This insurance bill is being seen as an usher into a new era of sweeping refurbishment of American healthcare. It could be remembered that President Obama had run a successful election campaign of which a big part had been health care reforms. Successful handling of this signature issue in his second year in office is as great a milestone as social security and civil rights acts of the past years. "This is what change looks like," an exuberant Obama said from the White House just before midnight.   He congratulated the people declaring that Americans are still capable of doing big things.