81I am not the first president to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for healthcare reform. And ever since, nearly every president and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell, Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.

Our collective failure to meet this challenge—year after year, decade after decade—has led us to a breaking point.

(—Barack Obama 2009)

The conditions in 2010 created a window for reform, but it was not a big one. To squeeze legislation through that window, Democrats had to work around the many constraints that might otherwise have doomed chances for passing a bill. And working around those constraints helped to shape the central choices they made, including the choices that left the law vulnerable to counterattack.

(—Paul Starr 2013, 16–17)

“What’s past is prologue,” William Shakespeare wrote—and it seems that’s especially true when it comes to healthcare. The history of health reform in American spans a century of false starts, near misses, and historic advances that culminated when President Obama signed the Patient Protection and Affordable Care Act into law on March 23, 2010. It was a day that a lot of people thought would never come and a moment that almost didn’t happen—and the story of how we got there is one of the most important stories in modern politics and public policymaking.

(—John Kerry 2010, 7)