In the annals of American liberalism, a (very) few years in our history stand out enough that the mere mention of the year summons a waterfall of images and emotions – 1933 means the start of the New Deal and the birth of modern liberalism, 1964 means the passage of the civil rights act, 1965 means the passage of universal healthcare for the elderly. Now, in the wake of this morning's narrow margin in the House of Representatives, 2010 joins that short list: the year we finally passed major healthcare reform after a century of trying.

It is a monumental accomplishment. The story of that century of failure is a story of multiple plots and subplots, but at its heart the story is about the tension in American society between the individual and the community – whether we are just a loose confederation of individuals who should be left alone to pursue self interest, or something more than that, a community of citizens with mutual ties and obligations.

I know that sounds awfully highfalutin and philosophical, but it's precisely what the healthcare debate, both the current and historic versions, has been about. Your average American thinks, I have my insurance coverage, so why should I worry about the loser who hasn't bothered to get his? For people who work hard and aren't exactly wallowing in spare dollars, it's a fair question to ask. But there is an answer to it, which is that in the long run, if coverage is universal and insurance companies face stricter rules, society will benefit, and your average American will benefit too, in the form of lower costs and better care.

The problem, of course, is that most people don't believe that. There are many reasons for this, but a central one is that very wealthy and powerful interests have spent blood-curdling amounts of money convincing them that extending insurance to 32 million more of their fellow citizens (and yes, citizens only – not undocumented immigrants) will be at least detrimental to them and more probably calamitous. A record $3.47 billion was spent lobbying Congress last year. Not all of that was about health care, but a hefty chunk of it was, and the vast majority of it by corporations and associations that wanted to kill the bill outright or shape it to reflect their financial priorities.

It's been those two forces – that deeply embedded philosophical resistance to the notion of a common interest, lashed to those billions from corporations whose oxen reform might gore – that have killed efforts like this one every time. The defeat of them is indeed a rare thing in American history.

It did not, you may have noticed, come easily. The Democrats pulled it out in the end, but they – especially the Democrats in Congress – behaved abominably throughout this process. Dozens of Democrats – mostly moderates, but a few on the left, too – acted more like members of a small-town city council considering a zoning application than legislators considering one of the most momentous votes in recent American history. And while it's certainly true that a "yea" vote last night will prove to be a risky one for some members, and will cost a few of them their jobs, even that reality is no justification for the preening and fretting we've witnessed in these recent weeks, weeks they could and should have spent promoting the bill.

Sometimes one had to wonder why some of these people are Democrats in the first place. Barack Obama, speaking to Democratic legislators on Saturday, sought to remind them of this, and he did so in just the philosophical terms I discussed above: "Something inspired you to get involved, and something inspired you to be a Democrat instead of running as a Republican. Because somewhere deep in your heart you said to yourself, I believe in an America in which we don't just look out for ourselves … but we also have a sense of neighborliness and a sense of community, and we are willing to look out for one another and help people who are vulnerable and help people who are down on their luck and give them a pathway to success and give them a ladder into the middle class. That's why you decided to run."

So now they've cast that vote, and they will have to defend it. Opposition will be feral. Democrats may well suffer losses in the near term. And substantively, the mandated purchase of insurance, which begins in 2014, will be a hardship for some people at first.

But here's the thing. Community hasn't succeeded very often in American politics, but when it has, it's tended to work better than advertised. Social Security and Medicare (universal coverage for senior citizens) are very popular. Once changes like these are made, well, it takes a while, but most people tend to like them. And maybe that's the real reason Republicans are so unhinged right now.