On Health-Care Reform, Obama Looks to the LBJ Model

President Urges Lawmakers to Act

President Obama returned to domestic affairs yesterday after a weeklong overseas tour with a warning for skeptics of his stalled health-care overhaul: "Don't bet against us."

The tough talk in the Rose Garden gave way hours later to behind-the-scenes Lyndon B. Johnson-style lobbying, as Obama pledged in a pair of private meetings with Democratic lawmakers to stake his political capital on this year's top agenda item.

"I just want to put everybody on notice because there was a lot of chatter during the week that I was gone," he said. "Inaction is not an option."

Despite Obama's forceful reengagement, congressional Democrats continued to struggle last night to finalize details of legislation aimed at overhauling the nation's health-care system. House leaders wrangled with rank-and-file members over plans to pay for expanded insurance coverage by increasing taxes on the wealthiest Americans.

At the White House session, Senate leaders came under fire for a slipping timetable that may make it difficult to meet Obama's deadline for floor action by the August recess.

"The urgency barometer is up," Senate Finance Committee Chairman Max Baucus (D-Mont.) said after the meeting.

Obama conveyed to the Senate leaders that he still expects the committee to begin action next week, two Democratic sources said.

The legislative tussles spoke to the daunting challenge of remaking a health system that consumes $1 out of every $6 spent in the country and illustrated why many reform advocates have been clamoring for Obama, who has studied the Johnson model, to dive deeper into the high-stakes battle.

"Members understand this is really the centerpiece to the president's agenda. They understand he values their input and their concerns," said Rep. Diana DeGette (D-Colo.), who spent three days last week listening to House colleagues catalog their questions, fears and gripes about the proposed bill. "Now that health care's front and center in both the House and Senate, he should have even more of an impact."

In sessions with Democrats, Obama and his advisers remind lawmakers that the defeat of President Bill Clinton's health-care overhaul spelled electoral disaster for the party in 1994, costing Democrats control of both the House and Senate.

"Behind closed doors, he essentially says: If this sinks, we will have trouble in 2010," said Jim Kessler, vice president for policy at the moderate Third Way think tank. "If this goes down, they will lose a whole lot of momentum on everything else. Clinton's whole agenda went down" after the reform's defeat.

In mapping its strategy, the Obama team chose to take its cues from another Democratic senator-turned-president: following the legislative model employed by Johnson to enact Medicare in 1965.