Little could better summarise Barack Obama’s approach to governing than his nomination on Monday of Kathleen Sebelius as his health secretary while sending aides out to describe Rush Limbaugh, the hard-right conservative talk show host, as the “leader of the opposition”.

Ms Sebelius, who has twice been elected Democratic governor of Kansas, in spite of the fact that the state has twice as many registered Republicans as Democrats, will help direct the president’s most ambitious domestic reform – the drive to achieve universal healthcare within a year.