When there's a big political event, the news media has a tendency to retrospectively analyze the tactical decisions of those involved. If they won, they did everything right, and if they lost, they did everything wrong. NBC's Domenico Montanaro actually avoids this trap and offers up a balanced take:
What DIDN’T prove to work for Obama and the Democrats was allowing the Senate (and especially the Senate Finance Committee) to take as long as it did; losing Olympia Snowe (and her public-option trigger); enabling process to dominate the debate; allowing much of the debate, for months, to center on the public option -- a topic Obama never discussed during the presidential campaign; and underestimating, early last year as the White House embarked on health care, how bad the economy turned out to be. But what DID work was going big rather than small; tying the fate of his presidency to the bill’s success; holding that bipartisan health-care summit, which served to rally Democrats behind the legislation; trusting House Speaker Nancy Pelosi to get 216 votes; becoming Candidate Obama again; and allowing Congress to steer much of the legislative work before taking control of the wheel. Indeed, his approach -- hands off at first, all hands on deck at the end -- worked.
I'd add that Congressional Democrats committed one other major error: they insisted on holding the ten-year cost of the bill under one trillion dollars. This had nothing to do with actual fiscal responsibility -- delaying implementation of the bill does not reduce in any meaningful way its real cost -- and everything to do with with minimizing the perception of big spending. But that calculation in turn hinged upon crediting the public's ability to distinguish one enormous number from another, which assumes that the voters have far more knowledge about policy than they actually do.
So the result is that Democrats delayed the implementation of the bill on the shaky assumption that a "trillion dollar" bill (as everybody calls it) would go over better than a $1.6 trillion bill. But the delay creates a significant window of political vulnerability that Republicans are eager to exploit.
Incidentally, Democrats -- or, at least, a handful of moderate Democrats and Republicans in the Senate -- made the same mistake with the stimulus. They thought the key factor was keeping down the price tag, which was true for about a month. Over the longer term, by far the most important thing was to get the most stimulus, and the greatest possible reduction in unemployment, into the system. Democrats really need to get into their heads that people can barely tell a million from a trillion, let alone comparatively tiny differences between large outlays.