WASHINGTON — In retrospect, President Barack Obama now says, he should have offered more details about health care proposals a few months ago, rather than give critics all summer to criticize them, often with baseless claims.
Such missed opportunities are one reason for Obama's prime-time speech to Congress on Wednesday night in which he hopes to salvage his top domestic priority. The summer was marked by several risks and dubious decisions that have forced the high-stakes speech.
Obama told ABC's "Good Morning America" that in an effort to give Congress ample leeway to draft a huge bill, he "probably left too much ambiguity out there, which allowed, then, opponents of reform to come in and to fill up the air waves with a lot of nonsense — everything from this ridiculous idea that we were setting up death panels to false notions that this was designed to provide health insurance to illegal immigrants."
A team of Associated Press reporters, interviewing dozens of key players, identified other crucial moments and decisions that brought the health care saga to this point.
The Gang of Six, and early signs of dissent
Harry Reid could hardly believe his ears.
The Senate majority leader was in Denver for a mid-August Democratic conference when he heard one of Congress' pivotal negotiators on health care trashing a bill on that very subject.
"You have every right to fear," Republican Sen. Charles Grassley told a raucous citizens' forum in Iowa that day. "We should not have a government program that determines you're going to pull the plug on Grandma."
Grassley's stunning comments made Reid second-guess a decision he and Obama had reluctantly made months earlier: to give six senators from small states, the so-called Gang of Six, the time and prominence to fashion a bipartisan bill on overhauling the health care system.
Reid always had questioned whether Grassley and the other five could produce a compromise that would attract enough Republican votes to pass the Senate without prompting a revolt by House liberals. Extending their deadline by more than a month was risky. It would send Democratic lawmakers into the long August recess unable to show voters a health care bill passed by the House or Senate.
Sure enough, critics seized the vacuum to attack the Democrats' plans in sometimes virulent terms. At the Iowa forum, Grassley, the Republican most vital to hopes for a bipartisan breakthrough, seemed to be stabbing Democrats in the back with his comments.
And on Wednesday, the Democratic leader of the Gang of Six, Sen. Max Baucus of Montana, acknowledged the ultimate futility of the time and effort spent. A bipartisan deal is unlikely, he said, and he will push legislation with or without GOP help.
Stoking fears about costs
The first big blow to Obama's health care agenda came from a bearded, bespectacled Harvard University-trained economist with a background in the Clinton administration.
Douglas Elmendorf, director of the nonpartisan Congressional Budget Office, sat before the Senate Budget Committee on July 16. Chairman Kent Conrad, D-N.D., cut to the chase: Would newly released House bills curb federal health care costs?
Nope, Elmendorf said. "On the contrary," he said, "the legislation significantly expands the federal responsibility for health care costs."
Republicans pounced. House GOP leader John Boehner of Ohio said Elmendorf "confirmed that the Democrats' government-run plan will make health care more costly than ever."
Obama later said Elmendorf was simply stating the obvious, that bringing 46 million new people into the system would cost money.
But the testimony emboldened conservative "Blue Dog" Democrats who felt the House's liberal leaders were ignoring their concerns about costs. House leaders agreed to postpone a floor vote until September.
Worries about raising taxes
Warning signs about the cost issue's volatility came as early as March 4.
Treasury Secretary Timothy Geithner explained the president's proposal to limit tax deductions for wealthy people as a way to raise money to help pay for expanded health care. But when lawmakers pushed back, Geithner did not dig in.
"We recognize there are other ways to do this," he told members of Congress. The comment seemed to unleash a flood of ideas, trial balloons and mixed messages.
There were proposals to tax soft drinks and increase taxes on alcohol. The Gang of Six senators spent months discussing a new tax on health benefits packages, then dropped it. Now it might be back in play, with Baucus proposing a 35 percent tax on the value of insurance plans exceeding $8,000 for individuals and $21,000 for families.
In July, several House committees agreed to a new tax on families making more than $350,000. But House Speaker Nancy Pelosi, D-Calif., said it should apply only to those making more than $1 million.
Obama? He said he didn't want to raise taxes on families making less than $250,000 a year. But a top Obama economic adviser, Larry Summers, said on Aug. 2 that "it is never a good idea to absolutely rule things out."
The next day, White House Press Secretary Robert Gibbs said Obama stood by his campaign pledge not to raise taxes on the middle class.
"A can of tuna fish"
Republicans appeared quick to grasp the intricacies and political value of exploiting worries about cost.
On June 19, pollster Wes Anderson traveled to the Capitol to show GOP leaders some surprising results from a poll that his firm, OnMessage Inc., had conducted for Republicans.
Most likely voters wanted to control health care costs, but only one in five wanted greater access to health care. And 90 percent of them already had health insurance, limiting the impact of Obama's emphasis on covering the uninsured.
If Republicans could drag out the debate, the group agreed, they could gain ground by hammering at costs.
"This is a can of tuna fish," Anderson told the House and Senate GOP leaders. "If you let it sit there in the sun for a couple of hours, no one is going to want to touch it."
A polarizing name
It's almost a Democratic article of faith that Obama is the best possible salesman for tough issues such as health care. But findings by the Herndon Alliance, a partnership of liberal, labor and some health care provider groups, raised doubts about that in June.
"All references to President Obama tend to be polarizing," the group said in a memo, drawing on findings from Lake Research Partners, a Democratic polling firm. "If President Obama is mentioned," it said, "use his name AFTER the strong and less polarizing message language so people don't tune out our core message."
Town hall meetings and a shifting wind
If Reid had any doubts that his political foes were taking full advantage of the drawn-out debate, all he had to do was watch the footage playing endlessly on cable news shows from Lebanon, Pa.
"One day God will stand before you and judge you!" a man shouted at Sen. Arlen Specter, D-Pa., before leaving as security guards approached him at a highly emotional public meeting.
For White House officials and Democratic leaders, Specter's widely broadcast berating was an early warning of what awaited dozens of other lawmakers. And it was an unmistakable sign that the wind was shifting against them.
"We weren't prepared for how angry it was," said Gerald Shea, the AFL-CIO's top health care policy adviser.