If, as seems increasingly likely, Obama wins passage of a health-care-reform bill in January, he will deliver his first State of the Union address having accomplished more in his first year than any other postwar American president. This isn’t an ideological judgment. It’s a neutral assessment of his emerging record.

The case for Obama’s successful freshman year rests above all on the health-care legislation now awaiting action in the Senate. Democrats have been trying to pass national health insurance for 60 years. Past presidents who tried to make it happen and failed include Harry Truman, Lyndon Johnson, Jimmy Carter, and Bill Clinton. Through the summer, Obama caught flak for letting Congress lead the process, as opposed to setting out his own proposal. Now his political strategy is being vindicated.

We are so submerged in the details of this debate—whether the bill will include a “public option,” limit coverage for abortion, or tax Botox—that it’s easy to lose sight of the magnitude of the impending change. For the federal government to take responsibility for health insurance will be a transformation of the American social contract and the single biggest change in government’s role since the New Deal. If Obama accomplishes nothing else, he may be judged the most consequential domestic president since LBJ. He will also undermine the view that Ronald Reagan permanently reversed a 50-year tide of American liberalism.