WHEELING, W.Va. — After punting the heavy lifting to Congress, President Barack Obama finally has decided to tell Americans exactly how he wants to overhaul health care.
Uncertainty feeds the fear and anger in the air. People without insurance fret they won't be able to get it. People who have coverage worry they'll lose it. The system, everyone says, must be fixed. But no one seems to know what the president seeks or what change will mean for them.
"Confusing," says William Rhon of Steubenville, Ohio, a laid-off machinist. "I don't know what he wants to do," says Phil Axworthy, a Pittsburgh software developer. And Janet Wood, also of Pittsburgh, complains about "too many stories and rumors," saying: "I'd sort of like his basic outline of actually what the plan is."
A failure of leadership? Or simply a failure to communicate? Are those things the same when a complicated issue is so important to so many? And if a president can't articulate his vision on something so sprawling and all-encompassing, how can he lead?
This is an era when misinformation can easily be seared into people's minds courtesy of the 24/7 information bullhorn that uses buzzwords and sound bites to boil down complex matters for an audience with a short attention span. Does there come a point when a president can no longer turn the tide of public opinion?
Or maybe Obama, an eloquent speaker, can still cut through that clutter Wednesday night with a precise explanation of how he will lower costs and expand coverage.
In more than three dozen interviews in this region — from the heart doctor and the business executive in suburban Akron, Ohio, to the firefighter and Goodwill employee in Wheeling — people say they want the system to change. But they also are deeply conflicted about just how. And they aren't confident Obama will succeed.
The third-generation head of family owned Valley Cheese would like to offer her employees insurance but can't. "Can't afford it. Absolutely not," Janet Richardson, 33, says at her counter in Wheeling's Centre Market.
In Stow, Ohio, near Akron, Katie Jackson, 22, a temp at an insurance company, says coverage isn't an option because of the cost. "It's either I get it and struggle," she says, "or I go without."
The issue touches Americans in personal ways in a country where people are living longer than they were only decades ago, making health care concerns more acute just as costs become more burdensome. It also involves institutions people don't trust — Congress, big business and government itself. Obama's marks on the issue have slipped along with his overall popularity.
Add partisan bickering with phrases like "public option" and "socialized medicine," a $1 trillion price tag over 10 years and no direct answers coming out of Washington, and it's easy to see why people are at a loss.
All this was clear recently at the Hall of Fame Cafe, a shoebox of a diner in downtown Wheeling where Patty Porter, works the early shift as cook, server and cashier.
She and her husband, a receiving manager at Kmart, count themselves among the Americans who lack comprehensive health insurance.
"It just pays for a little bit here and there," Porter, 55, says. "They need to do something," but exactly what "I have no clue."
Does she have faith Obama and Congress can get something done? "Not really."
At the only table in the place, registered nurse Erin Griffin and her boyfriend, police officer Greg Thorngate, wrestle with the matter over French toast and eggs. Neither of them understands it, and they say that no one they know does either.
"Someone's got to pay for it," says Thorngate, 45. He worries it's going to be the middle class or the next generation.
"It's a scary thing," laments Griffin, 33. "I don't know how he thinks he's going to come in here in eight months and just change the whole theme of the country's health care and make it like Canada or whatever he's trying to do."
She sees a lot of "charity cases" who lack insurance but still must be cared for, and "maybe in that way it would be better" if more people were covered. But she wonders: "For those of us that do have insurance, how much more is it going to cost us then if we're paying for everybody else too?"
Both Griffin and Thorngate say their coverage is far from ideal and much too expensive. Thorngate's solution, after dealing with high deductibles: "Just hoping I don't get sick or injured."
On this the couple agrees: It shouldn't be like that in America.
Obama says he doesn't think so either.
Before a joint session of Congress on Wednesday, he will try to tell America precisely what he wants in legislation the White House has asked lawmakers to approve this fall.
He has talked about broad goals for overhauling health care for months, but has left the operational and financial details to Congress — the very Congress to which Americans give bottom-barrel job approval ratings. And lurking in the background, always, is former President Bill Clinton's approach in the 1990s — the one where health care reform failed after the White House circumvented Congress and wrote the legislation itself.
But in trying so hard to be different, Obama may have created a whole new set of problems.
He never detailed exactly what he wanted, and thus left open a door for opponents to define his goals. By delegating the work to Congress, Obama also irked a public that doesn't trust its representatives or senators, particularly on this issue.
One recent survey by CBS and The New York Times showed this: Only 31 percent say the president has clearly explained his plans. And 60 percent say he hasn't.
With his speech, Obama will try to flip those numbers by communicating directly — and by providing the leadership so many seek.