I see this question posed all over the blogsphere as well as this site and I would like to comment on it.
Two of the most sweeping pieces of legislation in the last 100 years are Social Security and Medicare. Take a look at the history of each of these pieces of legislation and maybe we will not think of legislation as being "water downed" but rather as being a building block.
Social Security:
1935 - The Social Security Act, which covered workers in commerce and industry, was signed by President Roosevelt.
1937 - The Federal Insurance Contribution Act (FICA) required workers to pay taxes to support the Social Security system. Payroll taxes were 2%.
1939 - Social Security was expanded to cover dependents and survivors. Payroll taxes were 2%.
1950 - Coverage was expanded to job outside of commerce and industry, and benefit levels were increased. Payroll taxes were 3%.
1956 - Disability Insurance was created, and expanded over the following years. Early retirement at age 62 for women was permitted. Payroll taxes were 4%.
Read More of the history here:
Medicare:
"Since 1965, a number of changes have been made to CMS programs. A more detailed listing of those changes is at CMS milestones. Moreover, the agencies charged with implementing the programs have changed as well."
Read more of the history here
The point of this diary is not to suggest that we should "settle" for less in regards to HCR reform. In fact I believe that we should try and get as much out of HCR as possible now with the understanding that if we get legislation passed we can build on it in the future.
The idea (as some state) that it would be better to have nothing if we can't get it all right now or that "watered down" reform (as some label the opt-out) are ignoring the history of sweeping legislation IMO.
No matter what it looks like when it comes out of Congress history has shown us that it will be perfected in the future.