If the president had taken a pass on a big health bill, Democrats wouldn’t have spent so much of the crucial summer and fall of 2009 talking about health care. They might instead have been focused on the word that has emerged as the most important in this year’s election environment: jobs. Particularly because the debate on health dragged on through the end of 2009 and into 2010, many voters concluded the party had its priorities wrong…

Without a big health bill, there might not have been the marked escalation in public worries about government spending and debt that was seen at the end of 2009 and into 2010. There also might not have been such a vigorous tea-party movement; the movement, though born during the 2009 debate over economic stimulus, really flowered during town-hall debates over health care during last August’s congressional recess.

It’s also possible that without so much time taken up by health care, the Democratic Congress might have gotten around to passing a bill to combat greenhouse gases by reducing dependence on fossil fuels before the BP oil spill, changing the dynamics of the post-spill debate.