The utter failure of Paul Ryan, Mitch McConnell, and Donald Trump to pass a bill rolling back the Affordable Care Act makes one thing perfectly clear: love him or hate him, Barack Obama is one of the most consequential presidents in American history — and that he will be a particularly towering figure in the history of American progressivism.

He signed into law a comprehensive national health insurance bill, a goal that had eluded progressive presidents for a century — and built it strong enough to withstand assaults from the Supreme Court and avoid repeal from a Republican administration. He got surprisingly tough reforms to Wall Street passed as well, not to mention a stimulus package that both blunted the recession and transformed education and energy policy.

He's put in place the toughest climate rules in American history and signed a major international climate accord. He opened the US to Cuba for the first time in more than half a century, and reached a peaceful settlement to the nuclear standoff with Iran.

You can celebrate or bemoan these accomplishments. Liberals hail them as moves toward a social democratic welfare state and a foreign policy more skeptical of military intervention; conservatives critique Obama's efforts to expand regulation and the government's reach, and accuse him of abdicating America's role as world hegemon.

But no one can deny that the changes Obama has wrought are enormous in scale.

Obamacare: a big ****** deal

National health insurance has been the single defining goal of American progressivism for more than a century. There have been other struggles, of course: for equality for women, African Americans, and LGBTQ people; for environmental protection; and, of course, against militarism. But ever since its inclusion in Teddy Roosevelt's 1912 Bull Moose platform, a federally guaranteed right to health coverage has been the one economic and social policy demand that loomed over all others. It was the big gap between our welfare state and those of our peers in Europe, Canada, Australia, New Zealand, and Japan.

And for more than a century, efforts to achieve national health insurance failed. Roosevelt's third-party run came up short. His Progressive allies, despite support from the American Medical Association, failed to pass a bill in the 1910s. FDR declined to include health insurance in the Social Security Act, fearing it would sink the whole program, and the Wagner Act, his second attempt, ended in failure too. Harry Truman included a single-payer plan open to all Americans in his Fair Deal set of proposals, but it went nowhere. LBJ got Medicare and Medicaid done after JFK utterly failed, but both programs targeted limited groups.

Richard Nixon proposed a universal health care plan remarkably similar to Obamacare that was killed when then-Sen. Ted Kennedy (D-MA) walked away from a deal to pass it, in what Kennedy would later call his greatest regret as a senator. Jimmy Carter endorsed single-payer on the campaign trail but despite having a Democratic supermajority in Congress did nothing to pass it. And the failure of Bill Clinton's health care plan is the stuff of legend.

Then on March 23, 2010, President Obama signed the Affordable Care Act into law. It wasn't perfect by any means. Liberals bemoan that it wasn't single-payer; it lacked a public option, or even all-payer rate setting. And it still left many uninsured.

But it established, for the first time in history, that it was the responsibility of the United States government to provide health insurance to nearly all Americans, and it expanded Medicaid and offered hundreds of billions of dollars in insurance subsidies to fulfill that responsibility.

In an email, UC Berkeley's Paul Pierson likened the law to a "starter home" to be expanded later on, much as Social Security — which initially had no disability benefits, left out surviving dependents and widows, and excluded (largely black) agricultural and home workers — was.

Brian Steensland, a sociologist who studies American social policy at Indiana University–Purdue University Indianapolis, agrees. "The main thing it does, I think, is establish the expectation in the public’s mind that access to basic health care is a right," he says. "It’s going to be hard to go back to a time when access to health insurance, and the subsidies to help pay for it, wasn’t near universal."

To pay for it all, the Affordable Care Act cut back on Medicare spending and hiked taxes on rich people's investment income and health plans. It effected a massive downward redistribution of income. It's one of the most startlingly progressive laws this country has ever enacted.

And it was passed with more opposition than the social insurance programs it followed. "FDR and LBJ had lots of fellow Democrats in Congress when they pushed for the New Deal and Great Society," College of William and Mary political scientist Chris Howard says. "Their opponents, in and out of government, were not nearly as ideological or hostile as the ones facing Obama. The fact that the ACA exists at all is pretty remarkable."

A lot of these facts are familiar to people who've been following Obamacare, but it's worth dwelling on them for a second. When you consider the law in the context of 100 years of progressive activism, and in the grand scheme of American history, it starts to look less like a moderate reform and more like an epochal achievement, on the order of FDR's passage of Social Security or LBJ's Great Society programs.

It is, to quote Harvard political scientist Theda Skocpol, "a century-defining accomplishment in the last industrial democracy to resist using national government to ensure access to health coverage for most citizens." FDR failed, Truman failed, Nixon failed, Carter failed, Clinton failed — and Obama succeeded. He filled in the one big remaining gap in the American welfare state when all his forerunners couldn't.

And filling it in was most of the battle. As Pierson has written, it's very very difficult to roll back expansions of the social safety net, because it creates beneficiaries who will resist repeal. That's exactly what happened with the Affordable Care Act. Fear over denying people coverage led the Republican "coverage caucus" to go wobbly, eventually dooming the repeal effort.

But Obama's domestic achievements were not just limited to health care.

"On domestic issues Obama is the most consequential and successful Democratic president since LBJ. It isn't close."

The Affordable Care Act was hardly Obama's only accomplishment. He passed a stimulus bill that included major reforms to the nation's education system, big spending on clean energy, and significant expansions of antipoverty programs. He shepherded through the Dodd-Frank Act, the first significant crackdown on Wall Street's power in a generation, which has been far more successful than commonly acknowledged.

He used executive action to enact bold regulations to curb greenhouse gas emissions, and to protect nearly 6 million undocumented immigrants from deportation. He ended the ban on gay and lesbian service in the military, made it easier for women and minorities to fight wage discrimination, cut out wasteful private sector involvement in student loans, and hiked the top income tax rate. He reprofessionalized the Department of Justice and refashioned the National Labor Relations Board and the Wage and Hour Division of the Labor Department into highly effective forces for workers' rights.

His presidency holds massive symbolic value as proof that the reign of white men over American government can be halted and America as a whole can be represented. And while he was too slow in announcing support for same-sex marriage, he appointed two of the justices behind the Supreme Court's historic decision that legalized it nationwide, and enlisted his Justice Department on the side of the plaintiffs.

There are obviously places Obama fell short. I think he didn't take monetary policy nearly seriously enough, that he's fallen short on combating HIV/AIDS and other public health scourges abroad, that his early push to deport millions of unauthorized immigrants was indefensible, and that perpetrators of torture and other war crimes from the Bush administration should have been criminally prosecuted. But while Obama could have accomplished more, it could never be said that he accomplished little.

"When you add the ACA to the reforms in the stimulus package, Dodd-Frank, and his various climate initiatives," Pierson says, "I don't think there is any doubt: On domestic issues Obama is the most consequential and successful Democratic president since LBJ. It isn't close."

Obama's foreign policy was a new direction for the Democratic Party — and the country

And on foreign issues, Obama's record is perhaps the most successful of any Democratic president since Truman. He has reestablished productive diplomacy as the central task of a progressive foreign policy, and as a viable alternative approach to dealing with countries the GOP foreign policy establishment would rather bomb.

He established a viable alternative to the liberal hawks that dominated Democratic thinking during the Bush years, and held positions of influence on Hillary Clinton's 2008 campaign. And he developed a cadre of aides who can carry on that legacy to future Democratic administrations and keep a tradition of dovishness alive.

To understand how this happened, it's worth going back to 2008, when YouTuber Stephen Sorta asked the most important question of the Democratic primary debates: "Would you be willing to meet separately, without precondition, during the first year of your administration, in Washington or anywhere else, with the leaders of Iran, Syria, Venezuela, Cuba, and North Korea, in order to bridge the gap that divides our countries?"

The safe, reserved thing to do would be to say no: Sure, diplomacy's great, but obviously there will be "preconditions." This was the response of future Secretary of State Hillary Clinton, who called the idea "irresponsible and frankly naive" following the debate. It was also the response of future Vice President Joe Biden, who said, "World leaders should not meet with other world leaders unless they know what the agenda is, so you don’t end up being used."

This was, famously, not the response of future President Barack Obama. "I would," he replied. "And the reason is this: that the notion that somehow not talking to countries is punishment to them — which has been the guiding diplomatic principle of this administration — is ridiculous."

At the time, Obama's statement was treated like a gaffe. Today it feels more like a statement of purpose. Obama did correspond with Iranian President Hassan Rouhani. His secretary of state met for weeks at a time with Rouhani's foreign minister to hammer out a deal. And the result is a historic accord with Iran that, if successful, will stop Iran from developing a nuclear device for at least 10 years. More important than that, it eliminates the odds of a war between the US and Iran in the near future.

And of course, Iran isn't the only country on Sorta's list with whom Obama has engaged in direct talks. He also did away with America's failed policy of isolating Cuba, ending the embargo and allowing for a rapprochement after more than 50 years. His radical openness to dialogue abroad got results in the form of two of the biggest American diplomatic breakthroughs since the Oslo Accords in 1994, perhaps since Camp David in 1978.

But the Iran and Cuba deals were of a different nature than those accords, or similar breakthroughs by Ronald Reagan or George H.W. Bush. From Watergate through 2009, America's major diplomatic breakthroughs were generally either arms control deals with the Soviet Union or Russia, or trilateral agreements meant to protect Israel's long-term security, like Camp David and Oslo.

Those are important steps, but they solidified America's existing relationships. Obama, by contrast, achieved two huge openings to countries the US had previously counted as enemies for decades. They are achievements more like Nixon's opening to China than, say, the SALT accords. And, of course, Obama has a major Russian arms control deal under his belt in the form of New START, as well.

In December 2015, Obama added the climate deal in Paris to the list. This wasn't a traditional agreement, as it was not legally binding. But nonetheless, 195 countries agreed to submit plans for reducing greenhouse gas emissions. That's an astonishing degree of global consensus, even without a legally binding treaty.

And with luck, the Paris deal, for which the Obama administration fought hard, will encourage a flurry of bilateral or multilateral binding agreements between its signatories, creating a virtuous cycle in which nations pressure each other to cut emissions further and further. It may not be enough to stop catastrophic warming — but with 195 nations, it's likely the best anyone could've hoped for. Even with the Trump administration backing out of the accord, it remains standing policy in almost the entire rest of the world, in part due to Obama's effort.

Obama's decisions haven't been perfect. He revived Clinton-style militarism in the Middle East, where periodic airstrikes and special ops missions take the place of Bush-style invasion and occupation. The drone war is a moral catastrophe, and the 2009 surge in Afghanistan was a mistake. Syria remains a morass with no good options, though arguably Obama had no better choice than to muddle through. But certainly compared to his predecessors, Obama was a model of restraint, prudence, and openness in foreign policy.

You can generally divide American presidents into two camps: the mildly good or bad but ultimately forgettable (Clinton, Carter, Taft, Harrison), and the hugely consequential for good or ill (FDR, Lincoln, Nixon, Andrew Johnson). Whether you love or hate his record, there's no question Obama's domestic and foreign achievements place him firmly in the latter camp.

Watch: President Obama explains why he is so polarizing