[I]t’s not as if it will be impossible to scale up these reforms later on. If Congress passes and the president signs a bill putting in place the key institutional elements of reform now, they can always revisit, and strengthen, the measure later. During the 1980s, Henry Waxman almost single-handedly expanded Medicaid to its current levels by gradually making more people eligible and securing the funding to pay for them. All he needed was the institutional structure–the program, the rules, and the basic funding stream–on which to build the new coverage. The fact that Waxman is a chief architect for this year’s program ought to give liberals confidence that, once again, these reforms needn’t represent the upper limit of what might be achieved over the next few years. They are a start, and a very good start, but not a finish.