Political operative here. If you're wondering why healthcare reform has been so hard to get and so piecemeal, even though most Americans want it, the big reasons are:<p>1) any reform has to get past the Senate, and the Senate gives a lot of extra weight to states with conservative electorates. In 2009, this meant the pivotal Senators were right-wing Blue Dogs, an independent (Lieberman), and a former Republican (Specter). In 2024, this means the pivotal Senator will be a conservative Republican, since Dems run fewer Blue Dogs, and liberals can't win states like North Dakota and Louisiana.<p>2) people don't only vote on healthcare; Democrats also support much less popular stances on other issues, especially immigration.<p>Lobbying etc. matters some, but is much less important than those two big ones.