If the Dems had elected Hoyer as Speaker of the House instead of Pelosi, we would be living in an entirely different political situation (not necessarily all for the good).  He would have reached out to the GOP for ObamaCare and stimulus.  The end healthcare product would probably suck less, but still suck - BUT - the GOP would be complicit, and it would be much harder to repeal (already is hard to repeal).  Just think how the 2016 election would have turned out.... holy cow... we might have gotten Jeb! (blaaarrrrgh!)  Makes you wonder.... well, me anyway.