One of the few things everyone in Washington seems to agree on is that the Senate's approval of a massive health reform bill last week was a landmark event in modern American politics.

Democrats, led by President Barack Obama, never tire of repeating that this is the most important piece of American social legislation since 1965's passage of Medicare, the programme that provides close to universal health coverage for those over age 65. In their more effusive moments they compare it to the creation of Social Security (the US retirement programme) in the 1930s.

Republicans are equally sure that the health bill is groundbreaking. They believe Democrats have effectively nationalised the country's health care system and, in doing so, signed their own political death warrants. The GOP is positive that America hates health reform and believes its return to Congressional power and, eventually, the White House now involves little more than waiting out the electoral calendar.

Both sides, in this, offer a nugget or two of truth layered many times over with wishful thinking.

First of all, there is not a health bill — there are two: one passed by the House and another by the Senate. When Congress returns to work in January a committee drawn from both chambers will have to merge these into a single bill. Since there are major differences between the House and Senate bills, and little appetite for compromise on either side, this is not likely to be an easy or quick process. When a final bill does emerge from the Conference Committee (as the negotiators are known) it must be voted on again by both the House and Senate. If both houses approve the compromise legislation then, and only then, does it head over to the White House for Obama's signature.

Still, the Democrats' nugget of truth is that even getting this far is a major accomplishment, one that has eluded presidents of both parties for over a century. Their wishful thinking lies in the belief that their own supporters will overlook the many, often sordid compromises their leaders made to win the legislation's passage.

The GOP's nugget of truth is that a majority of Americans do, indeed, say they oppose the bill. Their wishful thinking lies in ignoring the fact that what these Americans "oppose" is a partisan caricature of the real legislation. The major components of reform, when presented individually, command far greater public support.

Hardly controversial

And what are these earth-shattering, supposedly controversial, proposals? That everyone should have access to decent health insurance. That insurance companies should be barred from cancelling policies when people become sick and, therefore, need the insurance they paid for. That, to this end, health insurers should be required to prove that most of the money they take in is actually used to pay for health care, not outsized executive salaries or out-of-control administrative costs. In any other rich country these would not even qualify as topics worth debating.

This, however, is America. From a distance it is hard to appreciate the degree to which health care looms over the lives of many middle and lower-middle class people in this country. Since the Second World War, Americans have tended to receive health insurance through their employers, but this recession, the deepest since the war, has left many with neither work nor coverage. Worse, many of those still in work find their employers are scaling back health coverage, if not dropping it altogether, because they can no longer afford it.

And yet, this remains a country where many politicians — not just right-wingers, and not just Republicans — hasten to tell anyone who will listen that they do not, repeat not, support "universal health care".

Therein lies the heart of the Democrats' problem: they long ago lost the rhetorical initiative to the Republicans and the GOP has shown little interest in actually solving America's myriad health care problems. Indeed, many in the GOP do not appear to believe that there is a problem that needs to be solved.

The Republicans may, however, be overly sanguine in counting on an anti-health care backlash to sweep them back into power next year. If Obama does manage to sign a health bill and if, as Democrats claim, at least some of its effects become apparent more-or-less immediately they may have the opportunity to turn the tables on the GOP. Congress is not a popular institution in much of the country, but it is even harder to find someone who has anything good to say about health insurers.

The Democrats' best hope of political survival lies in getting the president's signature on a bill — even a far-from-perfect one — then forcing their opponents to defend the worst abuses of the current system.

We are now, however, getting a bit ahead of ourselves. After all, we are still a long way from the point where the president has a bill to sign.

Gordon Robison, a writer and commentator who has lived in and reported on the Middle East for two decades, teaches political science at the University of Vermont.