"This is what change looks like," declared Barack Obama late on Sunday 21 March after his healthcare bill was approved by the House of Representatives. Change, it turns out, is a messy business. The health legislation absorbed much of the president's first year in office, involved countless compromises, received no support from across the political aisle, and will still leave 24 million Americans without medical insurance.

Further, as our man in Washington points out on page 18, the Republicans, should they regain control of Congress in November, could kill off some of the reforms enshrined in the new law. Nevertheless, this remains a historic achievement, extending health-care access to 32 million more Americans, and is rightly compared to Lyndon B Johnson's "Great Society" reforms a half-century ago. It is far too early to judge a president who promised so much, but Obama can only be emboldened by this hard-fought success. He faces challenges at home and abroad - most pressingly in his dealings with an intransigent ally, Israel - but Obama has finally proved that "change" is more than a campaign slogan.