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People who are for and against health care reform demonstrate before the arrival of President Barack Obama at St. Charles High School in St. Charles, Mo., on Wednesday. (Jeff Curry/AP/Jeff Curry)
People who are for and against health care reform demonstrate before the arrival of President Barack Obama at St. Charles High School in St. Charles, Mo., on Wednesday. (Jeff Curry/AP/Jeff Curry)

Konrad Yakabuski in D.C.

Obama prepares for a showdown on health care Add to ...

Barack Obama has missed so many self-imposed due dates for passing health-care reform that his signature initiative is now in its fifth trimester. And still this baby won't drop.

Over-caffeinated American media types have been recycling the same sports metaphors - endgame, late innings, final lap - every few weeks for most of the past year, each time suggesting the do-or-die moment for health-care reform is nigh.

So, believing that the President's decision to delay his departure on a Pacific Rim junket - to next Sunday from Thursday - somehow means the coming week really is crunch time for his defining initiative demands a certain degree of gullibility. Haven't we heard it all before?

Well, not quite like this. Since his March 3 call for a final vote "in the next few weeks" by the Senate and House of Representatives on his $950-billion (U.S.) reform proposal, Mr. Obama has finally been acting like he has set a deadline in which he believes.

After campaign-style speeches in Pennsylvania and Missouri, Mr. Obama will visit another swing state (Missouri) on Monday to sell his package. He's not doing this to boost his personal poll numbers.

"Every time this issue becomes the dominant issue - every time we're into 'the big push' - the President's job approval sinks to new lows," pollster Scott Rasmussen noted in an interview.

The stump speeches, in which Mr. Obama has been sounding almost as passionate about this cause as he did about "hope and change" during the 2008 race, are likely aimed more at firing up the progressive Democratic base than moving public opinion, which has hardened against his reform.

If Mr. Obama can get core Democrats to start pressuring fence-sitting congressman in their own districts to support him, there will be a bit less heavy-lifting left for the President and House Speaker Nancy Pelosi. Democrats have a crushing majority in the lower chamber - with 253 of 431 seats. But Ms. Pelosi is still having trouble amassing the 216 yeas needed to pass Mr. Obama's package.

Mr. Obama has already indicated he will try to push health-care reform through the Senate using reconciliation, a procedural device that enables budget measures to pass the upper chamber with a bare majority of 51 votes, instead of a filibuster-proof 60 nods. Since losing a Massachusetts Senate race in January, the Democrats are down to 59 seats.

But to get to that point, the President first needs the House to adopt the same bill the Senate passed in December. After that, a separate reconciliation package amending that Senate bill to include a series of changes (aimed largely at placating House Democrats) would need to muster majority support in both chambers.

Getting to 216 House votes will require Mr. Obama and Ms. Pelosi to wield every stick and carrot in their arsenal.

The hold-outs fall into three categories. First, diehard anti-abortion congressmen led by Michigan's Bart Stupak say they won't vote for the Senate bill because it does not categorically prohibit federally subsidized health-insurance plans from covering the procedure. And because the abortion clauses are not budgetary matters, there is no way to change them using the reconciliation process.

The second group of fence-sitters consists of fiscally conservative Democrats. Many of them won their seats in 2008 in traditionally Republican districts because of their own or Mr. Obama's personal popularity. Now, however, Mr. Obama is a drag on their re-election odds.

Finally, some liberal Democrats who voted 'yes' on the original House bill that passed in November - which proposed a government-run health plan to compete with private insurers - say they won't vote for the Senate bill because it has no such "public option" and taxes the kind of rich health plans many of their union supporters hold.

Some of the hold-outs may just be posturing, hoping to use their leverage to win goodies for their district or the promise of a promotion within the congressional ranks. Besides, how could liberals, who have long championed extending health coverage to most of the 47 million Americans without it, sabotage their last chance at making their dream a reality?

But, even if Mr. Obama gets the 216 yeas he needs in the House this week, he faces still more hurdles in the Senate. The reconciliation measures must pass muster with the Senate parliamentarian to even be eligible for a vote. And though Senate Republicans can't filibuster a reconciliation bill, they can propose any number of amendments up to infinity.

"For Republicans, the fantasy is that this issue keeps going right up until [mid-term]election day in November," Mr. Rasmussen mused.

To most Americans, that would feel like Chinese water torture. They already think the President has spent way too much time on health care, to the detriment of jobs. And fully 57 per cent, according to Rasmussen polling, think Obamacare (if passed) would further hurt the economy.

Mr. Obama really needs his baby born, raised and out of the House pronto if Democrats hope to salvage their dignity at the polls in November.

The latest "deadline" seems like the msost believable one yet.

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Follow on Twitter: @konradyakabuski


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