By Associated Press Writer
updated 7/28/2009 7:01:18 PM ET 2009-07-28T23:01:18

After months of talk, decision time is nearing for President Barack Obama on health care.

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Bipartisan Senate negotiators are weakening some of his top priorities, leaving the president with a difficult choice: He can give ground, and implore disappointed liberals to go along with him. Or he can try to ram through a Democratic bill with his wishes intact, infuriating Republicans.

His eventual decision could be a pivotal moment in his presidency. Remaking health care is Obama's top domestic priority. He wants to expand coverage, contain costs, make insurance more competitive and change the way doctors and hospitals are compensated.

Liberals, noting that Democrats control the House, Senate and White House, see no need for serious compromises. Some moderates and independents, however, say a one-party solution would undermine public confidence in the plan and poison the atmosphere in Congress for the rest of Obama's term.

For now, the president continues to hold his cards close, giving lawmakers more time to seek a compromise that could attract some Republican votes. But many Democrats are impatient, ready for Obama to insist that Republicans either endorse the main elements of his proposal or step aside as a Democrats-only bill is enacted.

‘Going to have to choose’
"He's going to have to choose pretty soon," Sen. Lindsey Graham, a South Carolina Republican, said Tuesday.

If Obama decides to run roughshod over the Republicans, Graham said, "he'll ruin his administration" by destroying his image as a political healer under a big tent.

But many Democrats want Obama to stand firm on his campaign proposals.

"Because we want three Republicans to come along on this, we betray what the American people want?" said Sen. Sherrod Brown, D-Ohio. "I don't think so."

The outlines of Obama's approaching choice are taking shape. Bipartisan negotiators on the Senate Finance Committee — the panel making the biggest effort to gain support from both parties — are starting to show details of their thinking. In several crucial respects, they fall well short of Obama's health care proposals.

For instance, Obama's campaign called for large employers either to provide their workers with health insurance or pay into a national fund to subsidize insurance for low-income people. The Senate Finance plan would require some type of contribution from large employers, but senators said Tuesday they believed it wouldn't go as far as Obama's "pay or play" plan.

Obama also proposed to help pay for health care by trimming tax deductions taken by high-income earners. Lawmakers rejected the idea months ago, and the Senate Finance plan offers no alternative means of extracting new revenue from wealthy people.

Most troubling to many liberal Democrats, the Senate Finance plan does not call for a robust government-run option for buying health insurance. It calls for an insurance cooperative, but liberals such as Sen. Bernard Sanders, a Vermont Independent, say that's unacceptable.

"I think we have the votes to pass a strong bill," he said, which would include a public option for health insurance that is comparable to Medicare in its reach and cost controls. If Republicans don't agree, Sanders said, then Senate Democrats can use a strong-arm tactic called "reconciliation" to pass major elements of Obama's plan without any GOP votes.

Asked if he would like Obama to speak out more forcefully for his campaign proposals, Sanders answered: "Yeah."

White House adviser David Axelrod said it's too early for Obama to fully endorse the Senate Finance Committee's bipartisan approach or the liberals' call to stand firm.

‘Keep the process moving forward’
"This is the legislative process," Axelrod said Tuesday. "The important thing is to keep the process moving forward."

"There's no doubt that what we'll have at the end of the day will not fully satisfy any major player in this process," he said. The most important goal, he said, is to improve the nation's health care system.

"Everyone is going to have to give a little to get there," Axelrod said.

But in a political system dominated by Democrats, some liberals say a down-the-middle approach will give conservatives and Republicans more influence than they have earned. Instead of everyone giving a little, they wonder if either GOP lawmakers or liberal activists will have to give a lot.

Obama has more power to answer that question than anyone. Decision time is coming.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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