President Barack Obama still may push through an overhaul of the American health care system, but political indicators point to a needed overhaul of his own tactics for selling reform.
Barely eight months in office, Obama is trapped between the jaws of a tightening vise. On one side, Republicans refuse to countenance further government involvement in health care; on the other, liberal Democrats insist Obama keep his campaign pledge to make sure the estimated 50 million Americans who are without coverage can afford health insurance.
"The people don't have sufficient information, and I'm surprised the administration and others backing reform haven't done much more to educate the public," said Robin Lauermann, professor of politics at Messiah College in Grantham, Pa.
As he struggles against a powerful wave of opposition to reforming the system, his poll numbers are slipping significantly.
A Washington Post-ABC News survey found that fewer than half of Americans — 49 percent — say they believe the president will make the right decisions for the country. That's down from 60 percent at the 100-day mark in his presidency.
The poll shows Obama's overall approval is 57 percent, 12 points lower than it was at its peak in April. Fifty-three percent disapprove of the way he's handling the budget deficit and his approval on health care continues to deteriorate.
A look at other bare numbers — significant Democratic majorities in both the House and Senate — doesn't explain the overwhelming complexity of bringing the United States in line with the world's other wealthy democracies that guarantee health care to everyone.
Mixed into that equation are the so-called Blue Dog Democrats — a conservative wing of the party that in many ways shares reform reservations with Republicans. The Blue Dogs oppose Obama's call for a government-run insurance option. Their votes against the Obama plan could negate the overall Democratic majority.
The president argues that a public option would embrace those now without coverage, give others a choice beyond private insurance and, in theory, bring down the cost for everyone through competition from a nonprofit government program.
As the health care argument swirls during the August congressional recess, Americans have witnessed ugly and offensive attacks on the motives of Obama and those who support changing the system, even though it is held responsible for a majority of private bankruptcies in the world's No. 1 economy.
Obama has allowed Congress to write the specifics of new health care legislation with minimal demands from the White House. He has said he wants assurances that any plan does not increase the soaring national debt. What's more, the president said he prefers a public option, although recent remarks by administration officials suggest he might back away from that preference.
The White House explains it took the more hands-off approach after studying former President Bill Clinton's failure to push through a health care package. He sent Congress a fully written plan and saw his fellow Democrats, the majority, revolt because they had no role in shaping policy changes.
Leaving the specifics to Congress has allowed debate to drag on, with three potential bills heading this fall to the House floor. In the Senate, the finance committee has been trying to write a bill but has left the negotiating to six members — three Republicans and three Democrats. In today's highly charged and deeply partisan climate, there is little chance Obama will get what he wants from the Senate process.
The lack of one specific piece of legislation for the president to sell has opened the door for opponents inside and outside government to heap unfounded allegations on the reform process. Some have been outrageous, including an assertion by former Alaska Gov. Sarah Palin, last year's Republican vice presidential nominee, who said the plan would include "death panels."
She appears to have created that scare tactic out of a now-abandoned portion of House legislation that would have required Medicare payments for consultation with a physician about a patient's wishes for treatment at the end of life. Such consultation would have been voluntary and dealt with questions such as the creation of a living will.
Such attacks on efforts to refashion health care have put Obama on the defensive, forced to debunk untrue claims and apparently losing ground in rethinking a system that has avoided a major overhaul for decades.