The Democrats do now have 60 senators, and they might pick up a Republican or two; but they cannot afford many defections. No fewer than 44 House Democrats, almost 20 per cent of the total caucus, voted against the bill. The Senate marches to a different drum than the House does, with senators facing re-election only every six years, not every two. But the prospect of voting for two very expensive and not very effective packages will make a few Democratic senators swallow hard.

Mr Obama promised, on the campaign trail, not to tax private health benefits. He also promised to cut taxes for all but the rich. Arithmetic suggests he will have to break his word on something.

© The Economist Newspaper Limited 2009