Passing healthcare reform in the US House of Representatives, where Democrats have a 258-177 majority, should have been easy. It was not. The House voted 220-215 for its bill, and only after frantic last-minute deals were struck. The party’s command of the Senate is weaker. Moving reform through that chamber, the reformers’ next hurdle, will be harder. The Democrats’ celebrations – Barack Obama called the weekend’s vote “historic” – are premature.

Healthcare reform, long overdue in the US, can still happen. But to be more confident of success, and to fashion a better bill, the Democrats’ leaders need to alter their approach. They must concentrate on essentials, around which a sufficient consensus can be built, and put their more divisive ideas aside. They must explain more honestly what reform will cost, and how to pay for it. Recalling that more US voters now oppose reform than support it, they must stop talking mainly to each other and convince the public of their case.