The Senate is on the cusp of passing comprehensive reform of America’s health care system — a goal that has eluded Congresses and residents going back to the administration of Teddy Roosevelt.

We have come to a historic crossroads, just as in 1935 when Congress voted to establish Social Security, and in 1965 when Congress created the Medicare program. Both of those programs were bitterly opposed by defenders of the status quo. But, in the end, a critical mass of Senators voted their hopes, not their fears. They created programs that were giant steps forward for the health and economic security of the American people.

Today, we are poised to take another giant step forward. And, with the help of projections by the Congressional Budget Office, we can predict where the Patient Protection and Affordable Care Act will take us next year and in the years that follow.

The CBO confirms that the legislation fulfills President Barack Obama’s pledge not to add a dime to the deficit. Indeed, it will reduce the deficit by $130 billion in its first decade, and by an estimated $650 billion in the second decade.

Our bill will extend coverage to more than 94 percent of Americans. If you already have insurance and you’re happy with it, you will be able to keep it. However, the bill will provide better insurance options. And CBO estimates that, thanks to the bill, premiums will be lower for the vast majority of Americans, including small businesses and the self-employed; the same policy will cost 14 percent to 20 percent less in the individual market under the Senate bill.

If the bill is signed into law in early 2010, these are some of the benefits that will kick in immediately:

• If you are uninsured with a pre-existing condition, our bill will give you access to affordable coverage, without discrimination.

• It immediately bans rescissions — the abusive practice whereby health insurance companies can cancel your existing insurance policy if you get sick.

• It prohibits insurers from imposing lifetime limits on benefits, and it will restrict the use of annual limits.

• It requires coverage for prevention and wellness services, with no co-pays, deductibles or out-of-pocket payments from policy-holders.

• It requires insurers to permit children to stay on family policies until age 26.

• If you are a small-business owner, our bill will offer tax credits of up to 35 percent of employer contributions toward premiums in order to make it more affordable for your employees to have health insurance.

Another critical focus of the Patient Protection and Affordable Care Act is that it will guarantee a choice of quality, affordable health insurance options to all Americans. Through new health insurance exchanges, people who currently do not have access to affordable coverage will be able to easily shop and choose from a menu of quality health plans — much in the way Members of Congress and federal employees are able to do today.

In addition, our bill includes a truly transformational element — a broad array of provisions promoting wellness, prevention and public health. The aim is to jump-start America’s transition from our current sick care system into a genuine health care system, one that is focused on keeping us healthy and out of the hospital in the first place.

To this end, at the clinical level, the bill requires reimbursement for proven, cost-effective preventive services such as cancer screenings, nutrition counseling and smoking-cessation programs. This means health professionals will be able to offer these services to you before you get diseases such as diabetes, cancer or emphysema.

For essential screenings and annual physicals, the bill gets rid of the co-pays and deductibles that currently discourage many people from doing the right things to stay healthy.

Our bill makes major new investments in community wellness and public health, and it helps businesses large and small to create workplace wellness programs. It requires large chain restaurants to post basic nutrition information right on the menu, so consumers can make healthy choices.

Make no mistake, the Patient Protection and Affordable Care Act doesn’t just tinker around the edges; it changes the paradigm. Our aim is to re-create America as a genuine wellness society focused on healthful lifestyles, good nutrition, physical activity and preventing the chronic diseases that take such a toll on our bodies and our budgets.

We need health care reform, because the status quo is unsustainable. We will succeed, because failure is not an option. We are going to create a reformed insurance and health care system that works not just for the healthy and the wealthy, but for all Americans.

Sen. Tom Harkin (D-Iowa) is chairman of the Health, Education, Labor and Pensions Committee.