This Christmas Eve’s symbolic vote on the American health care reform plan is illustrative of Barack Obama’s governance. He has succeeded where all the post-World War presidents have failed. One half-century after the establishment of Medicare, health insurance for elderly Americans, and of Medicaid, insurance for the poorest, he has instituted near-universal coverage. Obama knows that he does not have the right to presuppose the goodness and the perfection of men, and even less of voters and their Republican representatives. In all other countries, this rather modest plan would seem obvious and necessary. But in the United States, since the Reagan years, the state has maintained the image of an inquisitor. The public opinion still seems suspicious, due to the work of an unprecedented campaign of lobbies of health care profiteers - insurance companies, doctors and laboratories. Significantly, this reform was adopted along strictly partisan lines: All the Republican senators opposed the plan, contrasting the fundamental reforms of Johnson’s Great Society and the Civil Rights movement, which received the support of both parties. Upon coming to power, Obama extended his hand to his opposition, but the Republicans, with Obama's rival John McCain at the helm, preferred systematic and destructive confrontation. It is not certain that this tactic, while profitable in the short term, according to surveys, serves this party; if it desires to regain power, it should accept an ethic of compromise, as Obama has done.