It has been 44 years since an American President has succeeded at any new social policy nearly as ambitious as what Obama is trying to do. Yet Obama wondered whether there might be some lessons for him in that earlier President's achievement. So a couple of weeks ago, his health czar, Nancy-Ann DeParle, delivered to him a memo outlining how Lyndon B. Johnson got Medicare and Medicaid passed in 1965.

Obama was struck by the advantages LBJ had that he doesn't: Johnson was just coming off a landslide election victory and had bigger Democratic majorities on Capitol Hill, where individual members were not nearly as independent of their party leaders as they are now. Nor was the Republican Party of 1965 as uniformly conservative as it is today. Obama must contend with a rougher political culture, fueled by a press corps that in the President's words "gets bored with the details easily, and it very easily slips into a very conventional debate about government-run health care vs. the free market." (Read "Obama's Health Push: Too Few Details, Too Many Questions.")

But there is also much about how Washington works that hasn't changed. LBJ once said the only way to deal with Congress is "continuously, incessantly and without interruption." To get anything really big done, a President must not only rally public opinion but also keep the legislative machinery turning despite the brakes applied by moneyed interests and public doubts. That is the hard work of governing, and it is very different from campaigning.