Democrats say they never saw it coming, but the breakdown of President Barack Obama's health care overhaul was abetted by their own mistakes.
It wasn't just a political fluke brought on by the surprise election of a Republican senator in true-blue Massachusetts.
Looking back, Obama and his congressional allies failed to appreciate the depth of frustration with Washington — people's desire for health care legislation that would respond to their anxieties, not the clamor of interest groups.
Former President Bill Clinton was criticized for dictating to lawmakers when his health care plan imploded in the 1990s. But Obama may have swung too far in the opposite direction, giving free rein to Capitol Hill's culture of insider dealmaking.
Democrats bowed to ideology over pragmatism. They allowed a dispute within the party over a government insurance option pursued by liberals to drag on last year, even when it was clear the Senate wasn't going to pass it and Obama was unwilling to save it.
As Republicans closed ranks against the sweeping remake sought by Obama, Democrats lost more time last summer waiting to see if bipartisan talks in the Senate would produce a compromise bill.
But GOP negotiators came under relentless pressure from their own party, and the three-month exercise yielded nothing. Many Democrats felt it was an elaborate game of political rope-a-dope. Early on, Sen. Jim DeMint, R-S.C., had captured the defiant mood among Republicans when he said health care would be Obama's Waterloo. "It will break him," he said.
Maybe not.
Unlike the 1990s, Democratic congressional leaders are working overtime to salvage the health care overhaul that consumed them for a year. The House and Senate bills would cover more than 30 million uninsured people, yet neither chamber seems ready to yield on differences over important details. Even if leaders can agree, lawmakers worried about their re-election prospects this year may not go along with a complex rescue plan requiring a series of controversial votes.
Budget changes
Obama's 2011 budget, released Monday, renewed his call for major changes, saying the bills stuck in Congress would begin to rein in costs and contribute to the economic recovery.
Yet, at a pivotal moment in his presidency, Obama has turned introspective. In his State of the Union speech, he accepted responsibility for failing to communicate the benefits of the legislation to the public. With more workers in jobs that lack health insurance, the Democrats' plan for government to subsidize affordable coverage for millions had inherent appeal.
Instead, the legislation was defined by the activists who turned out at town hall meetings last summer riding a current of populist anger over the government's expanding role in a time of economic crisis. Obama was forced to relaunch health care with a September speech to Congress that calmed Democrats and got them back on track.
But the deals lawmakers cut to get votes fired up the critics again, and Obama belatedly has joined in pointing the finger at Congress.
"The health care debate as it unfolded legitimately raised concerns not just among my opponents, but also amongst supporters, that we just don't know what's going on," Obama said in a recent ABC News interview. "It's an ugly process and it looks like there are a bunch of backroom deals."
Ugly process. For Democrats in Congress, that stings. Administration officials cut deals, too — with drug companies, hospitals and others. Sen. Mary Landrieu, D-La., said she thought Obama endorsed the legislative strategy: one big bill in the House, two in the Senate.
"As far as I thought, the president thought it was a good idea to have three separate bills debated," said Landrieu, calling the strategy "a tough plan."
Sen. Tom Carper, D-Del., said Obama could have moved more quickly to settle differences between the House and Senate to get a final bill. The president jumped in the week before the Massachusetts election and drove them close to a deal.
"The president's role in health care reform initially is to steer the boat," said Carper. "At some point in time, the president needs to start rowing." Should Obama have done that sooner? "Probably so," said Carper, "but I wouldn't fault him."
Unclear vision?
What Obama wants now is unclear. Even as he insists Congress must pass comprehensive changes, he's not telling lawmakers how to break their impasse. Behind the scenes, administration aides are exploring all options.
The uncertainty recalls what happened for much of last year on one of the central issues in the debate, whether the government should offer its own insurance plan to compete with private carriers. Many liberals saw that as a pathway to Medicare-for-all, and Obama was unwilling to settle the dispute raging in his own party.
As a result, the slim chances for a bipartisan solution disappeared, and the public plan overshadowed almost everything else.
"The public option was a bright line for Republicans, and one we would not cross," said Michigan Rep. Dave Camp, author of the House GOP health care bill.
Drew Altman, president of the nonpartisan Kaiser Family Foundation, said the focus on the public option "diverted attention from core consumer issues such as affordability" and added to the delay.
Time is running out now. Obama has challenged Republicans to come up with a better health care plan if they don't like his. That's not likely, not when Republicans have the Democrats just where they want them.
Carper says his party fumbled the football a couple of yards short of scoring a touchdown. "The ball was bouncing around, and we fell on it and recovered it," said Carper.
The question now for Democrats is if Obama will call in a winning play.