The parties weren't yet ideologically sorted. The Democratic majority included dozens of members of the Blue Dog coalition, a conservative group who (among other things) didn't support healthcare reform.

Also the us Congress is blocked by the senate needing 60 votes/supporters to reach cloture on every single bill, except the once per year thing that got the bbb passed. So it's very easy to block the other side. https://en.wikipedia.org/wiki/Reconciliation_(United_States_...

They were trying to get Republican votes so that the law would be bipartisan. In the end it passed on a party line vote, so maybe the compromises were a mistake...

All the Democrats bought by the private health insurance companies I assume.

The 60th vote was Ted Kennedy who died in office and a Republican was elected to fill the seat, forcing passage of an earlier bill.

https://en.m.wikipedia.org/wiki/2010_United_States_Senate_sp...

Democrat senators Lieberman and Baucus mainly torpedoed it. And Pelosi refused to get republicans on board.