White House retooling message, strategy on health care

WASHINGTON — From the start of his presidency, Barack Obama made clear that his plan for enacting comprehensive health-care reform came down to three words: fast, broad and bipartisan.

That was then.

Now, as lawmakers begin to flee Washington for a monthlong recess, the White House team is retooling its message and strategy, hoping a more modest approach will reinvigorate Obama's signature domestic policy initiative and give him a first-year victory for Democrats to carry into the 2010 midterm elections.

Legislative wrangling, a well-coordinated Republican opposition and the sheer complexity of an issue that consumes nearly one-fifth of the nation's economy have taken a toll on the president and his bold ambitions. Polls show that support for Obama's handling of health reform has declined amid widespread anxiety about its effect on middle-class, insured Americans.

"There was a view that because of the recession this could be sold as an economic fix," said Howard Paster, President Bill Clinton's legislative affairs director in 1993. "That's not selling. The public has spoken loudly."

With the debate shifting from partisan-charged Capitol Hill to the kitchens, diners and churches of America, Democrats are under pressure to counter the GOP's "risky experiment" story line.

Four congressional committees have approved bills, largely on party lines, that would require that every person carry health insurance, would offer credits to families and small businesses that have trouble affording coverage, and would begin to realign financial incentives toward performance-based care.

A key fifth committee in the Senate is negotiating a more centrist bill, which could pave the way for a less-ambitious compromise.

"Over the next few weeks, we must build upon the historic consensus that has been forged and do the hard work necessary to seize this unprecedented opportunity," Obama said Saturday.

By leaving the bill-writing up to Congress, Obama is better positioned to claim success no matter which bill is adopted. Already, he has abandoned his opposition to the proposed requirement that everyone have insurance, known as an individual mandate, and signaled a willingness to consider financing schemes — including tax increases — that were originally not on his agenda.

His patient, hands-off style — reminiscent of his methodical primary campaign last year — has frustrated some anxious Democrats but stands in stark contrast to Clinton's unsuccessful strategy of crafting a 1,300-page bill in secret and then pressing lawmakers to approve it.