Brendan Smialowski for The New York Times House Speaker Nancy Pelosi and Democratic leaders after the health bill vote on Sunday night on Capitol Hill.

For many, the health care overhaul, which was approved by the House, 219 to 212, and will be signed into law by President Obama, is far from perfect. For some, it’s a disgrace. But for others, it’s a bold effort that expands health care to more Americans than ever in the nation’s history. Whatever the assessments, today’s vote in the House represented change.

Is this legislation as significant as the creation of Medicare? Will it fundamentally alter the social safety net?

We invited several public figures and historians to give us their thoughts on this moment.

• Tommy Thompson
• Donna E. Shalala
• Dick Armey
• Louis Wade Sullivan
• Ralph Nader
• Robert Reich
• Jesse Jackson
• Bill Frist

• Alan Brinkley
• Richard Carmona
• Geraldine A. Ferraro
• Robert Dallek
• Rick Santorum
• Bill Bradley
• Richard Reeves

Government-Controlled Health Care

Tommy Thompson, a former governor of Wisconsin, was secretary of the Department of Health and Human Services under President George W. Bush.

No, this legislation is not as significant as Medicare, which enabled the elderly and disabled to receive real protection when they were less capable of obtaining coverage and had no alternatives whatsoever. But this legislation has the potential to change the current social services fabric because the health insurance transformation that will pass will be the beginning of a government-controlled health care system.

Honoring Workers and Children

Donna E. Shalala, the secretary of the Department of Health and Human Services from 1993 to 2001, is the president of the University of Miami.

This historic legislation recognizes two fundamental rights: First, people who get up every day and go to work have a right to good health insurance for themselves and their families. Second, that every child no matter where they live or what their family’s income has a right to a healthy life. Medicare honored the most vulnerable — the elderly and disabled. We now honor working Americans and all our children.

An Unconstitutional Mandate

Dick Armey, former majority leader of the House, is chairman of FreedomWorks, a national grassroots organization fighting for lower taxes and less government.

At a time when Americans foremost wanted action on jobs and the economy, they were given an unconstitutional mandate that fundamentally expands the power of government. The real winners are insurance companies and big pharma. Americans want health care reform that improves access to health care through reforms that hold down costs. Instead they got a trillion dollar bill that was more politics than good policy. This debate is far from over, and will be a critical issue come November.

Expanding Access to Millions

Louis W. Sullivan, a doctor and the secretary of Health and Human Services under President George H.W. Bush, is chairman of the Sullivan Alliance to Transform America’s Health Professions.

The importance of this historic vote by the House of Representatives is exceeded only by the initiation of Medicare and Medicaid in the mid-1960’s. It will expand access to health insurance for more than 30 million Americans. While it does not provide a complete health safety net, it represents an improvement to our current system. The Congressional Budget Office projects significant long-term savings in health expenditures from this legislation. After its enactment, an increase in the number, and the racial and ethnic diversity, of the nation’s health professions workforce is needed to ensure unimpeded access to health services. Such staff improvements will make real the promises in this bill.

A Remnant of Reform

Ralph Nader is a consumer advocate and the author, most recently, of “Only the Super-Rich Can Save Us!”

The health insurance legislation is a major political symbol wrapped around a shredded substance. It does not provide coverage that is universal, comprehensive or affordable. It is a remnant even of its own initially compromised self — bereft of any public option, any safeguard for states desiring a single payer approach, any adequate antitrust protections, any shift of power toward consumers to defend themselves, any regulation of insurance prices, any authority for Uncle Sam to bargain with drug companies, and any reimportation of lower-priced drugs.

Government as a Solution

Robert Reich, a professor at the Goldman School of Public Policy at the University of California at Berkeley, was secretary of labor in the Clinton administration. He is the author, most recently, of “Supercapitalism,” and he blogs at Robert Reich’s Blog.

It’s not nearly as momentous as the passage of Medicare and won’t fundamentally alter how Americans think about social safety nets. But President Obama’s health care reform bill is the biggest thing Congress has done in decades, and has enormous political significance for the future. Medicare directly changed the life of every senior in America, giving them health security and dramatically reducing their rates of poverty. By contrast, most Americans won’t be affected by this health care legislation; they’ll continue to receive health insurance through their employers.

The Right Thing to Do

Jesse L. Jackson Sr., a former aide to the Rev. Dr. Martin Luther King Jr., is the president and founder of the RainbowPUSH Coalition.

Congress took a bold and courageous step today. Passing this landmark health care legislation in the face of virulent Republican opposition is the morally right thing to do. It makes health care more affordable and accessible — and more cost effective. It provides a health care safety net to protect Americans from falling into the abyss. Health care reform will also help families with their home mortgages and prevent foreclosures, as many families today are forced to choose between paying for their health or their house. It begins to close the gaps for the uninsured and under-insured, and moves us a step closer to Dr. King’s dream for a health system where everybody will be in and nobody is locked out.

The Bill Will Need Reform

Bill Frist, a surgeon and former majority leader of the Senate, is a professor of business and medicine at Vanderbilt University.

Medicare 45 years ago and the current health care legislation are historic in that they are both huge coverage bills, focused primarily on distributive justice: a country as prosperous as ours should ensure affordable access to health care for every American. But Medicare was a reform bill, and today’s Congressional bill is not. Without substantive reform that includes purposeful alignment of incentives throughout the care delivery value chain, spending will skyrocket, deficits will definitely increase, and the country’s recovery from recession will be slowed. With passage, we should immediately unite and commit to a true reform initiative that is patient-centered, provider friendly and consumer driven, fueled by 21st-century information and choice.

Coming Close to Universal Care

Alan Brinkley, the Allan Nevins Professor of History at Columbia University, is the author of the forthcoming “The Publisher: Henry Luce and His American Century.”

Despite the agonizing process that has led to the most significant health care bill since at least the 1960s, the legislation that has come to passage is not very different from where it began. It promises to make possible providing health care to 30 million currently uninsured Americans, and it promises to do so within the financial parameters President Obama set out at the start.

This is not a perfect bill by any means, as even its most fervent supporters would concede. But it is a historic bill nonetheless — perhaps the most important since Social Security in 1935, which was also deeply flawed at its creation but gradually improved over several decades to become the most successful social legislation of the 20th century.

Medicare Is Still the Gold Standard

Richard Carmona, the surgeon general from 2002 to 2006, is the vice chairman of Canyon Ranch and a professor of public health at the Mel and Enid Zuckerman College of Public Health, University of Arizona.

Due to differing economic, scientific, political, social and policy variables today, it is difficult to directly compare the historical magnitude of Medicare passage in 1965 to the proposed present legislation. However, I believe that Medicare is still the gold standard of health legislation and all present and future legislation will be compared to it.

Nothing to Sneeze At

Geraldine A. Ferraro, a lawyer and a former member of Congress, was the Democratic vice presidential candidate in 1984.

This legislation is not as historic as Medicare. Medicare was a giant step in government involvement in health care for hundreds of millions of people. But this bill is not something to sneeze at either. For more than 30 million Americans, it is more important than Medicare because it is a matter of life and death.

Political Consequences, Unknown

Robert Dallek is the author of several presidential biographies, including a two-volume biography of Lyndon B. Johnson. His new book, “The Lost Peace: Leadership in a Time of Horror and Hope, 1945-1953,” will be published in October.

The passage of President Obama’s national health insurance reform marks a major addition to the social safety net on a par with F.D.R.’s 1935 Social Security bill and Lyndon Johnson’s 1965 Medicare law. However, there is a major difference between Mr. Obama’s legislation and the two earlier reforms: Roosevelt and Johnson had bipartisan backing and the Obama law was strictly a Democratic initiative; Republican opposition was intense and uniform.

The political consequences of this division will likely be considerable: If the law works to improve the lives of millions of Americans as the White House expects, the Democrats will have a point of attack against the Republicans for the indefinite future. If it falls short of expectations, the Republicans will have a new, potent argument against big government entitlements.

Devastating to America

Rick Santorum is a former Republican senator from Pennsylvania and a senior fellow of the Ethics and Public Policy Center.

This legislation will indeed be historic in its destructive effect if it is not repealed or substantially altered. This bill will devastate our economy and its ability to create jobs and a higher standard of living; government spending and debt will explode; health care quality and choices for most Americans will suffer; and millions more innocent children in the womb will be killed. Worse still, to avoid bankrupting the country, care will be rationed so only those “useful lives” will be given the care they need.

This day will go down as either the day that America turned its back on our unique system of democratic capitalism or the day that ignited a firestorm to reclaim the vision that has made our country the greatest in the history of the world. Today is owned by those who believe that an all powerful federal government is the future of our republic, tomorrow freedom-loving patriots will begin the fight against this tyranny to reclaim our birthright.

We Need Guaranteed Coverage

Bill Bradley, the former Democratic senator from New Jersey, is the author of “The New American Story” and a managing director of Allen and Company.

Medicare is a basic right for every senior citizen in America — truly ground-breaking legislation. This bill doesn’t guarantee coverage — it facilitates coverage. But in our current political climate that is a significant achievement demonstrating that our government can act on a huge issue that affects millions of Americans.

Building a Birthright

Richard Reeves is the author of a presidential trilogy: “President Kennedy: Profile of Power,” “President Nixon: Alone in the White House” and “President Reagan: The Triumph of Imagination.”

The guy in South Carolina who yelled at his congressman to “Keep your government hands off my Medicare!” was on to something important. Once the government offers an entitlement it belongs to the people — and they will fight to keep it. So President Obama’s success in moving toward universal health care (the core of the reform package is expanding the number of Americans covered) will become part of the American social fabric, a birthright, like Social Security and Medicare.

And the Republicans were right too, in understanding that this bill is a significant expansion of the American welfare state. What they didn’t understand was that you can’t beat something with nothing. President Obama and the Democrats had something to offer. The Republicans didn’t.

National Archives and Records President Lyndon B. Johnson signing the Medicare bill at the Truman Library in Independence, Mo., on July 30, 1965, as Lady Bird Johnson, former President Harry S. Truman, Vice President Hubert H. Humphrey and Bess Truman look on.