Ezra makes an essential point:

Over the past hundred or so years, the health-care system has gone from a very small portion of our economy to about a fifth of it. That's a remarkable rise. And it has been accompanied by a similar rise in the political power of the health-care industry. I've previously argued that the history of health-care reform is a history of decreasing ambition: FDR and Harry Truman propose something like single-payer, John F. Kennedy and Lyndon Johnson ratchet back to single-payer for seniors and poor people, Richard Nixon and Bill Clinton offer national systems that rely on private providers, and now President Obama is building a private system that's initially limited to small businesses and individuals.

There are a lot of reasons for that. One is that political defeat engenders future timidity. But another is that the gaps between proposals give the health-care industry time to grow even larger and more politically powerful, which means that the next president who takes up the issue is faced with a more daunting task and pulls back his ambitions accordingly.

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