It was the height of the Depression.

Support in Congress was both overwhelming and bi-partisan.

The Democrats enjoyed huge majorities in both houses but the bill passed in the House of Representatives by a mammoth 372 votes to 33, with 81 Republicans voting in support. The following day, the Senate passed the bill by 77 votes to 6, with 16 Republicans voting 'yes'.

Thirty years later, in July, 1965, Congress passed the second major piece of the national safety net, the Medicaid and Medicare act.

It, too, passed by an overwhelming majority with bi-partisan support. That bill was championed by another Democratic President, Lyndon B. Johnson.

The vote was 307 to 116, with 70 Republicans voting with the Democratic majority. The bill was passed in the Senate by 70 to 24, with 13 Republicans in support.

Now comes the third major piece in the safety net when tomorrow (local time), President Barack Obama signs the Health Care and Education Affordability Reconciliation Act of 2010, introducing almost universal health care.

The bill passed yesterday in the House by a slender and contentious majority, 219 vote to 212.

Not a single Republican voted 'yes'.

Nor will a single Republican vote for the bill when it is passed in the Senate today, along strictly party lines.

This starkly partisan result, following a starkly partisan process, stands in vivid contrast to the resounding bi-partisan majorities for the earlier landmark legislation in social security and Medicare.

It also stands in vivid contrast to the rhetoric in Obama's victory speech after the 2008 presidential election.

On November 4, 2008, at Grant Park in Chicago, before a crowd of more than 100,000 and an international television audience, then Senator Obama said: "Let's resist the temptation to fall back on the same partisanship and pettiness and immaturity that has poisoned our politics for so long.

"Let's remember that it was a man from this state who first carried the banner of the Republican Party to the White House, a party founded on the values of self-reliance and individual liberty and national unity.

"Those are values that we all share. And while the Democratic Party has won a great victory tonight, we do so with a measure of humility and determination to heal the divides that have held back our progress."

Instead, he delivered one of the most partisan pieces of major legislation, delivered by one the most partisan processes, in the last 100 years.

State governments are lining up to challenge the bill as unconstitutional. The Republicans say they were shut out of the process and gave up.

Why were the Republicans so resolute, and so unified, in the final votes?

The deal-breaker, the event which tipped support for the bill over the line, was a report by the non-partisan Congressional Budget Office (CBO) that the health care plan will cut the cost of health care over the long term. This report is relied upon by the Democrats to rebut claims the bill will exacerbate the rise of unsustainable health care costs.

But The Wall Street Journal, along with the Republican leadership, has scoffed at the credibility of the CBO report, arguing the estimates are based on dubious figures and even more dubious assumptions supplied by the Obama Administration.

In the House, the Republican leader, John Boehner of Ohio, railed: "Can you say it was done openly with transparency and accountability, without backroom deals and struck behind closed doors, hidden from the people? Hell no you can't!"

America's most prominent long-standing conservative commentator, George Will, writing in The Washington Post today, explains the depth of Republican passion and concern:

"On Sunday, as will happen every day for two decades, another 10,000 baby boomers became eligible for Social Security and Medicare. And Congress moved closer to piling a huge new middle-class entitlement onto the rickety structure of America's Ponzi welfare state. Congress has a one-word response to the demographic deluge and the scores of trillions of dollars of unfunded liabilities: "More."

"There will be subsidized health insurance for families of four earning up to $88,200 a year, a ceiling certain to be raised, repeatedly. The accounting legerdemain spun to make this seem affordable -- e.g., cuts (to Medicare) and taxes (on high-value insurance plans) that will never happen -- is Enronesque.

"As America's teetering tower of unkeepable promises grows, so does the weight of government, in taxes and mandates that limit investments and discourage job creation. America's dynamism, and hence upward social mobility, will slow, as the economy becomes what the party of government wants it to be -- increasingly dependent on government-created demand."

Despite its 2,700 pages, the bill fails to meet the most egregious drain on the efficiency of health care in America - the high cost of litigation on medicine. In Massachusetts, the first state to introduce universal health care (and now mired in red ink), a study by the Massachusetts Medical Society found that about 25 per cent of doctor referrals, tests and procedures were being done for no medical reason but to cover the doctor from a potential malpractice lawsuit.

Litigation, and the threat of litigation, will remain an enormous drain on the system.

Whether the bill provides a permanent uplift in support for the President and the Democrats, or reaps political retribution in the mid-term Congressional elections on November 2, is the question for which we receive an answer in just over seven months.