The White House gets some credit for brokering those deals. Congressional leadership gets even more. But none of it would have been possible if elected Democrats didn't actually want to get health-care reform done. In that sense, the past 20 years of organizing and arguing worked. Health-care reform was so core to the identity of most Democrats that they stuck with the bill long after they would've let another priority die. If you want to see how it looks on the other side, check out climate change, where a lot of Democrats who are nominally in support of action on the issue seem totally disinterested in sticking their necks out on it, at least right now.I'd tweak that a bit...it wasn't 20 years, which would date it to the 1992 campaign; it really does go back to the Truman Administration, and before that to FDR. It really is, in Ezra's words, "core to the identity of most Democrats."
Climate is, to begin with, a much newer issue; we're just now getting to the point that people old enough to be in Congress may have, as teenagers or so, come to Democratic politics because of global warming. Before that, of course, there was environmentalism as an issue, but until Reagan it really wasn't something that separated the parties. I would argue, by the way, that health care is inherently partisan in a way that climate really isn't. Whether climate change is happening is a factual, rather than an ideological, question; if in fact climate change is happening, then there's no ideological case -- certainly not a conservative case -- for just ignoring it; and I don't believe there is a reasonable conservative case for the government ignoring it and leaving it to the private sector (or for that matter the states). But health care really was as close to an ideological question as American politics ever produces: liberals fundamentally believe that health care is a right that should be guaranteed for everyone; conservatives fundamentally believe that health care is simply not a right at all, and that the government has no business guaranteeing it to anyone. That's a fight about what you think government is for in the first place, one on which beliefs, and not facts, control.
There is, however, one other reason that climate is a tough sell to politicians. It's an issue in which the gains are long term, not short term (and even worse, an issue in which long-term gains are made avoid something terrible, so action is need to maintain the status quo: in that sense, no visible benefits even in the long term). It's nothing new to say that for all the benefits of democracy, it's unlikely that it's strength is dealing with problems that immediate costs and only long term benefits. It's no surprise, after all, that Democrats made sure that health care reform included some things that would be very tangible benefits before the first post-passage round of elections. Those who are advocating climate legislation have tried to navigate that by morphing it from climate to climate/energy, and then to redefine energy into something that has as many short term, visible benefits as possible, but it's a tough sell.
Now, those of us who support democracy tend to be optimistic that democracies can muddle through on such things, but it's a tough one, no question about it. And yes, this is a gloomy post for those who advocate climate legislation: if it helps for it to be a core party issue and that takes decades, and if even then the long term/short term problem makes it hard to pass...well, sorry about that. On the other hand, if it isn't an ideological problem, that suggests that at some point a real bipartisan deal is far more available on climate/energy than it ever was on health care. So perhaps there's some hope, after all: it might not eventually need supermajorities to get it done, as long as the GOP can be convinced that it's a real technocratic problem.