Building 44

Federal agencies and the Obama transition | FULL COVERAGE »

"President-elect Obama believes that change really comes from the ground up, not from Washington," Salazar said in an interview. "The drumbeat for change is one which goes across every single state -- red, blue and purple. That kind of a drumbeat will be very effective in achieving the change needed on health care."

The Obama team chose to begin its high-tech grass-roots experiment on the issue of health care because "every American is feeling the pressure of high health costs and lack of quality care, and we feel it's important to engage them in the process of reform," said spokeswoman Stephanie Cutter.

It started with a simple 63-second video posted on Change.gov, in which health advisers Dora Hughes and Lauren Aronson posed the question "What worries you most about the health-care system in our country?"

That triggered 3,700 responses, from personal tales of medical hardship to complaints about "socialized medicine." The cyber-conversation was interactive, allowing individuals to reply to one another and rate responses with a thumbs up or down. The top-scoring comment, a pitch for a "paradigm shift" toward prevention, had 82 thumbs up.

The Obama technology gurus then built a "word cloud" showing the 100 most frequently used words in the responses. The cloud's biggest words -- indicating those used most -- include "insurance," "system," "people" and "need."

"The Obama administration has learned that listening may be even more important than talking, because it diffuses opposition," said Andrew Rasiej, co-founder of Personal Democracy Forum, a nonpartisan Web site focused on the intersection of politics and technology.

Obama used the same strategy during the campaign, Rasiej said. When many of his most liberal supporters became enraged that he voted in favor of a surveillance law, Obama assigned staffers to monitor and respond to comments posted on the campaign's Web site. After a sort of cyber-catharsis of complaints, the controversy died down, Rasiej observed.

"It will be a lot easier to get the American public to adopt any new health-care system if they were a part of the process of crafting it," he said.

By moving early, Daschle and Obama are also applying a central lesson learned in past failed efforts to overhaul the health system, said Andrew Stern, president of the Service Employees International Union.

"This is an opportunity to deepen the education work and build the ultimate coalition for change before it's demonized or people try to oppose it," he said.

After the first health comments poured in to the transition Web site, Aronson made a second video, this time with Daschle, seated in shirt sleeves and a tie.

"We want to make sure you understand how important those comments and your contributions are," Daschle says into the camera. "Already we've begun to follow through with some of the ideas."

Daschle praises the suggestion of creating a "Health Corps" of volunteers, modeled after President John F. Kennedy's Peace Corps.

Aronson, who was a congressional health aide to incoming White House chief of staff Rahm Emanuel, then recounts the story of a small businesswoman struggling to provide affordable health insurance to her workers.

Says Daschle: "When I was in the Senate, it was stories like that, probably more than all the factual information, that really moved you to want to act."

Research director Lucy Shackelford contributed to this report.