"Had congressional Republicans taken pragmatic steps on health reform between 1994 and 2008, PPACA wouldn't have happened. President Bush's reform of the tax exclusion for employer-provided health insurance alone would have made a significant difference, as would his plan for giving the states greater control over Medicaid. If you believe that the 111th Congress made many bad calls, Republicans in previous years deserve much of the blame. Major policy shifts are rare. But when it rains, it pours," - Reihan Salam, NRO.