Obama's health-care test, front and center

President Obama faces a big leadership test tonight as he tries to seize back the health-care debate from conservative opponents in an address to Congress, after a summer spent on the political defensive.

Sharp Republican attacks have accused Obama and his Democratic allies, in sometimes sensational language, of pushing a socialist agenda with their efforts to overhaul the health-care system.

The pregame furor over yesterday's presidential speech urging students to stay in school and work hard - some conservatives feared Obama would use the occasion to indoctrinate children with what they consider his statist philosophy - showed how charged the atmosphere is.

"They've got to get ahead of the curve, because the other side is relentless," Neil Oxman, a Philadelphia-based Democratic strategist, said of the White House. "The opponents have completely dominated the agenda."

Obama's poll numbers are down sharply from the spring, particularly among independent voters. Trend lines mapping the major national polls since Obama took office, compiled by Pollster.com, show that on average, 48.3 percent of independents disapprove of his job performance, while 45.8 percent approve.

Opponents of the president have "done a wonderful job of raising doubts about the health-care proposals with loaded words," Oxman said. Those doubts "spilled into" other aspects of Obama's job performance, he said, and mixed with concerns about the efficacy of administration policies aimed at turning around the economy and growing federal deficits.

But, though tonight's speech is important, the moment almost surely will not determine the fate of Obama's presidency as many people either fear or hope.

After all, President Bill Clinton was supposedly doomed to one term after his failure to get a health-care overhaul passed in 1994, and he rebounded. In 1997, he was able to maneuver a piecemeal health change - the SCHIP program to give coverage to children - through a GOP-controlled Congress.

And, as Friday's eighth anniversary of the 9/11 terrorist attacks reminds us, unforeseen events can overwhelm an administration's agenda and redefine a presidency.

On health care, history favors step-by-step changes rather than a wholesale shift to universal coverage, which has been a goal of every president since Harry Truman.

President George W. Bush, for instance, added a prescription-drug benefit to Medicare, the popular government health-insurance program.

Medicare, pushed through in 1965 by President Lyndon B. Johnson, was itself a response to the political difficulty of enacting universal coverage, historians say.

"LBJ's main strategy was simple: Focus on the elderly, and do it through a program people were already familiar with, Social Security," said Julian Zelizer, a professor of history and public affairs at Princeton University.

Not that that was easy. "It's totally forgotten now, but there was a frenzy over Medicare - it was 'socialized medicine' and everything else," Zelizer said. Johnson, a former Senate majority leader, was a master of legislative arm-twisting and compromise, and the congressional politics of the time was different.

"Polarization is a little more intense today; there are fewer moderates in either party," Zelizer said.

Seeking to avoid repeating Clinton's mistakes, Obama sailed above the fray when he initiated his overhaul effort, speaking about the need for reform but leaving details to Congress. That led to a welter of competing bills and a message vacuum that opponents were only too happy to fill.

Analysts say Obama has to literally change the story from the GOP's critiques to a compelling pro-reform message and to get more specific with Congress and the nation about what he wants to achieve. In an interview taped yesterday with ABC News, Obama said he would offer "clarity" in his speech.

Earlier, Obama used a Labor Day AFL-CIO picnic in Cincinnati to attack overhaul opponents with some of his sharpest language yet.

"You've heard all the lies," Obama said. "I've got a question for all those folks: What are you going to do? What's your answer? What's your solution?

"And you know what? They don't have one. Their answer is to do nothing.. . . And we know what that future looks like: Insurance companies raking in the profits while discriminating against people because of preexisting conditions, denying or dropping coverage when you get sick."

Obama will have to bridge the gap between liberal Democrats in Congress, who say that a government-run health-insurance program is essential to keep private insurers honest, and more moderate and conservative Democrats, for whom the so-called public option is anathema.

In recent days, administration officials and Obama have said that while they would like a public insurance plan, such a plan is not a requirement. The question is whether liberal House members will stick with the president on the final vote.

It would be disappointing if Obama does not insist on a public option, said Marc Stier, Pennsylvania director of Health Care for America Now, a union-backed group campaigning for universal coverage.

He said that although early town-hall meetings held by lawmakers from Pennsylvania were dominated by sometimes-rowdy protesters opposing an overhaul of the health system, later sessions were quieter and more supportive. Two fiscally conservative House Democrats - Kathy Dahlkemper of Erie and Christopher Carney of the Scranton area - told town-hall meetings they would vote for legislation with a public option, Stier said.

"But we know it's tough," Stier said, "and the most important thing, for both health care and the Obama administration, is that we have a win."

President Obama will address a joint session

of Congress at 8 p.m. today about overhauling health care. Most major TV networks and cable news outlets will broadcast the speech.EndText