Could Obama have gone a completely different route and achieved much of what the left intended? Absolutely.

It’s called incrementalism.

Take the big problem of health care reform, and divide it up into separate issues. Allow insurance plans to be bought across state lines - see how that increases coverage and reduces costs.

By throwing everything into one basket, it sets up for a big fail, because everyone is pulling in different directions, and expectations on the left are so high that they’re guaranteed to be disappointed by anything less than the whole thing - and they’ll fight to get all they can to the exclusion of something less.