Progressives wanted a universal health care bill in 2009. But polling shows that most people like the health care they have. Consequently, instead of doing the straightforward thing and producing a plan in which everyone swaps out what they have now in exchange for something better, we’ve got something rather more complicated. The political thinking here is pretty clear and hard to question, but as Jonathan Cohn lays out at length it makes the resulting policy quite a bit worse.
Meanwhile, even with Obama being extremely incrementalist in his proposals, it’s still very hard to get anything through congress. And, indeed, the main lesson of the past 25 years worth of American politics is that big change is hard to make under any circumstances.