With the election of Barack Hussein Obama already you’re in improbable territory. Political scientists tell us that The Republicans have really moved right and the procedures of the congress have really slowed down what the Democrats were trying to do, and obviously the economy is so challenged. Right now if we had a 4 or 5% unemployment rate, much of what we were hearing would be noise within 25% of the public instead of 40%. There are just so many things coming to a head, including the demographic transformation of the country.

The sad thing is Democrats and Republicans actually have a lot of common ground here. Romney did a nice job in Massachusetts of creating something that was a workable plan. The Affordable Care Act—on the substance, even though it didn’t get any Republican votes—actually is the bipartisan market-based compromise on health reform. If the Republicans were to win power sometime down the line, they’d have to rename it and repackage much of it as something else.

You’ve written about how Obamacare will make a huge difference to millions of people on the ground, and I share your sentiment that the Left has been irrationally dismissive—to its own detriment—of the Affordable Care Act because it didn’t have certain elements like the public option.

First of all, I am a supporter of the public option. I believe, nonetheless, that the disillusionment with Obama is really misdirected in a destructive way. The reality was that you needed 60 senators and that included conservative Democrats. [The ACA] was a great achievement, and if you look at other things of comparable magnitude, they were passed in moments when the Democrats had dominant majorities in both houses. Even having all those votes, [the ACA] still had a heavy climb. Blaming Obama because Kent Conrad and Max Baucus and Charles Grassley had the ability to slow this down focuses attention on the wrong end of Pennsylvania Avenue.

I also think a lot of progressives don’t understand or don’t appreciate that the nuts of bolts of the ACA are just crucial to millions of people.

If I go down to 57th street, there’s the guy who’s bumming quarters there, right? Let’s suppose he has a substance abuse problem. He needs to get into a methadone program, not to mention he’s probably got a cardiovascular problem and some other health issues, too. Who will pay for that care? Right now, he’s not eligible for Medicaid because he’s not a vet, he’s not a mom, and substance abuse isn’t a disability that gains him eligibility to a federal disability program. Now with reform he can get on Medicaid because he’s poor. He can get treatment. He can get his cardiovascular problem taken care of.

This is something that your daily news reader may not think about. A lot of this stuff—the wish list for the National Multiple Sclerosis society, the advocacy arm of the American Cancer Society, getting rid of pre-existing conditions, eliminating lifetime and annual caps on insurance, requiring insurers to cover essential health benefits—was included in the nuts and bolts of health reform. That’s huge. There’s also $196 billion being used to provide health care for moderate and low-income people. This is a very important policy that now says we are responsible to make sure every American has access to affordable health care. I do regret how back-loaded it is, because once it’s on the ground people will not want it taken away.

Why was the bill so back-loaded?

The original sin of health reform… Because conservative Democrats needed direct outlays to come in at below $1 trillion. Also it takes some time to get things up and working; there are going to be so many administrative glitches when this thing comes online. We’re messing with a 2.8 trillion dollar medical economy. The real help is coming in 2014. So I’m as frustrated as anyone.

But if young progressives become disillusioned, this would be tragic. This is where you have to admire the Tea Party people who get really mad and when they don’t get their way, they don’t go home and say the political process is so messed up. They primary Republican politicians. Republicans in congress are terrified of them. I don’t think many Democratic politicians harbor the same fears of an Occupy primary challenge.