Progressives should be profoundly grateful to Speaker Nancy Pelosi. Many on the left have praised the president for advancing bold legislation despite ferocious opposition from the political right. But let’s not forget that at many critical points, the White House seemed willing to scale back or even abandon its policy objectives. Scott Brown’s surprise victory in Massachusetts panicked many leading Democrats, including Rahm Emanuel, into backing a pared-back approach to health-insurance reform. Speaker Pelosi pressed forth. Agree or disagree with her, it seems fairly clear that Speaker Pelosi deserves much of the credit, and the blame, for a truly historic expansion of the federal government’s size, power, and reach.

And now, of course, it seems very likely that Speaker Pelosi’s tenure is about to end. Even if the Democrats retain control of the House, an outcome that most observers consider unlikely, there is reason to believe that Steny Hoyer would be better placed to lead the Democratic caucus. Or perhaps Chris Van Hollen would step into the breach. I can’t say.

It’s worth thinking through what the 111th Congress has accomplished.

(1) The most consequential legislative achievement was, of course, PPACA. One can think of PPACA as a bundle of many discrete proposal. For simplicity’s sake, we can boil the legislation down to three separate mini-bills:

(a) First there is a very big tax increase. Depressingly, it’s a very opaque tax increase. It is widely recognized, on the right and the left, that the best and most transparent way to raise taxes to tackle cost growth in medical care would be to eliminate the expensive tax exclusion for employer-provided health insurance, as Sen. John McCain proposed during his 2008 presidential campaign and as proposed in the Ryan-Coburn Patients Choice Act. But as Noam Scheiber explained in a wonderful article on David Axelrod, the White House political team strongly opposed this approach, noting that the Obama campaign had spent millions of dollars attacking the Republican candidate for precisely this approach.

So instead we have a very peculiar “Cadillac tax” on high-cost health plans that will notionally come into force several years from now, after President Obama’s second term, assuming the president is elected to a second term.

Among other things, we also have a Medicare payroll tax increase and a new tax — the Unearned Income Medicare Contribution — on interest income and pass-through business income from high-earners. Taken together, these measures generate a great deal of revenue. Not enough revenue to close the existing fiscal imbalance, and not enough revenue to close the gap created by the president’s plan to make most of the 2001 and 2003 tax cuts permanent. But it is a decent amount of revenue that, if this were the sum total of PPACA, would certainly make a dent.

Other revenue-raisers include a long-term care insurance program and the elimination of private lenders from the federal student loan program. At the time PPACA passed, I though that eliminating these “middlemen” was a perfectly sensible thing to do. Now I have my doubts. But this is hardly the most egregious aspect of the new health law.

(b) The second mini-bill involved steep across-the-board payment reductions for medical providers in the Medicare FFS system. As a number of experts have observed, including James Capretta and Harold Luft and Richard Foster, these payment reductions are mechanistic. That is, they rest on productivity expectations that many providers will have a difficult time meeting if we don’t see significant structural reform. As a result, many medical providers will find themselves unwilling to continuing accepting Medicare patients. “Although this policy could be monitored over time to avoid such an outcome,” Foster writes, “changes would likely result in smaller actual savings than shown here for these provisions.”

The goals of this second mini-bill strike me as very admirable. The problem is that we need structural reform. IPAB is meant to deliver structural reform. But of course IPAB is subject to congressional approval. The moment when you’re committing to spend vast new sums of money is probably going to be the easiest moment to sell difficult structural reforms. That moment has passed.

(c) The third mini-bill creates a large, open-ended entitlement that increases implicit marginal tax rates on low-to-moderate-income households, treats households on the exchanges very differently from households receiving insurance through their employers, and may well encourage the excessive utilization of medical care. It also increases the number of U.S. households with insurance coverage, which is, in itself, a very good thing. But it seems fairly clear that we could have achieved this objective at much lower cost, e.g., if we had embraced the plan outlined in True Security by Michael Graetz and Jerry Mashaw or if we had embraced something along the lines of Martin Feldstein’s plan for universal catastrophic coverage.

(2) ARRA is a big, complicated animal. We can’t really do it justice. Let’s just say that we have good reason to believe that the tax provisions were very ineffective and that the infrastructure provisions were poorly and irresponsibly designed. Though the transfers to the states were not very well designed either, they were perhaps the most defensible aspect of the legislation. Fortunately, Democrats like former OMB director Alice Rivlin were willing to speak out in opposition to ARRA’s awkward marriage of an infrastructure program that merited more deliberation and short-term stimulus needs. But these voices were ignored.

(3) I haven’t covered financial regulation in great detail, but Charles Calomiris makes a strong case regarding the weaknesses of the Dodd-Frank legislation, which I’ll write about at greater length soon.

Overall, I’d say this wasn’t a banner couple of years for good policy. The open question is whether the 112th Congress can do a better job.