The health care reform of 2010 passed because it was the bill that could get support from the median member of the House and marginal member (either fiftieth or sixtieth, depending on the legislative vehicle) of the Senate. Being central, however, is not the same thing as winning. Even as colleagues to their left likely feel the swing legislators had disproportionate influence, the situation probably looked to those pivotal legislators like an extremely dangerous dilemma. They were right. But the danger had two dimensions: political dangers for themselves and their party's majority and the risk that policy would be incoherent.
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