Why did healthcare reform take so long? Not because of any clever strategy on Obama's part. It was because, right or wrong, he made a rational calculation not to repeat Bill Clinton's mistakes. So instead of pushing a plan of his own, he let Congress take the lead. And Congress decided to move very, very slowly.It's true that Congress moved slowly, and it's true that Obama didn't take the lead, at least in terms of preparing a fully formed bill to drop in the hopper (although the bill basically followed the outline of his campaign plan, and the White House was highly involved every step of the way). And it's even true that Congress could have moved slightly quicker in 2009 -- and that it's vaguely possible that they could have finished a reconciled bill in late December, instead of only getting ready for conference at that point.
But mostly, the bill took time because moving major legislation takes a lot of time, and this was one huge piece of legislation. It was going to take time to write the bill, to mark up the bill, to form coalitions, to cut deals...all that had to happen, and there just wasn't much choice in the matter. What's more, Republicans were insisting, and had the procedural precedents to do so, in dragging things out as long as possible.
Congress can move very quickly when it wants to (TARP, for example, came to the floor with no delays at all, and only a floor defeat slowed it up a bit). Given that ACA was going to get at least near-unanimous opposition from Republicans and that they would use more or less every possible procedural mechanism available to them to slow it down, there was just no way that it was going to be resolved in fewer than eight or nine months.
The one piece of legislation that I think Obama and the Democrats might have moved very quickly was Dodd-Frank. I can imagine a choice to work out a bill during November and December 2008, a successful GOP buy-in of at least half a dozen Senators, and then an accelerated 1933-style process parallel to the stimulus bill or even before that one. It's possible that in the depths of the recession and the very first days of the Obama presidency that a fair number of Republicans might -- might! -- have chosen cooperation over confrontation on the banking issue. But health care? That was always going to be a fierce partisan fight, and therefore it was going to take time. No matter who was in the Oval Office.