One thing we have learned from the fight over health care reform is that Barack Obama had to engage strongly, personally and mobilize his own party. His bipartisan appeals fell on deaf ears.

What now? That is the question after Congress confirmed the bill to get health care to Americans. Extra time was needed to make some final adjustments to the bill that was passed last week, but there is no doubt. The largest social reform since the 1960s in the United States is a fact.

The final tally in the House of Representatives was 220 for and 207 against; in the Senate it was 56 for, 43 against. In both chambers, Republicans said a unanimous no — which was followed by some representatives from the right wing of the Democratic Party.

Obama can rejoice over his largest political win since he moved into the White House on January 20 last year. In the end, he prevailed, despite predictions of a humiliating defeat. But health care reform has taken so much of the spotlight that other cases have been overshadowed.

A part of the price is also the fact that the tone of American political discourse has become even harder and more uncompromising. The most extreme opponents of reform have been way out of line. Some Democratic politicians have received death threats. There have been relentless personal attacks, where politicians have been attacked for the color of their skin or their sexual orientation. John Boehner, the Republican leader of the House of Representatives, has distanced himself from these types of grave attacks, but has also said that people have a right to be angry.

The need to bridge the party divide was one of Obama's most popular themes during the presidential campaign. He hit many Americans right at home with his wish to make the political debate be dominated less by emotion and artificial differences, and more by reason and cooperative solutions.

As president, Obama has tried to live by those principles. He invited experts with different views to listen to their advice. A critical voiced called him “the Harvard professor.” It said he acted like the leader of a political seminar and not as the highest decision maker in the world's only superpower.

The handling of health care reform was used an example. Obama made it his number one priority, but remained passive when it came to the work representatives did. Democratic leaders in Congress felt Obama gave little help. Republicans were offered to be part [of the legislative process], but it did not make them more willing to compromise.

One of the most important moments in Obama's time as president has been when he realized that he would never have wide agreement on health care reform. The consequence is that Democrats carried the reform on their own shoulders. That realization must have felt good. Obama seems more inspired and upbeat than he has in a long time.

This experience will probably decide Obama's policies before the important mid-term elections in November and on, approaching the 2012 elections. We will see a president with a more clear and leftist profile, especially in economic matters.

The number one priority here is to regulate the financial sector to stop a repetition of the denial of responsibility that led to the worst economic crisis since the 1930s. Tighter banking regulations are one potential winning formula for Obama.

The second priority is the fight against unemployment, which is still hovering around 10 percent. There are ideas to increase unemployment benefits and the cash flow to the states, but much more is needed. The development of the job market could decide Obama's election.

Further down the list is energy and climate policy, where hope of new jobs could increase the chances of greener policies. Obama is also concerned with school reform, where America has lost the competitive edge it had a few generations ago. Immigration policy also needs a significant overhaul. Many millions of people are permanently residing in the U.S. without documentation.

When it comes to health care reform, it is important to be aware that it is to be gradually implemented over a period of many years. The many who have health insurance through their employer will not notice much difference. That means that the promised entitlements are slow in coming, but it also means that the ones who have warned of disaster will have credibility problems.

That final item should worry the Republicans, who want to keep the temperature at the boiling point. They have received the not very flattering label as the “party of no,” but that is an accurate description. The party's attitude to health care reform is summed up in the slogan “repeal, replace, reform.” The bill is to be repealed and replaced with something based on “common sense.”

The Republican idea of good health care reform is to give people tax credits for insurance premiums, which is fine, but it is not a solution for the many that have little or no income. This does not seem to worry the Republican leadership too much. They are letting their party act as a vehicle for extremist protests, like the populist Tea Party movement's anger against anything that has anything to do with tax or government interference. This is beginning to strip away the Republican Party's status as an alternative fit to govern.

America today is lacking a moderate conservative party who can ask critical, constructive questions — questions about the spending of the president and Congress. There can be no doubt that Obama's reforms are costly, even if the results are beneficial. They will be added on top of a dangerous budget deficit, and at some point in time the budget has to be brought more in balance.

But it is Obama's successor who will have the worst headache.