The odyssey of American healthcare reform should by now have removed any lingering illusions about the difficulty – some would say, the near impossibility – of legislating complex public policy in a system as hedged by checks and balances as that of the US.
By historical standards, the vote by the House of Representatives late on Saturday night passing a measure that extends coverage to tens of millions of Americans currently without it, and imposes tough new rules on the privately run insurance industry, was a triumph. Not since Lyndon Johnson bulldozed Medicare and Medicaid into law in the 1960s has an effort to overhaul the country's manifestly inadequate healthcare system progressed as far.
It is worth remembering that the last such attempt, by Bill Clinton more than 15 years ago, did not even make it out of committee on Capitol Hill. This time the Senate is finalising a bill, while the House has actually passed one, that would reshape a sector accounting for one-sixth of the entire US economy. Alas, the hard part is yet to come.
The House vote was fraught enough; with almost 40 of Mr Obama's own Democrats defecting, it was approved by a majority of just 220-215, and then thanks only to last-minute horse-trading over the ever-vexed matter of abortion. The Senate will be an even tougher obstacle. A leading Republican there has already pronounced the House measure "dead on arrival", while approval by the Senate of its own bill depends on more deals, not only on abortion, but also on a government-run insurance scheme, the so-called "public option" opposed by many moderate Democrats as well as virtually every Republican.
Whatever legislation emerges must command the support of 60 of the 100 members of the Senate, if it is not to be filibustered to death in a chamber where party discipline is notoriously weak. There are only 58 Democratic Senators, plus a couple of independents. The margin of error for Harry Reid, the majority leader, is precisely zero.
Healthcare reform moreover is only the beginning. Two more measures of massive import, tackling climate change and placing new regulations on the financial markets, are lumbering towards the legislative runway. In the current sour economic climate, both will be a tough sell; they have already prompted criticism that Mr Obama is trying to do too much, too quickly. All of which of course merely underscores the often-forgotten reality of the US system – that while a president has vast discretionary powers in foreign policy, in the domestic arena he is as easily tied down as a sleeping Gulliver.
But foreign policy too threatens to be barely less frustrating and unmanageable. Mr Obama's impending trip to Asia, where he visits China, Japan and Korea and attends the Apec summit in Singapore, offer a let-up in the pressure. But in the Middle East, his push for a breakthrough between Israel and Palestine has collapsed, while his critical decision on whether, and by how much, to increase American troop strength in Afghanistan – a decision made no easier by last week's rampage by a Muslim officer at Fort Hood in Texas, in which 13 people were killed – cannot much longer be delayed.
Mr Obama's greatest asset remains his personal popularity. Americans may have doubts about his policies, but they still seem to like the man himself. However, likeability, intelligence and large majorities in Congress are no guarantee he will succeed, either at home or abroad. Not for the first time, the presidency is on display for what it is: the toughest and most thankless job on earth.Reuse content