Health Crossroads

When President Obama was having all those health-care interest groups to the White House to promise cost-cutting, join hands and sing kumbaya, I was, to put it mildly, skeptical.

Having lived through the Hillarycare battle more than a decade ago, I knew that general principles sound great until you get down to crunching the numbers on who has to give up what.

And even though the administration has done a good job in, at the very least, neutralizing opposition from doctors and hospitals, it's still asking members of Congress to impose substantial pain, which politicians hate to do.

The trillion or so dollars to cover a major chunk of the uninsured has to come from somewhere. Some would be squeezed through lower Medicare and Medicaid payments from docs, hospitals and drugmakers, and they have political clout. The rest would either be drained by a surtax on the wealthy or taxing the most generous employer-provided benefits -- both of which are making many Democrats nervous.

Add to that the controversy over Obama's preferred "public option," which can easily be caricatured as government-run health care, and a general unease about rising federal spending, and you've got a prescription for gridlock.

I'm not suggesting Obama will fall short. If Democrats are convinced that his presidency will be crippled by a failure on health care, which grievously wounded Bill Clinton in his first term, they may ram something through. But it's a monstrously hard problem, in part because while people believe the system is broken, they are generally satisfied with their own health care.

The president's response is to mount another media blitz, which includes Jim Lehrer yesterday, this morning's "Today" interview with Meredith Vieira, tonight's Katie Couric sitdown and tomorrow night's prime-time presser. (Vieira pushed him on the timing, cost and political import, with Obama saying, It's not about me. I already have health care.)

The president even did a call yesterday with liberal bloggers, including those from MyDD and Crooks and Liars, saying: "I know the blogs are best at debunking myths that can slip through a lot of the traditional media outlets. And that is why you are going to play such an important role in our success in the weeks to come."

Talk about pulling out the stops.

The sense that Obama is on the defensive was deepened by the WP/ABC poll finding that "since April, approval of Obama's handling of health care has dropped from 57 percent to 49 percent, with disapproval rising from 29 percent to 44 percent. Obama still maintains a large advantage over congressional Republicans in terms of public trust on the issue, even as the GOP has closed the gap." His overall approval rating, though, is still a healthy 59 percent.

But Obama had the sound bite of the day, repeating the words of Jim DeMint: "Just the other day, one Republican senator said -- and I'm quoting him now -- 'If we're able to stop Obama on this, it will be his Waterloo. It will break him.' Think about that. This isn't about me. This isn't about politics. This is about a health-care system that is breaking America's families, breaking America's businesses, and breaking America's economy." It's never particularly smart for the opposition to read the stage directions.

In the New Republic, Jonathan Cohn says the president will have to draw blood to make this work: