Normally, Congress can make laws without teeth, which have little effect.
This allows Congress to manage the conflict of public expectations on the one hand and vested special interests that make huge campaign contributions on the other.
So the routine is to legislate new laws with weaknesses that satisfy lobbyists, at the expense of the constituents Congress (nominally) represents.
The recent credit card reform is a glaring example. Usurious interest rates are allowed, while a few tricks are disallowed. In this case, much of the public probably won't expect the extra interest burdens will sink the general economy (but in combination with other problems, the extra interest burden is more harmful to local economic fabric than widely understood.) Congress can seem to have done something meaningful, since they did in fact prohibit certain practices, and in this way they can rationalize they did something meaningful, avoid a public backlash, and preserve their stream of contributions from financial institutions. Likely many members of Congress did believe they were doing the right thing voting against limiting credit card interest rates through a psychological process of rationalization -- you always can justify that which lines your pockets.
Health Care Reform, today, is different than the usual situation in two ways.
First, there is vibrant and widespread internet discussion on health care that actually penetrates to the root causes of the spiraling cost crisis. Mainstream media is broadcasting the root causes -- such as too much quantity instead of quality. Mainstream media is discussing real problems because the real problems are very serious. More than a small minority of the electorate understand real root causes of the cost spiral.
Across the nation, a great majority of Americans not only want real reform, but actually care a great deal. They understand so well that a "public option" is popular (70%+). When fake reform ideas are put forward, a great number of active citizens will quickly learn and discuss the inadequate nature of such reforms.
The issue is big enough that a majority ends up understanding the broad implications.
The political contributions from lobbies are also facts, and can be used in elections as proof of being purchased by lobbyists.
Second, health care costs are a rapidly increasing crisis as the economy is retreating from the false ground of the credit bubble. If no fundamental reform is undertaken, the health care cost crisis will only grow relative to the economy, spreading distress more and more widely. If Congress passes a reform that fails to address costs at the roots (such as this way), the crisis will grow worse, and the current Congress will reap the political outcome in November, 2010 and 2012.
So, the rules are different here. Is Congress aware of that?