want to keep the law or change it to do more, while 44 percent want to change it to do less or repeal it altogether.

Driving support for the law: Voters by margins of 2-1 or greater want to keep some of its best-known benefits, such as barring insurers from denying coverage for pre-existing conditions. One thing they don’t like: the mandate that everyone must buy insurance.

The fight over health care reform will be one of the defining battles over the next two years. Expect the Republicans to overplay their hand.

It’s been a long year since President Obama and the Democrats began the process to reform our health care system and provide relief to the million of Americans, mostly working families, who didn’t have access to affordable health insurance. Last night, victory was finally achieved.

The process was brutal. Passing legislation is rarely an easy process. It’s usually messy, and with an initiative this big and controversial, it was bound to be a difficult process. But it was made even worse by the strategic decision by the GOP to do everything possible to kill the bill. Obama tried to strike a bipartisan deal, and the GOP happily strung him along while they whipped up opposition from the angry right and the Tea Party crazies. The process became the story, hurting the popularity of Obama and the Democrats.

Despite all these challenges, the Democrats were poised to pass health care when Scott Brown won a stunning win in Massachusetts. Most assumed that Obama would fold and that his presidency was permanently wounded. Pundits on the right and the left had a field day questioning Obama’s effectiveness and his toughness.

Yet Obama doubled down, and he had a tough ally in Nancy Pelosi. The right loves to hate her, and now they have another reason, as she pushed this through the House when most assumed she’d never pull it off.

There were many ups and downs in the process, but I think that Obama’s visit to the Republican House retreat will be remembered as one of the turning points. The GOP was feeling cocky after Brown’s victory, and they were believing their own talking points. Obama eviscerated one Republican congressman after another on live national television. It was like a professor schooling a bunch of obnoxious high school kids.

I think the White House realized that it was time to fight and take on the GOP. Obama was back on his game, and the overconfident GOP wasn’t up to the fight.

This is a huge victory for Obama, the Democrats and the country. Health care is the signature issue of this presidency, and failure here was not an option.

Ezra Klein explains why the mandates are necessary.

The untimely disappearance of Sally Marrari’s medical coverage goes a long way toward explaining why insurance companies are cast as the villain in the health-care reform drama.

“They said I never mentioned I had a back problem,” said Marrari, 52, whose coverage with Blue Cross was abruptly canceled in 2006 after a thyroid disorder, fluid in the heart and lupus were diagnosed. That left the Los Angeles woman with $25,000 in medical bills and the stigma of the company’s claim that she had committed fraud by not listing on a health questionnaire “preexisting conditions” Marrari said she did not know she had.

By the time she filed a lawsuit in 2008, she also got a diagnosis of pancreatic cancer and her debts had swelled beyond $200,000. She was able to see a specialist by trading office visits for work on the doctor’s 1969 Porsche at the garage she owns with her husband.

This outrageous behavior by insurance companies happens way too often in this country. It’s an outrage and it’s why we need reform. Insurance companies want to increase profits, so they screw over patients by canceling their policies when they need it most.

In the past 18 months, California’s five largest insurers paid almost $19 million in fines for marooning policyholders who had fallen ill. That includes a $1 million fine against Health Net, which admitted offering bonuses to employees for finding reasons to cancel policies, according to company documents released in court.

If health care reform implodes this year, the administration could ratchet up the pressure by having the Justice Department investigate these companies for fraud and potential RICO charges. There was a clear conspiracy to screw over patients, and they ought to be held accountable.

This also highlights why it’s important to pass reform with or without the public option. Insurance reform would benefit millions of Americans by protecting them from these practices.

That may be changing, as the Huffington Post reports that liberals are starting to out-number the health care opponents and screamers at the town hall events.

This can help, but they need much more. If they want to sway wavering members of Congress, then they have to do a better job of mobilizing support for health care reform and the public option.

I support the public option, but I’m not willing to kill health care reform if we have to settle for co-ops instead.

The insurance industry is up in arms over congressional proposals to create a publicly financed competitor in an effort to bring down health-care costs. That may be because it doesn’t have to face much in the way of competition now: Most regions of the U.S. are dominated by just one or two health insurers.

Each year the American Medical Assn. (AMA) surveys the commercial health-insurance landscape and finds little if any competition. Its latest report says that, out of 314 metropolitan markets, 94% are controlled by one or two companies, or fewer. In 15 states, one insurer has 50% or more of the entire market.

Such market concentration has become a potent argument for supporters of a public insurer, President Barack Obama among them. With no need to generate profits, a public plan could offer lower premiums, thus bringing competitive pressure to bear on the private insurers to do the same.

Ezra Klein makes a similar point in the Washington Post.

In the modern health-care system, there is no higher power than the insurance market. And the insurers who populate that market have grown all the stronger. The Justice Department judges an industry “highly concentrated” if a single company controls more than 42 percent of the market. By that definition, 94 percent of statewide insurance markets are highly concentrated. A recent study by the advocacy organization Health Care for America Now showed that in Indiana, WellPoint controls 60 percent of the insurance market; in Iowa, Wellmark accounts for 71 percent; and in Alabama, Blue Cross/Blue Shield holds 83 percent. In the past 13 years, there have been more than 400 corporate mergers involving health insurers.

Economics textbooks tell us that concentrated markets reduce the competitive behavior that benefits consumers and lead to outsize profits for the dominant firms. Predictably, health-care premiums shot up more than 90 percent between 2000 and 2007, while the profits of the 10 largest insurers increased 428 percent over the same period.

We have a system that is not sustainable. This isn’t capitalism – instead we have several large insurance companies practically stealing money from American taxpayers.

Right now, President Obama is trying hard to get a bill with the help of all the major players, including the insurance companies. Therefore we’ve seen him go after costs and premiums, but he has not taken on the insurance companies in a direct manner.

If the current effort at reform fails or stalls, expect to see a full-throttled attack against these companies that informs the American people just how much money they are making and the tactics they are using to deny coverage to pad profits.