There was a fourth lesson: Try in the Senate to find Republican support at an early stage, instead of waiting until the political dynamic shifts toward implacable opposition. The failure to engage John Chafee, Chuck Grassley, Orrin Hatch, and their colleagues at an early point in 1993, when they crafted their own plan and were willing to negotiate and cut a deal, proved deeply damaging, if not deadly in 1994. As the midterms loomed and Democrats were on the defensive, Chafee and his colleagues were told by then-Republican Leader Bob Dole that there would be no deal, period.

In the House, that lesson was not applicable this time; Eric Cantor and House Republicans had already made it crystal clear that they were not cooperating under any circumstances. There, Democrats debated the issue for several months, but mostly amongst themselves, before introducing a detailed bill that emerged from committees in July 2009 and passing it through the House later in the year with just one Republican vote.

But with Obama’s blessing, the Senate, through its Finance Committee, took a different tack, and became the fulcrum for a potential grand bargain on health reform. Chairman Max Baucus, in the spring of 2009, signaled his desire to find a bipartisan compromise, working especially closely with Grassley, his dear friend and Republican counterpart, who had been deeply involved in crafting the Republican alternative to Clintoncare. Baucus and Grassley convened an informal group of three Democrats and three Republicans on the committee, which became known as the “Gang of Six.” They covered the parties’ ideological bases; the other GOPers were conservative Mike Enzi of Wyoming and moderate Olympia Snowe of Maine, and the Democrats were liberal Jeff Bingaman of New Mexico and moderate Kent Conrad of North Dakota.

Baucus very deliberately started the talks with a template that was the core of the 1993-4 Republican plan, built around an individual mandate and exchanges with private insurers—much to the chagrin of many Democrats and liberals who wanted, if not a single-payer system, at least one with a public insurance option. Through the summer, the Gang of Six engaged in detailed discussions and negotiations to turn a template into a plan. But as the summer wore along, it became clear that something had changed; both Grassley and Enzi began to signal that participation in the talks—and their demands for changes in the evolving plan—would not translate into a bipartisan agreement.

What became clear before September, when the talks fell apart, is that Senate Republican Leader Mitch McConnell had warned both Grassley and Enzi that their futures in the Senate would be much dimmer if they moved toward a deal with the Democrats that would produce legislation to be signed by Barack Obama. They both listened to their leader. An early embrace by both of the framework turned to shrill anti-reform rhetoric by Grassley—talking, for example, about death panels that would kill grandma—and statements by Enzi that he was not going to sign on to a deal. The talks, nonetheless, continued into September, and the emerging plan was at least accepted in its first major test by the third Republican Gang member, Olympia Snowe (even if she later joined every one of her colleagues to vote against the plan on the floor of the Senate.)