Ted Kennedy fought longer than the doctors had expected he could, and yet, died before he could see the outcome of the battle that he had often described as the greatest cause of his life. “This whole issue in terms of universal and comprehensive care has always burned in my soul,” he said in a fiery speech on the floor of the Massachusetts State House in 2006, as he joined with a Republican Governor to convince the legislature to make his home state the first in the nation to provide near-universal health care coverage to its citizens. Whether the country will do the same is made more difficult as a result of his passing. And yet, whatever law results will be very much Ted Kennedy’s legacy, and is almost certain to be named in his honor.

On TIME.com, Richard Lacayo sums up the mark left by “the brother who mattered most” this way:

There was a time 40 years ago, right after the assassination of his brother Robert, when it looked like Edward Kennedy would become President someday by right of succession. The Kennedy curse, the one that had seen all three of his brothers cut down in their prime, had created for him a sort of Kennedy prerogative, or at least the illusion of one, an inevitable claim on the White House. For years he seemed like a man simply waiting for the right moment to take what everybody knew was coming his way.

Everybody was wrong. Ted Kennedy would never reach the White House. His weaknesses — and the long shadow of Chappaquiddick — were an obstacle that even his strengths couldn’t overcome. But his failure to get to the presidency opened the way to the true fulfillment of his gifts, which was to become one of the greatest legislators in American history.

His absence has been felt all year on Capitol Hill, and his loss comes at a particularly difficult moment in the battle for health care reform. It deprives the Senate of that crucial 60th Democratic vote needed to overcome a filibuster. What to do about that raises a particularly touchy question: