Sam is reminding people that he's complicated. He voted against Medicare the first time, and hasn't really changed his stripes. But yes it's a wakeup call, and a broader part of this trajectory where it's really kinda important that the McGoverners and the Boll Weevils are at odds with one another. Fortunately on an issue like MECA the Cold War liberals (yer Scoops on the right, yer Humps on the left) are still aboard the SS Rainbow Progressive Awakening for the social programz. Otherwise one could really get stuck. Also it is worth noting both the salience and the importance of reaching out to the Republican liberals on this, of whom there's an unusually high concentration in the Senate.