White House/Chuck Kennedy
The vice president called it a "big [expletive] deal."Paul Krugman concurs, placing health reform at the center of President Obama's "big deal." Mr. Obama seems preoccupied with achieving presidential greatness in the eyes of historians and Americans. Indeed, he consulted historians for guidance on how to make his second inaugural address a speech for the ages.
Others can decide whether his other accomplishments in office warrant his inclusion in the pantheon of great presidents. But if he is counting upon the Affordable Care Act (ACA) to cement his place, he is destined for disappointment.
Process matters. Despite election campaign assurances that "we're not going to pass universal health care with a 50-plus-one strategy," he did not hesitate to ram through the most sweeping reform of health care since Medicare on a pure party-line vote-a maneuver completely without precedent in American history.
Great presidents lead by influencing public opinion, not ignoring it. President Obama not only ran roughshod over Republicans in Congress: he likewise ignored strong and persistent public opposition to his plan. Once again, such sustained public opposition to a signature piece of domestic legislation is completely without historical precedent. For example, while it faced some public opposition, Medicare, for example, persistently had majority public support.
It's not just process or popularity; outcomes matter too. The president sought to persuade public opinion with a series of lofty but very concrete promises of very questionable accuracy:
- "In an Obama administration, we'll lower premiums by up to $2,500 for a typical family per year." FALSE
- "I will not sign a plan that adds one dime to our deficits." FALSE
- Health reform will "bend the cost curve." FALSE
- "I can make a firm pledge under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes." FALSE
- "If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you'll be able to keep your health care plan, period. No one will take it away, no matter what." FALSE
- "Medicare is a government program. But don't worry: I'm not going to touch it." FALSE
Some may call this Monday-morning quarterbacking but the president was well aware that his plan was "full of gimmicks and smoke-and-mirrors" many weeks before the final bill was passed because Rep. Paul Ryan told him so. To have charged ahead anyway suggests a president more attentive to securing his place in history by achieving something that could be labeled health reform (i.e., something even the great presidents before him had failed to do) than by securing a plan that actually would work and had a plausible prospect of achieving these lofty promises.
Americans may not expect their presidents to be completely truthful especially in political campaigns. Point taken. But as the disconnect keeps widening between what was promised and what actually happens as Obamacare plays out, disappointment will gradually give way to anger-even among those who are on the fence about the plan. Some components of the law were so bad that there was bipartisan support to junk them. It remains to be seen whether Obamacare will crash and burn entirely.
Even if it does not, it might well enter the pantheon of government-sponsored programs such as the Post Office and Amtrak that are an on-going source of late-night humor. Surely this does not bode well for its contributing to a legacy of greatness.
There's no question that the President's decision to go for broke in early 2010-despite having lost his filibuster-proof Senate majority following the election of Scott Brown-was a bold move. Historians can decide whether he was bullied into this decision by then House Speaker Nancy Pelosi or whether he would have made this risky (but ultimately successful) call on his own. His chief of staff and veteran of the Clinton health debacle had strongly counseled that he instead find a more modest bipartisan compromise, declare victory and go home (i.e., go for the game-tying field goal rather than the game-winning touchdown).
But at the end of the day, he should get credit for making the call (recognizing that this call would have been worthless without Mrs. Pelosi's skillful execution of the play, etc.). But a single gutsy call does not make a great president. Perhaps it's a bad metaphor (occasioned by recently reading my dad's letters to my mom during his Korean War stint), but ACA might be likened to the first battle for Pork Chop Hill. Americans won that battle, but later lost the hill to the Chinese. And in the grand scheme of things-the outcome of the war itself-it literally made no difference. 
 I'm no presidential historian, so perhaps every president has been similarly preoccupied. But as one who has paid reasonably close attention to presidential behavior for more than four decades, it struck me as unusual that President Obama has, since his first few months in office, been having regular meetings with presidential historians to discuss his legacy. Mr. Obama's own inflated opinion of that legacy (and his preoccupation with it) is neatly encapsulated in his remark that "I would put our legislative and foreign policy accomplishments in our first two years against any president - with the possible exceptions of Johnson, F.D.R. and Lincoln - just in terms of what we've gotten done in modern history." In The Amateur: Barack Obama in the White House, a former editor of New York Times magazine (i.e., hardly a partisan hack) systematically documents the characteristics-arrogance, conceit, egotism, vanity, hubris and, above all, rank amateurism-that have marred Mr. Obama's presidency. That such an individual would be obsessed with his place in history should surprise no one.
 For example, a majority of Republicans in the House voted in favor of Medicare and Senate Republicans were nearly evenly divided when that law passed in 1965. Likewise, House Republicans voted more than 5 to 1 in favor of Social Security and Senate Republicans voted more than 3 to 1 in favor. This puts a lie to revisionist claims that these programs have been steadfastly opposed by Republicans from the get-go. Note that in both cases, the Democrats held far more commanding majorities in both chambers of Congress than in 2010. Thus, in principle, Presidents Roosevelt and Johnson might well have elected to drive through a version of their plans more to their liking on a purely partisan vote, but recognized the foolishness of such a divisive strategy.
 Of more than 140 polls tracked by RealClearPolitics.com between March 2010 and November 4, 2011, only one lone CBS poll conducted in January 2011 shows opponents of repeal outnumbering those who favor repeal.
 Of course, passage of the Affordable Care Act made a huge difference in the 2010, with consequences so devastating to the Democrats that even progressives such as Rep. Barney Frank retrospectively conceded that President Obama made a mistake in not backing down on health reform after the Scott Brown victory in January 2010. And from the standpoint of sensible health reform, one could argue that ACA has made it substantially more difficult to get on a sustainable path, so in that regard, the law was hugely consequential-but not in a good way.