All this explains why the usual right-wing think tanks weren’t especially vocal during the final stretches of the bill’s path to enactment. Their ideas were going to become law—which makes it all the more puzzling that the Republicans have fought so hard against the legislation.

“The significance of Obama’s health legislation is more political than substantive,” Reich wrote in his TMP column. “For the first time since Ronald Reagan told America government is the problem, Obama’s health bill reasserts that government can provide a major solution”—albeit a solution that relies on the private market to deliver the goods. The question is whether health care is a commodity that the marketplace can manage with government help. Or will something else be needed in the distant future?

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.