Obama's big gamble on healthcare debate

Reporting from Washington -- President Obama's announcement that he will take his case for revamping healthcare before a joint session of Congress next week reflects a decision to go "all in" politically, laying his prestige on the line for the defining domestic issue of his young presidency.

Obama is gambling that he can tilt the balance in his favor by spelling out in detail just what he wants from the House and Senate in the coming weeks.

Until now, Obama has avoided laying out a blueprint for healthcare, confining himself to statements of broad goals and leaving the particulars to Congress. White House officials said Wednesday that this strategy had helped keep the legislative wheels turning and avoid stalemate.

But it also has left many of Obama's supporters confused about where he stands and has given conservative critics a chance to seize control of the debate, as when some charged that Democrats would create "death panels" to deny medical treatment for the severely ill. Although no such language has ever appeared in legislation being considered in either house, the controversy focused attention on claims that care would be rationed among the elderly in a new healthcare system.

White House strategists say the joint session speech, scheduled next Wednesday, will end the uncertainty and confusion, enabling Obama to shift from defense to offense as Congress begins to make the hard decisions on healthcare.

"I think the path that he believes we should go [in] will be clear to everyone who hears this speech," senior White House advisor David Axelrod said Wednesday. "I don't think anyone will leave . . . without a clear sense of what he proposes, and what healthcare reform is not."

Ralph Neas, head of the National Coalition on Health Care, an amalgam of union, health and medical groups supporting the legislation, said, "President Obama must become the salesman-in-chief" to regain the political momentum. "The most ambitious and important legislation in 45 years compels such a massive presidential effort."

Republicans reacted skeptically. "I don't think the problem is the messaging, I think the problem is the substance," said Senate Minority Leader Mitch McConnell (R-Ky.). "The problem is what he's trying to sell. I think there's been serious blowback and negative reaction across the country to what they are proposing."

The exact time of the speech has not been set, but is likely to be in prime time.

As White House strategists prepare for the address, they are struggling with problems on two fronts.

Their own party is divided; liberals are demanding a more active role for government while moderates balk at radical change and the potential cost. Meantime, large segments of the public are uneasy about changing a system that, though troubled, continues to serve the needs of many.

To address those concerns, the administration may face compromises on several key issues:

On cost containment, with estimates that the overhaul could cost $1 trillion over 10 years, Republicans have hammered Obama on the ballooning deficit. Doing more to lower costs would require cutting back the scope of the program, which could stir anguish among the president's liberal supporters.

On Medicare, proposals to offset new expenditures by curbing outlays for the program serving the elderly have spread panic among senior citizens. Strategists say Obama must find a way to still their anxieties.

On the creation of a government insurance plan to pressure private insurers to offer better deals, the GOP has charged that a government takeover of healthcare is in the works. White House officials are considering a "trigger," authorizing a government plan only if private insurers fail to offer more affordable coverage.