No wonder Bill Clinton picked a relatively straightforward goal such as Middle East peace after attempting healthcare reform. Now that one version of Obamacare has passed a key Senate committee, supporters face a determined new opponent – one another.

In order to get to the reconciliation process before a full Senate vote, the $829bn plan had to show it was budget-neutral over a decade. Although it only did so with dubious assumptions, the exercise was enough to alienate trade unions, key White House allies, who object to taxation of expensive “Cadillac” health plans. Their members would be disproportionately affected. Health insurers, already sceptical, also turned sharply against the legislation this week when penalties that would encourage uninsured people to get coverage were watered down. Insurers argue that forcing them to cover higher-risk patients while allowing young, healthy people to opt out would inflate costs.