Abstract
The tumultuous journey of health reform from President Barack Obama's opening push in February 2009 to his bill signing in March 2010 may be inexplicable from afar. Swept into power on promises of change, Democrats controlled the White House and enjoyed the largest Congressional majorities in decades, and they agreed that the existing health care system cost too much and delivered too little—stranding over 30 million with no health insurance and leaving millions more with only inadequate coverage or dependent on emergency rooms for urgent care. Unified party control and programmatic agreement would seem like a veritable checklist of what was needed to pass health reform legislation.
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