After the Republican gains in the 2010 midterms, Congress has fallen on hard times. The legislative branch has had no meaningful legislative accomplishments in over four years, and congressional productivity has dropped to lows unseen in modern American history. As the public respect for the institution deteriorates, it’s been hard to watch.

It’s also why it was such a pleasant surprise to see Congress actually do something

The Senate on Tuesday overwhelmingly approved sweeping changes in the way Medicare pays doctors, clearing the bill for President Obama and resolving an issue that has bedeviled Congress and the Medicare program for more than a decade. The 92-to-8 vote in the Senate, following passage in the House last month by a vote of 392 to 37, was a major success for Republicans, who devised a solution to a complex policy problem that had frustrated lawmakers of both parties. Mr. Obama has endorsed the bill, saying it “could help slow health care cost growth.”

At the risk of sounding ungenerous, I’m not sure I’d call it a “major success for Republicans,” so much as this was a rare example of bipartisan policymaking. Far-right GOP lawmakers still opposed the compromise, but their objections were not enough to derail the deal.

The details of the package get a little wonky – readers can revisit our coverage from March to get an overview – but the underlying point is to resolve the “doc fix” problem that has annoyed lawmakers for years, ask high-income seniors to pay a little more for their Medicare coverage, and extend funding for the Children’s Health Insurance Program, which was facing a dangerous cliff this year, for two additional years.

In the bigger picture, this compromise is easily the most significant health care legislation approved by Congress since the Affordable Care Act passed more than five years ago, and I don’t think it’s an exaggeration to say it’s the biggest legislative accomplishment for Congress in over four years.

What’s more, let’s not overlook how this happened: House Speaker John Boehner (R-Ohio) approached House Minority Leader Nancy Pelosi (D-Calif.) and effectively said, “Let’s try to work something out here.” And they did.

The question then becomes: maybe this can happen again?

Remember, since early 2011, Boehner has started every policy conversation asking himself what his far-right GOP conference will tolerate. If the Speaker’s conservative members were disinclined to support a proposal, the proposal was likely doomed.

To pass this “doc fix” bill, he did the opposite, starting with Pelosi. If Boehner had started governing this way from the start, his Speakership probably would have been less ridiculous.

As for whether mainstream members can repeat the success, hope springs eternal, but I’d advise lowering expectations. I’m reminded of something Greg Sargent wrote in March, before Congress left for its spring break, and before the outcome of this bill was certain.

There are plenty of differences between this situation and the other potential chaos points that loom in coming weeks and months. For one thing, as Dem Rep. Sander Levin said on the House floor today, the basic outlines of today’s compromise have been in place for a year. For another, as Paul Kane and Jason Millman write, “a significant bloc of conservatives supported the legislation,” leading to a split among the most “rebellious” of them. So the price on the right might not be too high. Also consider the specifics of the battles that lie ahead. The Highway Trust Fund is set to run low on money this spring, which could stall infrastructure projects around the country and cost jobs, and Republicans say they want to replenish the fund. But that will require agreeing on an actual way to pay for it, which will be harder in this case than it was for the Medicare doc fix.

There are some ugly pitfalls ahead: a debt-ceiling increase, a possible response to the Supreme Court gutting the American health care system; an appropriations process that could lead to another government shutdown; etc. So far, there’s literally nothing to suggest Republicans are ready to reach out to Dems to make a deal.