In one swoop, President Barack Obama must regain the public's attention on health care, clarify in detail exactly what he wants in a final deal, unify a restless Democratic Party, prod Congress to get him a bill and bring clarity to a bewildering debate.
Vacation is over.
Obama's decision to give a prime-time speech to Congress on Wednesday underscores the stakes for a president, and even a young presidency.
He's got to get a law passed in a form that would genuinely help millions of people with their health insurance without having the liberals in his party rebel on him.
The White House signaled Thursday that it remains open to compromises necessary to get a deal through Congress. "There are fundamental principles that he believes in," senior adviser David Axelrod said. "He's not dogmatic about how we get there."
The responsibility is back on Obama.
He's the one who opted to let Congress hash out the details and hold out for pragmatic bipartisanship, approaches that stalled and in some ways backfired. He is the one who promised repeatedly that a health care overhaul would pass this year. And he is the one who said that it his job to get a deal done.
So after keeping out of the spotlight on health care over the last few weeks, Obama wants to come back big.
He chose one of the largest forums any president can grab, the grand stage of an address to Congress.
In his favor, the move gives Obama something he had lost from the public: sheer anticipation in what he is going to say.
Bogged down in the details
There had been a stretch in summer when Obama was talking nearly every day on health care. The debate got bogged down in messy legislative details and media coverage of angry, if unrepresentative, town halls.
Now the White House is promising Obama will offer more specificity and direction.
"I don't think anybody will leave Wednesday night without a clear sense of what he proposes, and what health care reform is not," Axelrod said. Vice President Joe Biden seemed to go even further, promising Obama will clearly spell out what the "pieces have to be and will be."
Obama's critics say that's late in coming. So do many of his supporters, who wonder privately whether the quiet stretch of late has been an opportunity lost.
Congress is run by Obama's party, but there are significant splinters among Democrats about what a final bill must contain. Some dissatisfied liberal activists are going so far as to petition the man they helped elect to stand behind the so-called public option of a government-run program to compete with private insurers.
"At this point, it's not just about the president," said Karen Finney, a former top Democratic National Committee official who worked in former President Bill Clinton's White House. "It's time frankly for Democrats to recognize that from a political context, their fate is linked to the president as well. It's time for the Democrats to come together on a proposal that they can all agree on."
Yet Obama is the one under demand to be more aggressive.
His oft-stated principles on health care — instilling competition and choice, ensuring people won't be cut off for pre-existing conditions, trying to rein in the crushing costs — have not been enough. Congressional committees made much more progress than in years past, but that now seems more process than progress.
"He's now, very late in the game, it appears, maybe going to be a lot more clear about what exactly he wants — and more importantly, what he's willing to fight for," said Tony Fratto, a former spokesman for President George W. Bush. "There's hardly a bigger stage than doing it before a joint session of Congress. So he's going all in from a communications standpoint. The question is whether he's going to go all in on a policy standpoint."
Since the start of June, Obama has given 25 speeches and statements alone on his health care plan, according to Mark Knoller of CBS News, who keeps a detailed log of presidential activities. And that doesn't include a battery of interviews on the topic.
Obama's first prime-time news conference on Feb. 9 drew nearly 50 million viewers. His last one, a July 22 event focused on health care, drew half that number.
"The problem isn't that the president has had too many opportunities to speak," Axelrod said. "The problem is that there's a cacophony of voices out there. So even as large as the megaphone that he has, it's not always easy to over-shout the noise."
Meanwhile, Obama's approval rating has eroded. A CBS News poll from late August found just 40 percent of people supported his handling of health care.
‘He's got to take ownership ...’
"He's got to take ownership of it in a way that he hasn't quite yet, and he'll only do that by providing the specifics," said Wayne Fields, a professor at Washington University in St. Louis who studies presidential speechmaking.
For a nation lost in where the whole matter stands, Obama is expected to do some recapping in his speech. He is likely to give a nod to the messy legislative process as a part of decision-making but one that must now end in votes. He may shoot down untruths about his plan and call for a calm, quick conclusion.
And he must get detailed without getting so wonky that he loses people, Fields said.
"If he just comes out with the same rhetoric that we've heard in countless town meetings and press conferences and no hard lines are drawn," Fratto said, "I think everybody's going to say, `What was that all about?'"