In an effort to regain momentum for changes to the nation's health care system, President Obama will make a tactical shift when he addresses a joint session of Congress on Wednesday.
Nearly 16 years ago, President Clinton delivered his own high-profile health care speech to Congress — a year later, his reform effort was dead. The Obama White House is determined to avoid that fate.
So Obama is abandoning his initial strategy of sticking to broad principles and letting Congress write the legislation. The plan was that both houses would pass bills before the August recess, and then he would get involved with the details as the House and Senate negotiated later in the fall.
That didn't happen, so now the president has a new plan: He'll be much more specific about what he wants in a health care bill.
Senior adviser David Axelrod says the time is ripe for the president to step in more forcefully.
"We've been talking about it for months and months and months. All the ideas are on the table now. We're well down the road, 90 yards down the field, and now we have to go the last 10 yards together," Axelrod said. "And the best way to start that is for the president to address this issue with force and clarity, and that's what he's going to do Wednesday night."
White House aides say Obama's goal is to clear up the confusion, particularly among Americans who have health insurance. By the time he's done, they say people will understand how coverage will work, who will get subsidies to buy health insurance, how those subsidies will be paid for and how the bill will cut costs and increase competition among insurers.
The president also will stress popular health insurance reforms with wide agreement on Capitol Hill. But he probably won't be more specific about one of the most polarizing issues in the health care debate: what kind of government-backed option, if any, should compete with private insurers.
Axelrod says he still believes in the public option "as a device to promote competition and choice and keep the insurance companies honest." But the administration has signaled in a dozen ways that a Medicare-style public option, the kind desired by many congressional Democrats, is not a requirement. Even liberal Democratic Rep. Jan Schakowsky of Illinois says that while a robust public option must be in the initial House bill, it's not a make-or-break issue for her final vote.
"Even insured Americans can't get health care," she said. "So, yes, the public option is very important; it's important to our base. But so is the assurance that they're going to have health care when they need it."
On Wednesday night, the president will say he's still open to compromise with Republicans, but the earlier hopes of a big bipartisan consensus on health care are gone. No House Republican is likely to vote yes, and the White House has decided it's unrealistic to expect more than one, maybe two Senate Republicans to sign on.
That means Democrats must find their own consensus — a bill that balances the interests of their liberal and moderate wings. Schakowsky says the stakes for the president and the party are very high.
"This is an issue on which his presidency hinges, on which the Democratic future in 2010 hinges," she said. "He's aware of that, we're aware of that, and we're going to get a bill passed."
During the August recess, public support slid for Obama's health care effort. Obama's job approval percentage rating also has declined steeply, from the mid-60s at the beginning of the year to the low 50s today. That might diminish his clout with members of his own party or, as political analyst Norman Ornstein suggests, have the opposite effect.
"A lot of Democrats were there in 1994 when the failure of the Clinton health care plan sent them into a disastrous election that, in turn, meant 12 years in the political equivalent of Guantanamo: the minority," Ornstein said.
Now that Democrats have been back in power since 2006, he said, they know they must follow the lead of their president — even a weakened one.
"If they don't follow the lead of the president," Ornstein said, "if they don't pass any kind of health care plan and show that government now works after years of gridlock, they're going to be back in the minority or dangerously close to it."
It's hard to find anyone in Washington who believes Democrats will fail to pass something. The only question is how close the final product will be to their original vision of sweeping reform.