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BY THE END OF JULY 2009, some version of the healthcare bill had passed out of all the relevant House committees. The Senate Health and Education Committee had completed its work as well. All that remained was getting a bill through Max Baucus’s Senate Finance Committee. Once that was done, we could consolidate the different versions into one House and one Senate bill, ideally passing each before the August recess, with the goal of having a final version of the legislation on my desk for signature before the end of the year.

No matter how hard we pressed, though, we couldn’t get Baucus to complete his work. I was sympathetic to his reasons for delay: Unlike the other Democratic committee chairs, who’d passed their bills on straight party-line votes without regard for the Republicans, Baucus continued to hope that he could produce a bipartisan bill. But as summer wore on, that optimism began to look delusional. McConnell and Boehner had already announced their vigorous opposition to our legislative efforts, arguing that it represented an attempted “government takeover” of the healthcare system. Frank Luntz, a well-known Republican strategist, had circulated a memo stating that after market-testing no fewer than forty anti-reform messages, he’d concluded that invoking a “government takeover” was the best way to discredit the healthcare legislation. From that point on, conservatives followed the script, repeating the phrase like an incantation.

Senator Jim DeMint, the conservative firebrand from South Carolina, was more transparent about his party’s intentions. “If we’re able to stop Obama on this,” he announced on a nationwide conference call with conservative activists, “it will be his Waterloo. It will break him.” Unsurprisingly, given the atmosphere, the group of three GOP senators who’d been invited to participate in bipartisan talks with Baucus was now down to two: Chuck Grassley and Olympia Snowe, the moderate from Maine. My team and I did everything we could to help Baucus win their support. I had Grassley and Snowe over to the White House repeatedly and called them every few weeks to take their temperature. We signed off on scores of changes they wanted made to Baucus’s draft bill. Nancy-Ann became a permanent fixture in their Senate offices and took Snowe out to dinner so often that we joked that her husband was getting jealous.

“Tell Olympia she can write the whole damn bill!” I said to Nancy-Ann as she was leaving for one such meeting. “We’ll call it the Snowe plan. Tell her if she votes for the bill, she can have the White House…Michelle and I will move to an apartment!” And still we were getting nowhere. Snowe took pride in her centrist reputation, and she cared deeply about healthcare (she had been orphaned at the age of nine, losing her parents, in rapid succession, to cancer and heart disease). But the Republican Party’s sharp rightward tilt had left her increasingly isolated within her own caucus, making her even more cautious than usual, prone to wrapping her indecision in the guise of digging into policy minutiae.

Grassley was a different story. He talked a good game about wanting to help the family farmers back in Iowa who had trouble getting insurance they could count on, and when Hillary Clinton had pushed healthcare reform in the 1990s, he’d actually cosponsored an alternative that in many ways resembled the Massachusetts-style plan we were proposing, complete with an individual mandate. But unlike Snowe, Grassley rarely bucked his party leadership on tough issues. With his long, hangdog face and throaty midwestern drawl, he’d hem and haw about this or that problem he had with the bill without ever telling us what exactly it would take to get him to yes. Phil’s conclusion was that Grassley was just stringing Baucus along at McConnell’s behest, trying to stall the process and prevent us from moving on to the rest of our agenda. Even I, the resident White House optimist, finally got fed up and asked Baucus to come by for a visit.

“Time’s up, Max,” I told him in the Oval during a meeting in late July. “You’ve given it your best shot. Grassley’s gone. He just hasn’t broken the news to you yet.”

Baucus shook his head. “I respectfully disagree, Mr. President,” he said. “I know Chuck. I think we’re this close to getting him.” He held his thumb and index finger an inch apart, smiling at me like someone who’s discovered a cure for cancer and is forced to deal with foolish skeptics. “Let’s just give Chuck a little more time and have the vote when we get back from recess.” A part of me wanted to get up, grab Baucus by the shoulders, and shake him till he came to his senses. I decided that this wouldn’t work. Another part of me considered threatening to withhold my political support the next time he ran for reelection, but since he polled higher than I did in his home state of Montana, I figured that wouldn’t work either. Instead, I argued and cajoled for another half hour, finally agreeing to his plan to delay an immediate party-line vote and instead call the bill to a vote within the first two weeks of Congress’s reconvening in September.

WITH THE HOUSE and the Senate adjourned and both votes still looming, we decided I’d spend the first two weeks of August on the road, holding healthcare town halls in places like Montana, Colorado, and Arizona, where public support for reform was shakiest. As a sweetener, my team suggested that Michelle and the girls join me, and that we visit some national parks along the way.

I was thrilled by the suggestion. It’s not as if Malia and Sasha were deprived of fatherly attention or in need of extra summer fun—they’d had plenty of both, with playdates and movies and a whole lot of loafing. Often, I’d come home in the evening and go up to the third floor to find the solarium overtaken by pajama-clad eight- or eleven-year-old girls settling in for a sleepover, bouncing on inflatable mattresses, scattering popcorn and toys everywhere, giggling nonstop at whatever was on Nickelodeon.

But as much as Michelle and I (with the help of infinitely patient Secret Service agents) tried to approximate a normal childhood for my daughters, it was hard if not impossible for me to take them places like an ordinary dad would. We couldn’t go to an amusement park together, making an impromptu stop for burgers along the way. I couldn’t take them, as I once had, on lazy Sunday afternoon bike rides. A trip to get ice cream or a visit to a bookstore was now a major production, involving road closures, tactical teams, and the omnipresent press pool.

If the girls felt a sense of loss over this, they didn’t show it. But I felt it acutely. I especially mourned the fact that I’d probably never get a chance to take Malia and Sasha on the sort of long summer road trip I’d made when I was eleven, after my mother and Toot decided it was time for Maya and me to see the mainland of the United States. It had lasted a month and burned a lasting impression into my mind—and not just because we went to Disneyland (although that was obviously outstanding). We had dug for clams during low tide in Puget Sound, ridden horses through a creek at the base of Canyon de Chelly in Arizona, watched the endless Kansas prairie unfold from a train window, spotted a herd of bison on a dusky plain in Yellowstone, and ended each day with the simple pleasures of a motel ice machine, the occasional swimming pool, or just air-conditioning and clean sheets. That one trip gave me a glimpse of the dizzying freedom of the open road, how vast America was, and how full of wonder.

I couldn’t duplicate that experience for my daughters—not when we flew on Air Force One, rode in motorcades, and never bunked down in a place like Howard Johnson’s. Getting from Point A to Point B happened too fast and too comfortably, and the days were too stuffed with prescheduled, staff-monitored activity—absent that familiar mix of surprises, misadventures, and boredom—to fully qualify as a road trip. But over the course of an August week, Michelle, the girls, and I had fun all the same. We watched Old Faithful blow and looked out over the ocher expanse of the Grand Canyon. The girls went inner tubing. At night, we played board games and tried to name the constellations. Tucking the girls into bed, I hoped that despite all the fuss that surrounded us, their minds were storing away a vision of life’s possibilities and the beauty of the American landscape, just as mine once had; and that they might someday think back on our trips together and be reminded that they were so worthy of love, so fascinating and electric with life, that there was nothing their parents would rather do than share those vistas with them.

OF COURSE, one of the things Malia and Sasha had to put up with on the trip out west was their dad peeling off every other day to appear before large crowds and TV cameras and talk about healthcare. The town halls themselves weren’t very different from the ones I’d held earlier in the spring. People shared stories about how the existing healthcare system had failed their families, and asked questions about how the emerging bill might affect their own insurance. Even those who opposed our effort listened attentively to what I had to say.

Outside, though, the atmosphere was very different. We were in the middle of what came to be known as the “Tea Party summer,” an organized effort to marry people’s honest fears about a changing America with a right-wing political agenda. Heading to and from every venue, we were greeted by dozens of angry protesters. Some shouted through bullhorns. Others flashed a single-fingered salute. Many held up signs with messages like OBAMACARE SUCKS or the unintentionally ironic KEEP GOVERNMENT OUT OF MY MEDICARE. Some waved doctored pictures of me looking like Heath Ledger’s Joker in The Dark Knight, with blackened eyes and thickly caked makeup, appearing almost demonic. Still others wore colonial-era patriot costumes and hoisted the DON’T TREAD ON ME flag. All of them seemed most interested in expressing their general contempt for me, a sentiment best summed up by a refashioning of the famous Shepard Fairey poster from our campaign: the same red, white, and blue rendering of my face, but with the word HOPE replaced by NOPE.

This new and suddenly potent force in American politics had started months earlier as a handful of ragtag, small-scale protests against TARP and the Recovery Act. A number of the early participants had apparently migrated from the quixotic, libertarian presidential campaign of Republican congressman Ron Paul, who called for the elimination of the federal income tax and the Federal Reserve, a return to the gold standard, and withdrawal from the U.N. and NATO. Rick Santelli’s notorious television rant against our housing proposal back in February had provided a catchy rallying cry for the loose network of conservative activists, and soon websites and email chains had begun spawning bigger rallies, with Tea Party chapters proliferating across the country. In those early months, they hadn’t had enough traction to stop the stimulus package from passing, and a national protest on Tax Day in April hadn’t amounted to much. But helped by endorsements from conservative media personalities like Rush Limbaugh and Glenn Beck, the movement was picking up steam, with local and then national Republican politicians embracing the Tea Party label.

By summer, the group was focused on stopping the abomination they dubbed “Obamacare,” which they insisted would introduce a socialistic, oppressive new order to America. As I was conducting my own relatively sedate healthcare town halls out west, newscasts started broadcasting scenes from parallel congressional events around the country, with House and Senate members suddenly confronted by angry, heckling crowds in their home districts and with Tea Party members deliberately disrupting the proceedings, rattling some of the politicians enough that they were canceling public appearances altogether.

It was hard for me to decide what to make of all this. The Tea Party’s anti-tax, anti-regulation, anti-government manifesto was hardly new; its basic story line—that corrupt liberal elites had hijacked the federal government to take money out of the pockets of hardworking Americans in order to finance welfare patronage and reward corporate cronies—was one that Republican politicians and conservative media had been peddling for years. Nor, it turned out, was the Tea Party the spontaneous, grassroots movement it purported to be. From the outset, Koch brother affiliates like Americans for Prosperity, along with other billionaire conservatives who’d been part of the Indian Wells gathering hosted by the Kochs just after I was inaugurated, had carefully nurtured the movement by registering internet domain names and obtaining rally permits; training organizers and sponsoring conferences; and ultimately providing much of the Tea Party’s financing, infrastructure, and strategic direction.

Still, there was no denying that the Tea Party represented a genuine populist surge within the Republican Party. It was made up of true believers, possessed with the same grassroots enthusiasm and jagged fury we’d seen in Sarah Palin supporters during the closing days of the campaign. Some of that anger I understood, even if I considered it misdirected. Many of the working- and middle-class whites gravitating to the Tea Party had suffered for decades from sluggish wages, rising costs, and the loss of the steady blue-collar work that provided secure retirements. Bush and establishment Republicans hadn’t done anything for them, and the financial crisis had further hollowed out their communities. And so far, at least, the economy had gotten steadily worse with me in charge, despite more than a trillion dollars channeled into stimulus spending and bailouts. For those already predisposed toward conservative ideas, the notion that my policies were designed to help others at their expense—that the game was rigged and I was part of the rigging—must have seemed entirely plausible.

I also had a grudging respect for how rapidly Tea Party leaders had mobilized a strong following and managed to dominate the news coverage, using some of the same social media and grassroots-organizing strategies we’d deployed during my own campaign. I’d spent my entire political career promoting civic participation as a cure for much of what ailed our democracy. I could hardly complain, I told myself, just because it was opposition to my agenda that was now spurring such passionate citizen involvement.

As time went on, though, it became hard to ignore some of the more troubling impulses driving the movement. As had been true at Palin rallies, reporters at Tea Party events caught attendees comparing me to animals or Hitler. Signs turned up showing me dressed like an African witch doctor with a bone through my nose and the caption OBAMACARE COMING SOON TO A CLINIC NEAR YOU. Conspiracy theories abounded: that my healthcare bill would set up “death panels” to evaluate whether people deserved treatment, clearing the way for “government-encouraged euthanasia,” or that it would benefit illegal immigrants, in the service of my larger goal of flooding the country with welfare-dependent, reliably Democratic voters. The Tea Party also resurrected and poured gas on an old rumor from the campaign: that not only was I Muslim, but I’d actually been born in Kenya and was therefore constitutionally barred from serving as president. By September, the question of how much nativism and racism explained the Tea Party’s rise had become a major topic of debate on the cable shows—especially after former president and lifelong southerner Jimmy Carter offered up the opinion that the extreme vitriol directed toward me was at least in part spawned by racist views.

At the White House, we made a point of not commenting on any of this—and not just because Axe had reams of data telling us that white voters, including many who supported me, reacted poorly to lectures about race. As a matter of principle, I didn’t believe a president should ever publicly whine about criticism from voters—it’s what you signed up for in taking the job—and I was quick to remind both reporters and friends that my white predecessors had all endured their share of vicious personal attacks and obstructionism.

More practically, I saw no way to sort out people’s motives, especially given that racial attitudes were woven into every aspect of our nation’s history. Did that Tea Party member support “states’ rights” because he genuinely thought it was the best way to promote liberty, or because he continued to resent how federal intervention had led to an end to Jim Crow, desegregation, and rising Black political power in the South? Did that conservative activist oppose any expansion of the social welfare state because she believed it sapped individual initiative, or because she was convinced that it would benefit only brown people who’d just crossed the border? Whatever my instincts might tell me, whatever truths the history books might suggest, I knew I wasn’t going to win over any voters by labeling my opponents racist.

One thing felt certain: A pretty big chunk of the American people, including some of the very folks I was trying to help, didn’t trust a word I said. One night around then I watched a news report on a charitable organization called Remote Area Medical that provided medical services in temporary pop-up clinics around the country, operating out of trailers parked outside arenas and fairgrounds. Almost all the patients in the report were white southerners from places like Tennessee, Georgia, and West Virginia—men and women who had jobs but no employer-based insurance or had insurance with deductibles they couldn’t afford. Many had driven hundreds of miles—some sleeping in their cars overnight, leaving the engines running to stay warm—to join hundreds of other people lined up before dawn to see one of the volunteer doctors who might pull an infected tooth, diagnose debilitating abdominal pain, or examine a lump in their breast. The demand was so great that patients who arrived after sunup sometimes got turned away.

I found the story both heartbreaking and maddening, an indictment of a wealthy nation that failed too many of its citizens. And yet I knew that almost every one of those people waiting to see a free doctor came from a deep-red Republican district, the sort of place where opposition to our healthcare bill, along with support of the Tea Party, was likely to be strongest. There had been a time—back when I was still a state senator driving around southern Illinois or, later, traveling through rural Iowa during the earliest days of the presidential campaign—when I could reach such voters. I wasn’t yet well known enough to be the target of caricature, which meant that whatever preconceptions people may have had about a Black guy from Chicago with a foreign name could be dispelled by a simple conversation, a small gesture of kindness. After sitting down with folks in a diner or hearing their complaints at a county fair, I might not get their vote or even agreement on most issues. But we would at least make a connection, and we’d come away from such encounters understanding that we had hopes, struggles, and values in common.

I wondered if any of that was still possible, now that I lived locked behind gates and guardsmen, my image filtered through Fox News and other media outlets whose entire business model depended on making their audience angry and fearful. I wanted to believe that the ability to connect was still there. My wife wasn’t so sure. One night toward the end of our road trip, after we’d tucked the girls in, Michelle caught a glimpse of a Tea Party rally on TV—with its enraged flag-waving and inflammatory slogans. She seized the remote and turned off the set, her expression hovering somewhere between rage and resignation.

“It’s a trip, isn’t it?” she said.

“What is?”

“That they’re scared of you. Scared of us.”

She shook her head and headed for bed.

TED KENNEDY DIED on August 25. The morning of his funeral, the skies over Boston darkened, and by the time our flight landed the streets were shrouded in thick sheets of rain. The scene inside the church befitted the largeness of Teddy’s life: the pews packed with former presidents and heads of state, senators and members of Congress, hundreds of current and former staffers, the honor guard, and the flag-draped casket. But it was the stories told by his family, most of all his children, that mattered most that day. Patrick Kennedy recalled his father tending to him during crippling asthma attacks, pressing a cold towel to his forehead until he fell asleep. He described how his father would take him out to sail, even in stormy seas. Teddy Jr. told the story of how, after he’d lost his leg to cancer, his father had insisted they go sledding, trudging with him up a snowy hill, picking him up when he fell, and wiping away his tears when he wanted to give up, the two of them eventually getting to the top and racing down the snowy banks. It had been proof, Teddy Jr. said, that his world had not stopped. Collectively, it was a portrait of a man driven by great appetites and ambitions but also by great loss and doubt. A man making up for things.

“My father believed in redemption,” Teddy Jr. said. “And he never surrendered, never stopped trying to right wrongs, be they the results of his own failings or of ours.”

I carried those words with me back to Washington, where a mood of surrender increasingly prevailed—at least when it came to getting a healthcare bill passed. The Tea Party had accomplished what it had set out to do, generating reams of negative publicity for our efforts, stoking public fear that reform would be too costly, too disruptive, or would help only the poor. A preliminary report by the Congressional Budget Office (CBO), the independent, professionally staffed operation charged with scoring the cost of all federal legislation, priced the initial House version of the healthcare bill at an eye-popping $1 trillion. Although the CBO score would eventually come down as the bill was revised and clarified, the headlines gave opponents a handy stick with which to beat us over the head. Democrats from swing districts were now running scared, convinced that pushing forward with the bill amounted to a suicide mission. Republicans abandoned all pretense of wanting to negotiate, with members of Congress regularly echoing the Tea Party’s claim that I wanted to put Grandma to sleep.






“I guess not, Mr. President.”

I guess not.

At the White House, the mood rapidly darkened. Some of my team began asking whether it was time to fold our hand. Rahm was especially dour. Having been to this rodeo before with Bill Clinton, he understood all too well what my declining poll numbers might mean for the reelection prospects of swing-district Democrats, many of whom he’d personally recruited and helped elect, not to mention how it could damage my own prospects in 2012. Discussing our options in a senior-staff meeting, Rahm advised that we try to cut a deal with Republicans for a significantly scaled-back piece of legislation—perhaps allowing people between sixty and sixty-five to buy into Medicare or widening the reach of the Children’s Health Insurance Program. “It won’t be everything you wanted, Mr. President,” he said. “But it’ll still help a lot of people, and it’ll give us a better chance to make progress on the rest of your agenda.” Some in the room agreed. Others felt it was too early to give up. After reviewing his conversations on Capitol Hill, Phil Schiliro said he thought there was still a path to passing a comprehensive law with only Democratic votes, but he admitted that it was no sure thing.

“I guess the question for you, Mr. President, is, Do you feel lucky?”

I looked at him and smiled. “Where are we, Phil?”

Phil hesitated, wondering if it was a trick question. “The Oval Office?”

“And what’s my name?”

“Barack Obama.”

I smiled. “Barack Hussein Obama. And I’m here with you in the Oval Office. Brother, I always feel lucky.”

I told the team we were staying the course. But honestly, my decision didn’t have much to do with how lucky I felt. Rahm wasn’t wrong about the risks, and perhaps in a different political environment, on a different issue, I might have accepted his idea of negotiating with the GOP for half a loaf. On this issue, though, I saw no indication that Republican leaders would throw us a lifeline. We were wounded, their base wanted blood, and no matter how modest the reform we proposed, they were sure to find a whole new set of reasons for not working with us.

More than that, a scaled-down bill wasn’t going to help millions of people who were desperate, people like Laura Klitzka in Green Bay. The idea of letting them down—of leaving them to fend for themselves because their president hadn’t been sufficiently brave, skilled, or persuasive to cut through the political noise and get what he knew to be the right thing done—was something I couldn’t stomach.

AT THAT POINT, I’d held town halls in eight states, explaining in both broad and intricate terms what healthcare reform could mean. I’d taken phone calls from AARP members on live television, fielding questions about everything from Medicare coverage gaps to living wills. Late at night in the Treaty Room, I pored over the continuing flow of memos and spreadsheets, making sure I understood the finer points of risk corridors and reinsurance caps. If I sometimes grew despondent, even angry, over the amount of misinformation that had flooded the airwaves, I was grateful for my team’s willingness to push harder and not give up, even when the battle got ugly and the odds remained long. Such tenacity drove the entire White House staff. Denis McDonough at one point distributed stickers to everyone, emblazoned with the words FIGHT CYNICISM. This became a useful slogan, an article of our faith.

Knowing we had to try something big to reset the healthcare debate, Axe suggested that I deliver a prime-time address before a joint session of Congress. It was a high-stakes gambit, he explained, used only twice in the past sixteen years, but it would give me a chance to speak directly to millions of viewers. I asked what the other two joint addresses had been about.

“The most recent was when Bush announced the War on Terror after 9/11.”

“And the other?”

“Bill Clinton talking about his healthcare bill.”

I laughed. “Well, that worked out great, didn’t it?”

Despite the inauspicious precedent, we decided it was worth a shot. Two days after Labor Day, Michelle and I climbed into the backseat of the Beast, drove up to the Capitol’s east entrance, and retraced the steps we’d taken seven months earlier to the doors of the House chamber. The announcement by the sergeant at arms, the lights, television cameras, applause, handshakes along the center aisle—on the surface, at least, everything appeared as it had in February. But the mood in the chamber felt different this time—the smiles a little forced, a murmur of tension and doubt in the air. Or maybe it was just that my mood was different. Whatever giddiness or sense of personal triumph I’d felt shortly after taking office had now been burned away, replaced by something sturdier: a determination to see a job through.

For an hour that evening, I explained as straightforwardly as I could what our reform proposals would mean for the families who were watching: how it would provide affordable insurance to those who needed it but also give critical protections to those who already had insurance; how it would prevent insurance companies from discriminating against people with preexisting conditions and eliminate the kind of lifetime limits that burdened families like Laura Klitzka’s. I detailed how the plan would help seniors pay for lifesaving drugs and require insurers to cover routine checkups and preventive care at no extra charge. I explained that the talk about a government takeover and death panels was nonsense, that the legislation wouldn’t add a dime to the deficit, and that the time to make this happen was now.

A few days earlier, I’d received a letter from Ted Kennedy. He’d written it back in May but had instructed Vicki to wait until after his death to pass it along. It was a farewell letter, two pages long, in which he’d thanked me for taking up the cause of healthcare reform, referring to it as “that great unfinished business of our society” and the cause of his life. He added that he would die with some comfort, believing that what he’d spent years working toward would now, under my watch, finally happen.

So I ended my speech that night by quoting from Teddy’s letter, hoping that his words would bolster the nation just as they had bolstered me. “What we face,” he’d written, “is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.” According to poll data, my address to Congress boosted public support for the healthcare bill, at least temporarily. Even more important for our purposes, it seemed to stiffen the spine of wavering congressional Democrats. It did not, however, change the mind of a single Republican in the chamber. This was clear less than thirty minutes into the speech, when—as I debunked the phony claim that the bill would insure undocumented immigrants—a relatively obscure five-term Republican congressman from South Carolina named Joe Wilson leaned forward in his seat, pointed in my direction, and shouted, his face flushed with fury, “You lie!” For the briefest second, a stunned silence fell over the chamber. I turned to look for the heckler (as did Speaker Pelosi and Joe Biden, Nancy aghast and Joe shaking his head). I was tempted to exit my perch, make my way down the aisle, and smack the guy in the head. Instead, I simply responded by saying “It’s not true” and then carried on with my speech as Democrats hurled boos in Wilson’s direction.

As far as anyone could remember, nothing like that had ever happened before a joint session address—at least not in modern times. Congressional criticism was swift and bipartisan, and by the next morning Wilson had apologized publicly for the breach of decorum, calling Rahm and asking that his regrets get passed on to me as well. I downplayed the matter, telling a reporter that I appreciated the apology and was a big believer that we all make mistakes.

And yet I couldn’t help noticing the news reports saying that online contributions to Wilson’s reelection campaign spiked sharply in the week following his outburst. Apparently, for a lot of Republican voters out there, he was a hero, speaking truth to power. It was an indication that the Tea Party and its media allies had accomplished more than just their goal of demonizing the healthcare bill. They had demonized me and, in doing so, had delivered a message to all Republican officeholders: When it came to opposing my administration, the old rules no longer applied.

DESPITE HAVING GROWN UP in Hawaii, I have never learned to sail a boat; it wasn’t a pastime my family could afford. And yet for the next three and a half months, I felt the way I imagine sailors feel on the open seas after a brutal storm has passed. The work remained arduous and sometimes monotonous, made tougher by the need to patch leaks and bail water. Maintaining speed and course in the constantly shifting winds and currents required patience, skill, and attention. But for a span of time, we had in us the thankfulness of survivors, propelled in our daily tasks by a renewed belief that we might make it to port after all.

For starters, after months of delay, Baucus finally opened debate on a healthcare bill in the Senate Finance Committee. His version, which tracked the Massachusetts model we’d all been using, was stingier with its subsidies to the uninsured than we would have preferred, and we insisted that he replace a tax on all employer-based insurance plans with increased taxes on the wealthy. But to everyone’s credit, the deliberations were generally substantive and free of grandstanding. After three weeks of exhaustive work, the bill passed out of committee by a 14-to-9 margin. Olympia Snowe even decided to vote yes, giving us a lone Republican vote.

Speaker Pelosi then engineered the quick passage of a consolidated House bill over uniform and boisterous GOP opposition, with a vote held on November 7, 2009. (The bill had actually been ready for some time, but Nancy had been unwilling to bring it to the House floor—and force her members to cast tough political votes—until she had confidence that the Senate effort wasn’t going to fizzle.) If we could get the full Senate to pass a similarly consolidated version of its bill before the Christmas recess, we figured, we could then use January to negotiate the differences between the Senate and House versions, send a merged bill to both chambers for approval, and with any luck have the final legislation on my desk for signature by February.

It was a big if—and one largely dependent on my old friend Harry Reid. True to his generally dim view of human nature, the Senate majority leader assumed that Olympia Snowe couldn’t be counted on once a final version of the healthcare bill hit the floor. (“When McConnell really puts the screws to her,” he told me matter-of-factly, “she’ll fold like a cheap suit.”) To overcome the possibility of a filibuster, Harry couldn’t afford to lose a single member of his sixty-person caucus. And as had been true with the Recovery Act, this fact gave each one of those members enormous leverage to demand changes to the bill, regardless of how parochial or ill-considered their requests might be.

This wouldn’t be a situation conducive to high-minded policy considerations, which was just fine with Harry, who could maneuver, cut deals, and apply pressure like nobody else. For the next six weeks, as the consolidated bill was introduced on the Senate floor and lengthy debates commenced on procedural matters, the only action that really mattered took place behind closed doors in Harry’s office, where he met with the holdouts one by one to find out what it would take to get them to yes. Some wanted funding for well-intentioned but marginally useful pet projects. Several of the Senate’s most liberal members, who liked to rail against the outsized profits of Big Pharma and private insurers, suddenly had no problem at all with the outsized profits of medical device manufacturers with facilities in their home states and were pushing Harry to scale back a proposed tax on the industry. Senators Mary Landrieu and Ben Nelson made their votes contingent on billions of additional Medicaid dollars specifically for Louisiana and Nebraska, concessions that the Republicans cleverly labeled “the Louisiana Purchase” and “the Cornhusker Kickback.” Whatever it took, Harry was game. Sometimes too game. He was good about staying in touch with my team, giving Phil or Nancy-Ann the chance to head off legislative changes that could adversely affect the core parts of our reforms, but occasionally he’d dig his heels in on some deal he wanted to cut, and I’d have to intervene with a call. Listening to my objections, he’d usually relent, but not without some grumbling, wondering how on earth he would get the bill passed if he did things my way.

“Mr. President, you know a lot more than I do about healthcare policy,” he said at one point. “But I know the Senate, okay?”

Compared to the egregious pork-barreling, logrolling, and patronage-dispensing tactics Senate leaders had traditionally used to get big, controversial bills like the Civil Rights Act or Ronald Reagan’s 1986 Tax Reform Act, or a package like the New Deal, passed, Harry’s methods were fairly benign. But those bills had passed during a time when most Washington horse-trading stayed out of the papers, before the advent of the twenty-four-hour news cycle. For us, the slog through the Senate was a PR nightmare. Each time Harry’s bill was altered to mollify another senator, reporters cranked out a new round of stories about “backroom deals.” Whatever bump in public opinion my joint address had provided to the reform effort soon vanished—and things got markedly worse when Harry decided, with my blessing, to strip the bill of something called “the public option.” From the very start of the healthcare debate, policy wonks on the left had pushed us to modify the Massachusetts model by giving consumers the choice to buy coverage on the online “exchange,” not just from the likes of Aetna and Blue Cross Blue Shield but also from a newly formed insurer owned and operated by the government. Unsurprisingly, insurance companies had balked at the idea of a public option, arguing that they would not be able to compete against a government insurance plan that could operate without the pressures of making a profit. Of course, for public-option proponents, that was exactly the point: By highlighting the cost-effectiveness of government insurance and exposing the bloated waste and immorality of the private insurance market, they hoped the public option would pave the way for a single-payer system.

It was a clever idea, and one with enough traction that Nancy Pelosi had included it in the House bill. But on the Senate side, we were nowhere close to having sixty votes for a public option. There was a watered-down version in the Senate Health and Education Committee bill, requiring any government-run insurer to charge the same rates as private insurers, but of course that would have defeated the whole purpose of a public option. My team and I thought a possible compromise might involve offering a public option only in those parts of the country where there were too few insurers to provide real competition and a public entity could help drive down premium prices overall. But even that was too much for the more conservative members of the Democratic caucus to swallow, including Joe Lieberman of Connecticut, who announced shortly before Thanksgiving that under no circumstances would he vote for a package that contained a public option.

When word got out that the public option had been removed from the Senate bill, activists on the left went ballistic. Howard Dean, the former Vermont governor and onetime presidential candidate, declared it “essentially the collapse of health reform in the United States Senate.” They were especially outraged that Harry and I appeared to be catering to the whims of Joe Lieberman—an object of liberal scorn who’d been defeated in the 2006 Democratic primary for his consistently hawkish support for the Iraq War and had then been forced to run for reelection as an independent. It wasn’t the first time I’d chosen practicality over pique when it came to Lieberman: Despite the fact he’d endorsed his buddy John McCain in the last presidential campaign, Harry and I had quashed calls to strip him of various committee assignments, figuring we couldn’t afford to have him bolt the caucus and cost us a reliable vote. We’d been right about that—Lieberman had consistently supported my domestic agenda. But his apparent power to dictate the terms of healthcare reform reinforced the view among some Democrats that I treated enemies better than allies and was turning my back on the progressives who’d put me in office.

I found the whole brouhaha exasperating. “What is it about sixty votes these folks don’t understand?” I groused to my staff. “Should I tell the thirty million people who can’t get covered that they’re going to have to wait another ten years because we can’t get them a public option?” It wasn’t just that criticism from friends always stung the most. The carping carried immediate political consequences for Democrats. It confused our base (which, generally speaking, had no idea what the hell a public option was) and divided our caucus, making it tougher for us to line up the votes we’d need to get the healthcare bill across the finish line. It also ignored the fact that all the great social welfare advances in American history, including Social Security and Medicare, had started off incomplete and had been built upon gradually, over time. By preemptively spinning what could be a monumental, if imperfect, victory into a bitter defeat, the criticism contributed to a potential long-term demoralization of Democratic voters—otherwise known as the “What’s the point of voting if nothing ever changes?” syndrome—making it even harder for us to win elections and move progressive legislation forward in the future.

There was a reason, I told Valerie, why Republicans tended to do the opposite—why Ronald Reagan could preside over huge increases in the federal budget, federal deficit, and federal workforce and still be lionized by the GOP faithful as the guy who successfully shrank the federal government. They understood that in politics, the stories told were often as important as the substance achieved.

We made none of these arguments publicly, though for the rest of my presidency the phrase “public option” became a useful shorthand inside the White House anytime Democratic interest groups complained about us failing to defy political gravity and securing less than 100 percent of whatever they were asking for. Instead, we did our best to calm folks down, reminding disgruntled supporters that we’d have plenty of time to fine-tune the legislation when we merged the House and Senate bills. Harry kept doing Harry stuff, including keeping the Senate in session weeks past the scheduled adjournment for the holidays. As he’d predicted, Olympia Snowe braved a blizzard to stop by the Oval and tell us in person that she’d be voting no. (She claimed it was because Harry was rushing the bill through, though word was that McConnell had threatened to strip her of her ranking post on the Small Business Committee if she voted for it.) But none of this mattered. On Christmas Eve, after twenty-four days of debate, with Washington blanketed in snow and the streets all but empty, the Senate passed its healthcare bill, titled the Patient Protection and Affordable Care Act—the ACA—with exactly sixty votes. It was the first Christmas Eve vote in the Senate since 1895.

A few hours later, I settled back in my seat on Air Force One, listening to Michelle and the girls discuss how well Bo was adjusting to his first plane ride as we headed to Hawaii for the holiday break. I felt myself starting to relax just a little. We were going to make it, I thought to myself. We weren’t docked yet, but thanks to my team, thanks to Nancy, Harry, and a whole bunch of congressional Democrats who’d taken tough votes, we finally had land within our sights.

Little did I know that our ship was about to crash into rocks.

OUR MAGIC, FILIBUSTER-PROOF hold on the Senate existed for only one reason. After Ted Kennedy died in August, the Massachusetts legislature had changed state law to allow the governor, Democrat Deval Patrick, to appoint a replacement rather than leaving the seat vacant until a special election could be held. But that was just a stopgap measure, and now, with the election scheduled for January 19, we needed a Democrat to win the seat. Fortunately for us, Massachusetts happened to be one of the most Democratic states in the nation, with no Republican senators elected in the previous thirty-seven years. The Democratic nominee for the Senate, attorney general Martha Coakley, had maintained a steady, double-digit lead over her Republican opponent, a little-known state senator named Scott Brown.

With the race seemingly well in hand, my team and I spent the first two weeks of January preoccupied by the challenge of brokering a healthcare bill acceptable to both House and Senate Democrats. It was not pleasant. Disdain between the two chambers of Congress is a time-honored tradition in Washington, one that even transcends party; senators generally consider House members to be impulsive, parochial, and ill-informed, while House members tend to view senators as long-winded, pompous, and ineffectual. By the start of 2010, that disdain had curdled into outright hostility. House Democrats—tired of seeing their huge majority squandered and their aggressively liberal agenda stymied by a Senate Democratic caucus held captive by its more conservative members—insisted that the Senate version of the healthcare bill had no chance in the House. Senate Democrats—fed up with what they considered House grandstanding at their expense—were no less recalcitrant. Rahm and Nancy-Ann’s efforts to broker a deal appeared to be going nowhere, with arguments erupting over even the most obscure provisions, members cursing at one another and threatening to walk out.

After a week of this, I’d had enough. I called Pelosi, Reid, and negotiators from both sides down to the White House, and for three straight days in mid-January we sat around the Cabinet Room table, methodically going through every dispute, sorting out areas where House members had to take Senate constraints into account and where the Senate had to give, with me reminding everyone all the while that failure was not an option and that we’d do this every night for the next month if that’s what it took to reach an agreement.

Though progress was slow, I felt pretty good about our prospects. That is, until the afternoon I stopped by Axelrod’s small office and found him and Messina leaning over a computer like a pair of doctors examining the X-rays of a terminal patient.

“What’s the matter?” I asked.

“We’ve got problems in Massachusetts,” Axe said, shaking his head.

“How bad?”

“Bad,” Axe and Messina said in unison.

They explained that our Senate candidate, Martha Coakley, had taken the race for granted, spending her time schmoozing elected officials, donors, and labor bigwigs rather than talking to voters. To make matters worse, she’d taken a vacation just three weeks before the election, a move the press had roundly panned. Meanwhile, Republican Scott Brown’s campaign had caught fire. With his everyman demeanor and good looks, not to mention the pickup truck he drove to every corner of the state, Brown had effectively tapped into the fears and frustrations of working-class voters who were getting clobbered by the recession and—because they lived in a state that already provided health insurance to all its residents—saw my obsession with passing a federal healthcare law as a big waste of time.

Apparently neither the tightening poll numbers nor nervous calls from my team and Harry had shaken Coakley out of her torpor. The previous day, when asked by a reporter about her light campaign schedule, she had brushed the question off, saying, “As opposed to standing outside Fenway Park? In the cold? Shaking hands?”—a sarcastic reference to Scott Brown’s New Year’s Day campaign stop at Boston’s storied ballpark, where the city’s hockey team, the Boston Bruins, were hosting the annual NHL Winter Classic against the Philadelphia Flyers. In a town that worshipped its sports teams, it would be hard to come up with a line more likely to turn off large segments of the electorate.

“She didn’t say that,” I said, dumbfounded.

Messina nodded toward his computer. “It’s right here on the Globe website.”

“Nooooo!” I moaned, grabbing Axe by the lapels and shaking him theatrically, then stomping my feet like a toddler in the throes of a tantrum. “No, no, no!” My shoulders slumped as my mind ran through the implications. “She’s going to lose, isn’t she?” I said finally.

Axe and Messina didn’t have to answer. The weekend before the election, I tried to salvage the situation by flying to Boston to attend a Coakley rally. But it was too late. Brown won comfortably. Headlines around the country spoke of a STUNNING UPSET and HISTORIC DEFEAT. The verdict in Washington was swift and unforgiving.

Obama’s healthcare bill was dead.

EVEN NOW, it’s hard for me to have a clear perspective on the Massachusetts loss. Maybe the conventional wisdom is right. Maybe if I hadn’t pushed so hard on healthcare during that first year, if instead I’d focused all my public events and pronouncements on jobs and the financial crisis, we might have saved that Senate seat. Certainly, if we’d had fewer items on our plate, my team and I might have noticed the warning signs earlier and coached Coakley harder, and I might have done more campaigning in Massachusetts. It’s equally possible, though, that given the grim state of the economy, there was nothing we could have done—that the wheels of history would have remained impervious to our puny interventions.

I know that at the time all of us felt we’d committed a colossal blunder. Commentators shared in that assessment. Op-ed pieces called for me to replace my team, starting with Rahm and Axe. I didn’t pay much attention. I figured any mistakes were mine to own, and I took pride in having built a culture—both during the campaign and inside the White House—where we didn’t go looking for scapegoats when things went south.

But it was harder for Rahm to ignore the chatter. Having spent most of his career in Washington, the daily news cycle was how he kept score—not just on the administration’s performance but on his own place in the world. He constantly courted the city’s opinion makers, aware of how quickly winners became losers and how mercilessly White House staffers were picked apart in the wake of any failure. In this case, he saw himself as unfairly maligned: It was he, after all, who more than anyone had warned me about the political peril in pressing ahead with the healthcare bill. And as we’re all prone to do when hurt or aggrieved, he couldn’t help venting to friends around town. Unfortunately that circle of friends turned out to be too wide. About a month after the Massachusetts election, Washington Post columnist Dana Milbank wrote a piece in which he mounted a vigorous defense of Rahm, arguing that “Obama’s greatest mistake was failing to listen to Emanuel on health care” and outlining why a scaled-back healthcare package would have been the smarter strategy.

Having your chief of staff appear to distance himself from you after you’ve been knocked down in a fight is less than ideal. Though I wasn’t happy with the column, I didn’t think Rahm had deliberately prompted it. I chalked it up to carelessness under stress. Not everyone, though, was so quick to forgive. Valerie, ever protective of me, was furious. Reactions among other senior staffers, already shaken by the Coakley loss, ranged from anger to disappointment. That afternoon, Rahm entered the Oval appropriately contrite. He hadn’t meant to do it, he said, but he’d let me down and was prepared to tender his resignation.

“You’re not resigning,” I said. I acknowledged that he’d messed up and would need to square things with the rest of the team. But I also told him he’d been a great chief of staff, that I was confident that the error would not be repeated, and that I needed him right where he was.

“Mr. President, I’m not sure—”

I cut him off. “You know what your real punishment is?” I said, clapping him on the back as I ushered him toward the door.

“What’s that?”

“You have to go pass the goddamn healthcare bill!”

That I still considered this possible wasn’t as crazy as it seemed. Our original plan—to negotiate a compromise bill between House and Senate Democrats and then pass that legislation through both chambers—was now out of the question; with only fifty-nine votes, we’d never avoid a filibuster. But as Phil had reminded me the night we’d received the Massachusetts results, we had one remaining path, and it didn’t involve going back to the Senate. If the House could just pass the Senate bill without changes, they could send it straight to my desk for signature and it would become law. Phil believed that it might be possible to then invoke a Senate procedure called budget reconciliation—in which legislation that involved strictly financial matters could be put up for a vote with the agreement of a simple majority of senators rather than the usual sixty. This would allow us to engineer a limited number of improvements to the Senate bill via separate legislation. Still, there was no getting around the fact that we’d be asking House Democrats to swallow a version of healthcare reform they’d previously rejected out of hand—one with no public option, a Cadillac tax the unions opposed, and a cumbersome patchwork of fifty state exchanges instead of a single national marketplace through which people could buy their insurance.

“You still feeling lucky?” Phil asked me with a grin.

Actually, I wasn’t.

But I was feeling confident in the Speaker of the House.

The previous year had only reinforced my appreciation for Nancy Pelosi’s legislative skills. She was tough, pragmatic, and a master at herding members of her contentious caucus, often publicly defending some of her fellow House Democrats’ politically untenable positions while softening them up behind the scenes for the inevitable compromises required to get things done.

I called Nancy the next day, explaining that my team had drafted a drastically scaled-back healthcare proposal as a fallback but that I wanted to push ahead with passing the Senate bill through the House and needed her support to do it. For the next fifteen minutes, I was subjected to one of Nancy’s patented stream-of-consciousness rants—on why the Senate bill was flawed, why her caucus members were so angry, and why the Senate Democrats were cowardly, shortsighted, and generally incompetent.

“So does that mean you’re with me?” I said when she finally paused to catch her breath.

“Well, that’s not even a question, Mr. President,” Nancy said impatiently. “We’ve come too far to give up now.” She thought for a moment. Then, as if testing out an argument she’d later use with her caucus, she added, “If we let this go, it would be rewarding the Republicans for acting so terribly, wouldn’t it? We’re not going to give them the satisfaction.” After I hung up the phone, I looked up at Phil and Nancy-Ann, who’d been milling around the Resolute desk, listening to my (mostly wordless) side of the conversation, trying to read my face for a sign of what was happening.

“I love that woman,” I said.

EVEN WITH THE SPEAKER fully on board, the task of rounding up the necessary votes in the House was daunting. Aside from having to drag progressives kicking and screaming to support a bill tailored to the sensibilities of Max Baucus and Joe Lieberman, the election of Scott Brown less than a year before the midterms had spooked every moderate Democrat who would be in a competitive race. We needed something to help shift the doom-and-gloom narrative and give Nancy time to work her members.

As it turned out, our opposition gave us exactly what we needed. Months earlier, the House Republican caucus had invited me to participate in a question-and-answer session at their annual retreat, scheduled for January 29. Anticipating that the topic of healthcare might come up, we suggested at the last minute that they open the event to the press. Whether because he didn’t want the hassle of dealing with pushback from excluded reporters or because he was feeling emboldened by the Scott Brown victory, John Boehner agreed.

He shouldn’t have. In a nondescript Baltimore hotel conference room, with caucus chair Mike Pence presiding and the cable networks capturing every exchange, I stood on the stage for an hour and twenty-two minutes fielding questions from Republican House members, mostly about healthcare. For anyone watching, the session confirmed what those of us who’d been working on the issue already knew: The overwhelming majority of them had little idea of what was actually in the bill they so vehemently opposed, weren’t entirely sure about the details of their proposed alternatives (to the extent that they had any), and weren’t equipped to discuss the topic outside the hermetically sealed bubble of conservative media outlets.

Returning to the White House, I suggested that we press our advantage by inviting the Four Tops and a bipartisan group of key congressional leaders to come to Blair House for an all-day meeting on healthcare. Once again, we arranged to have the proceedings broadcast live, this time through C-SPAN, and again the format allowed Republicans to make whatever points or ask whatever questions they wanted. Having been caught off guard once, they came prepared with a script this time. House GOP whip Eric Cantor brought a copy of the House bill, all 2,700 pages of it, and plopped it on the table in front of him as a symbol of an out-of-control government takeover of healthcare. Boehner insisted that our proposal was “a dangerous experiment” and that we should start over. John McCain launched into a lengthy harangue about backroom deals, prompting me at one point to remind him that the campaign was over. But when it came to actual policy—when I asked GOP leaders what exactly they proposed to help drive down medical costs, protect people with preexisting conditions, and cover thirty million Americans who couldn’t otherwise get insurance—their answers were as threadbare as Chuck Grassley’s had been during his visit to the Oval months before.

I’m sure that more people watched bowling that week than caught even five minutes of these conversations on TV, and it was clear throughout both sessions that nothing I said was going to have the slightest impact on Republican behavior (other than motivating them to bar TV cameras from my future appearances before their caucuses). What mattered was how the two events served to reinvigorate House Democrats, reminding them that we were on the right side of the healthcare issue, and that rather than focusing on the Senate bill’s shortcomings, they could take heart in how the bill promised to help millions of people.

BY THE BEGINNING of March, we had confirmed that Senate rules would allow us to clean up parts of the Senate bill through reconciliation. We enhanced the subsidies to help more people. We trimmed the Cadillac tax to placate the unions and got rid of the twin embarrassments of the “Cornhusker Kickback” and “Louisiana Purchase.” Valerie’s public engagement team did great work lining up endorsements from groups like the American Academy of Family Physicians, the American Medical Association, the American Nurses Association, and the American Heart Association, while a grassroots network of advocacy groups and volunteers worked overtime to educate the public and keep the pressure on Congress. Anthem, one of America’s largest insurers, announced a 39 percent rate hike, conveniently reminding people of what they didn’t like about the current system. And when the United States Conference of Catholic Bishops announced that it couldn’t support the bill (convinced that the bill’s language prohibiting the use of federal subsidies for abortion services wasn’t explicit enough), an unlikely ally arrived in the form of Sister Carol Keehan, a soft-spoken, perpetually cheerful nun who headed up the nation’s Catholic hospitals. Not only did the sixty-six-year-old Daughter of Charity break with the bishops by insisting that passage of the bill was vital to fulfilling her organization’s mission of caring for the sick; she inspired the leaders of Catholic women’s orders and organizations representing more than fifty thousand American nuns to sign a public letter endorsing the bill.

“I love nuns,” I told Phil and Nancy-Ann.

Despite all this work, our tally still showed us at least ten votes shy of what we needed for passage. Public opinion remained sharply divided. The press had run out of fresh stories to write. There were no more dramatic gestures or policy tweaks that might make the politics easier. Success or failure now depended entirely on the choices of the thirty or so House Democrats who represented swing districts, all of whom were being told that a vote in favor of the ACA could cost them their seat.

I spent much of each day talking one-on-one to these members, sometimes in the Oval Office, more often by phone. Some cared only about the politics, closely monitoring polls in their district and letters and phone calls from constituents. I tried to give them my honest assessment: that support for the healthcare reform bill would improve once it passed, though maybe not until after the midterms; that a “no” vote was more likely to turn off Democrats than it was to win over Republicans and independents; and that whatever they did, their fates in six months would most likely hinge on the state of the economy and my own political standing.

A few were looking for White House support on some unrelated project or bill they were working on. I sent them to Rahm or Pete Rouse to see what we could do.

But most of the conversations weren’t transactional. In a roundabout way, what representatives were looking for was clarity—about who they were and what their consciences demanded. Sometimes I just listened as they ran through the pros and cons. Often, we compared notes about what had inspired us to get into politics, talking about the nervous excitement of that first race and all the things we’d hoped to accomplish, the sacrifices we and our families had made to get where we were and the people who’d helped us along the way.

This is it, I’d say to them finally. The point of it all. To have that rare chance, reserved for very few, to bend history in a better direction.

And what was striking was how, more often than not, that was enough. Veteran politicians decided to step up despite active opposition in their conservative districts—folks like Baron Hill of southern Indiana, Earl Pomeroy of North Dakota, and Bart Stupak, a devout Catholic from Michigan’s Upper Peninsula who worked with me on getting the abortion funding language to a point where he could vote for it. So did political neophytes like Betsy Markey of Colorado, or John Boccieri of Ohio and Patrick Murphy of Pennsylvania, both young Iraq War vets, all of them seen as rising stars in the party. In fact, it was often those with the most to lose who needed the least convincing. Tom Perriello, a thirty-five-year-old human rights lawyer turned congressman who’d eked out a victory in a majority-Republican district that covered a wide swath of Virginia, spoke for a lot of them when he explained his decision to vote for the bill.

“There are things more important,” he told me, “than getting reelected.”

It’s not hard to find people who hate Congress, voters who are convinced that the Capitol is filled with poseurs and cowards, that most of their elected officials are in the pocket of lobbyists and big donors and motivated by a hunger for power. When I hear such criticism, I usually nod and acknowledge that there are some who live up to these stereotypes. I admit that watching the daily scrum that takes place on the House or Senate floor can sap even the hardiest spirit. But I also tell people about Tom Perriello’s words to me before the healthcare vote. I describe what he and many others did so soon after they’d first been elected. How many of us are tested in that way, asked to risk careers we’ve long dreamed of in the service of some greater good?

Those people can be found in Washington. That, too, is politics.

THE FINAL VOTE on healthcare came on March 21, 2010—more than a year after we held that first White House summit and Ted Kennedy made his surprise appearance. Everyone in the West Wing was on edge. Both Phil and the Speaker had done informal head counts that showed us getting over the hump, but just barely. We knew it was always possible that a House member or two could have a sudden change of heart, and we had few, if any, votes to spare.

I had another source of worry, one I hadn’t allowed myself to dwell on but that had been in the back of my mind from the start. We’d now marshaled, defended, fretted over, and compromised on a 906-page piece of legislation that would affect the lives of tens of millions of Americans. The Affordable Care Act was dense, thorough, popular with only one side politically, impactful, and surely imperfect. And now it would need to be implemented. Late in the afternoon, after Nancy-Ann and I had worked through a round of last-minute calls to members heading off to vote, I stood up and looked out the window, across the South Lawn.

“This law better work,” I told her. “Because starting tomorrow, we own the American healthcare system.”

I decided not to watch the preliminary hours of speechmaking that went on in the House chamber, instead waiting to join the vice president and the rest of the team in the Roosevelt Room once the actual voting began, around seven-thirty p.m. One by one, the votes accumulated as House members pressed either “yea” or “nay” buttons on electronic voting panels, the running tally projected on the TV screen. As the “yeas” slowly ticked up, I could hear Messina and a few others muttering under their breath, “Come on…come on.” Finally the vote hit 216, one more than we needed. Our bill would go on to pass by a margin of seven votes.

The room erupted in cheers, with people hugging and high-fiving as if they’d just witnessed their ball club winning with a walk-off home run. Joe grabbed me by the shoulders, his famous grin even wider than usual. “You did it, man!” he said. Rahm and I embraced. He’d brought his thirteen-year-old son, Zach, to the White House that evening to watch the vote. I leaned down and told Zach that because of his dad, millions of people would finally have healthcare if they got sick. The kid beamed. Back in the Oval, I made congratulatory calls to Nancy Pelosi and Harry Reid, and when I was done, I found Axelrod standing by the door. His eyes were a little red. He told me he’d needed some time alone in his office following the vote, as it had brought back a flood of memories of what he and his wife, Susan, had gone through when their daughter Lauren had been first stricken with epileptic seizures.

“Thanks for sticking with this,” Axe said, his voice choked up. I put my arm around him, feeling my own emotions swell.

“This is why we do the work,” I said. “This. Right here.”

I had invited everyone who worked on the bill up to the residence for a private celebration, about a hundred people in all. It was Sasha and Malia’s spring break, and Michelle had taken them to New York for a few days, so I was on my own. The evening was warm enough that we could mingle outside on the Truman Balcony, with the Washington Monument and Jefferson Memorial lit up in the distance, and I made an exception to my rule of weekday sobriety. Martini in hand, I made the rounds, hugging and thanking Phil, Nancy-Ann, Jeanne, and Kathleen for all the work they’d done. I shook hands with scores of junior staffers, many of whom I’d never met and who no doubt felt a little overwhelmed to be standing where they were. I knew they had toiled in the background, crunching numbers, preparing drafts, sending out press releases, and answering congressional inquiries, and I wanted them to know how critical their work had been.

For me, this was a celebration that mattered. The night we’d had in Grant Park after winning the election had been extraordinary, but it had been just a promise, not yet realized. This night meant more to me, a promise fulfilled.

After everyone had left, well past midnight, I walked down the hallway to the Treaty Room. Bo was curled up on the floor. He’d passed much of the evening on the balcony with my guests, threading through the crowd, looking for a pat on the head or maybe a dropped canapé to snack on. Now he looked pleasantly fatigued, ready to sleep. I leaned down to give him a scratch behind the ears. I thought about Ted Kennedy, and I thought about my mom.

It was a good day.

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