For the sake of the uninitiated, U.S is a representative democracy, not a direct democracy. In a country like Switzerland which practices direct democracy, decisions are made by the assembly of citizens. Most policies (be it at the level of a town or country) are in the hands of the public - the recent vote to ban minarets being one of them. Whereas in the U.S (and most other democracies) the general public elects officials who are entrusted to make decisions concerning their welfare - from their county to the country. Essentially, the elected officials are believed to possess a sharp long-term understanding of what's good and what's not for their societies.
Watching the debate yesterday was quite appalling because the representatives of the House were just echoing the popular opinion of their constituencies. Every Republican and 34 conservative Democrats voted against the bill. (It passed 219-212). As a representative, not of the lower House of the U.S Congress, but of the U.S democracy, their job is to evaluate the bill and vote based on the what they think is right. But what happened was everyone bowing down to the political pressure of pleasing their constituents and pitching for re-election. All Republicans acknowledge how screwed up the health care system is, but they're just not happy with the bill tabled (although it has close to 200 suggestions from their party members). They want reform, but not in this format which is going to result in record deficit.
Obama joked a few weeks back when talking to members of the Congress: "When Americans say they're concerned about jobs, they mean their jobs, not ours". Only that he wasn't joking.
 Here's my very brief take: I support this bill in spite of being a fiscal conservative. The bill is watered down and doesn't actually reform. And though the budget office estimates that over a 10 year period the government will save $140 billion with its Medicare cuts, I highly doubt that. Taxes inevitably are going to go up and people are going to dislike that. Once people get used to a welfare scheme it becomes politically impossible to revoke (like reservations in India). And the right-wing would be quite right in fighting government expansion only if it weren't for health care system. But I believe any great nation should have a great health care system, where one doesn't go bankrupt in the process of taking care of one's family or is dropped coverage when one develops an expensive illness. It is a moral issue not a money issue. Good health coverage should be ahead of good education and good military for a developed nation.