The stakes for the US in the struggle to pass health reform could not be higher. If this project goes down to defeat, Barack Obama’s presidency will be irreparably damaged. More important, the country will be stuck with a ruinously expensive and ethically indefensible healthcare system. Who knows how long it will be before another administration summons the courage to try again?

It ought to be unthinkable that a popular Democratic president, elected on a promise of comprehensive health reform, supported by big Democratic majorities in Congress – now with a filibuster-proof contingent in the Senate – should fail to get this done. Moreover, unlike in the early 1990s, when the Clinton administration took on the challenge, resistance from organised interests is weak. In 2009, the usual suspects as good as surrendered in advance. Yet failure is anything but unthinkable. Many commentators are now betting on defeat. What went wrong?

Recent setbacks are real, but it must be emphasised, first of all, that some kind of health reform is still likely to pass. For the Democratic party to come up with nothing under these circumstances would be an act of self-harm remarkable even by its own standards. The Democrats would be seen as incapable of governing. Essays describing the long-term leftward realignment of US politics in 2008 would have to be trashed, less than a year after that supposed electoral earthquake.

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