This one is for all the marbles. Democrats seem poised to squeak through President Obama's landmark healthcare legislation late on Sunday, and the repercussions could be profound, especially on America's Middle East policy.
Forget for a moment that Obama's domestic approval ratings are at their lowest - less than 50 per cent - or that he has disappointed many around the world by failing to fulfil major objectives, like the closing of the Guantanamo Bay prison.
By scoring a victory of this scale - one that has eluded American presidents for close to 100 years - Obama could not only bring the bounce back to the step of his administration, but provide himself the bandwidth to focus on some of the changes he campaigned on.
He can now begin to fulfil his promise to recalibrate America's relations with the Arab and Muslim world, starting with the Arab-Israeli conflict, as he promised in his Cairo speech in June 2009.
Passing healthcare reform will mean that he (or in this case, Secretary Clinton), can stride into events like Monday's AIPAC annual conference with self-confidence that they otherwise could not.
Nethanyahu had to be hoping that Obama's healthcare reform would fail. But if it passes, there is no denying that Obama will be stronger and Netanyahu will be weaker.
Consider how former President Bill Clinton failed at his biggest domestic agenda - healthcare - which not only took the wind out of his sails at home but also put him in a position of weakness with the congress in 1993 when the then-controversial Oslo negotiations between Israelis and Palestinians had only begun.
In the years that followed, it was Prime Minister Netanyahu (first iteration) who was masterful in playing to Clinton's shakiness with the US congress via AIPAC, especially when Clinton tried to gain Israeli concessions during the Lewinsky scandal. Using truly asymmetrical warfare, Netanyahu was able to court America's right-wing, which in turn frustrated Clinton's ambitions.
Clinton missed both grand prizes in the end: a healthcare law to memorialise his domestic legacy and a final status Arab-Israeli agreement to secure him a Nobel Prize.
Obama's already got one of those, deservedly or not. And if he adds healthcare to his resume, it will be much harder for Netanyahu to pull the same shenanigans should Obama finally decide to assert himself on Middle East peace.
In the end, it will come down to a simple calculus. General David Petraeus recently testified before the US Senate that Israel's ongoing violence towards Palestinians is creating a hostile atmosphere that is endangering the lives of American troops stationed in the Arab and Muslim world.
That's a simple truth that many have long believed but few dared to speak. And while some in the Jewish community have spoken out against Petraeus, the remaining two years of Obama's presidency will present an even more historic opportunity: to decide if America values its own security more than Jewish settlers and their lust for Palestinian land.
Should Obama succeed at healthcare, Americans will remember him for doing so when all others could not.
But for many around the world, the prize of an indepdendent Palestine will be the most telling, and perhaps, rewarding legacy item he could ever hope to fulfil.