So far Obama has taken a hands off approach to healthcare, letting key players define their battle lines. But now is the time for the president to step into the fray.
President Barack Obama is seeing the downside of his light touch on revamping the nation's health care system.
Congressional Democrats are off to a halting start, blindsided by a high cost estimate and divided over how to proceed. The confusion has emboldened Republican critics of the administration's approach to its top domestic priority.
While too early to rule out eventual success, it seems Obama will have to be more forceful and hands-on.
His proposal to provide health care coverage for some 50 million Americans who lack it has become a contentious point for a Democratic-controlled House and Senate struggling to reach a consensus Obama desperately wants.
Much of the concern came after the nonpartisan Congressional Budget Office estimated that the plan would cost $1 trillion over 10 years but cover only about one-third of those now lacking health insurance.
Democrats protested that the estimate overlooked important money-savers to be added later. But Republicans seized on the costly projection and the bill's half-finished nature, throwing Democratic leaders on the defensive, though his plan did receive a boost over the weekend when drugmakers agreed to commit $80 billion over the next 10 years to help lower costs.
Obama hailed the agreement as a breakthrough.
"The agreement by pharmaceutical companies to contribute to the health reform effort comes on the heels of the landmark pledge many health industry leaders made to me last month, when they offered to do their part to reduce health spending $2 trillion over the next decade," Obama said in a statement announcing the agreement.
But the concession, which is expected to be written into law soon, may not be enough to move the needle on the universal health care pledge that Obama made during the campaign.
The United States is the only developed nation that does not have a comprehensive national health care plan for all its citizens.
Sen. Chuck Grassley, the top Republican on the Finance Committee, said officials would have to rethink their best-case scenario for providing a sweeping overhaul of the health care system at a relatively low price.
"So we're in the position of dialing down some of our expectations to get the costs down so that it's affordable and, most importantly, so that it's paid for because we can't go to the point where we are now of not paying for something when we have trillions of dollars of debt," said the Iowa senator.
Sen. Dianne Feinstein, a California Democrat, said she wasn't certain there are enough votes in the president's own party to support the proposal.
"I think there's a lot of concern in the Democratic caucus," she said.
The overhaul's chief proponent in the Senate, Chris Dodd of Connecticut, urged patience as lawmakers continued working on the bill. However, Republican Sens. John McCain of Arizona, and Lindsey Graham of South Carolina, said the bill's cost was problematic.
"You do the math," McCain said. "It comes up to $3 trillion. And so far, we have no proposal for having to pay for it."
The CBO estimates "were a death blow to a government-run health care plan," Graham said. "The Finance Committee has abandoned that. We do need to deal with inflation in health care, private and public inflation, but we're not going to go down to the government-owning-health-care road in America and I think that's the story of this week. There's been a bipartisan rejection of that."
Competing plans abound in Congress, complicating Obama's task.
"As a matter of fact, I don't have the slightest idea what is in either of the two bills in the committees," said Sen. Richard Lugar, an Indiana Republican. "None of us do because much of it hasn't been written, still being drafted. ... What I would suggest is we hang on now for a period of study so that we find literally what the alternatives are."
As for his favored outcome, "I think it should be incremental steps," Lugar said.
Health care changes have widespread public support, according to a CBS-New York Times poll released Saturday. Almost two-thirds say the government should guarantee health insurance for all Americans while half that many think it's not the government's responsibility.
People are more divided when it comes to such a program's impact on the economy and whether they are willing to pay higher taxes so that all Americans have health care.
The U.S. government provides coverage for the poor, disabled, elderly and veterans, but most Americans rely on private insurance, usually received through their employers. However, not all employers provide insurance and not everyone can afford to buy it on their own. With unemployment rising, many Americans are losing their health insurance when they lose their jobs.
The U.S. spends about two-and-half times as much on health care as other industrialized countries, but it does no better on life expectancy and other measures than nations that spend far less.