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Commentary: How Obama can win on health care

WASHINGTON -- President Obama can still secure major health care legislation this year if he learns from his mistakes in recent months and spends more time reminding Americans why they were once eager for fundamental change.

His White House lost sight of the need to make a strong case that reform would deliver specific benefits to the insured as well as the uninsured. Absent a consistent set of arguments from reformers, advocates of the status quo filled the vacuum -- often with outright lies.

The administration also sent mixed and confusing signals about its position on a public insurance option. This set off a liberal firestorm and increased the role that the public option played in the public debate.

Obama's aides did not foresee just how fraught the situation would become in the Senate, where Max Baucus, the Democratic chairman of the Finance Committee, allowed Charles Grassley, the committee's ranking Republican, to string negotiations along.

Senate leaders signaled Obama as early as June that they wanted him to intervene more actively to push Baucus along. The administration held back. Baucus' failure to produce a proposal before the summer recess added to the sense of legislative chaos.

Despite that, supporters of change are in better shape than the accounts of recent weeks would suggest. The House is poised to pass a bill in early fall that would achieve most of Obama's major goals. And Obama is a full year ahead of the schedule on which the Clinton administration found itself in the 1990s.

Obama has forced a showdown with plenty of time left before the midterm elections.

But backers of reform say that if Obama is to prevail, he will have to be much clearer about what he is fighting for.

Democratic strategists as well as members of Congress argue that for middle-of-the-road voters, the issues that matter are the high cost of insurance, fears of losing coverage with pre-existing conditions, and the fact that policies often fail to cover necessary procedures and sometimes cut off benefits.

"They pay their premiums, they pay their co-pays, and then a doctor tells them they need a test and they discover their insurance company won't pay for it," said Anna Greenberg, a Democratic pollster.

John Marttila, another top Democratic adviser, argued in a memo to party leaders that "medical bankruptcies evoke profound empathy, fear and moral outrage" and that reformers should highlight as a central goal "that no American family should be bankrupted by catastrophic health care bills."

In the meantime, by failing to make a strong and comprehensible case for the public insurance option, the administration has left many confused.

Sen. Charles E. Schumer, D-N.Y., argues for a simple analogy to drive home the idea that government has the capacity to expand choices. "In my state and every state, we have excellent private universities and excellent public universities," he said. "People have a choice."

Marttila broadly agrees with Schumer's analysis, but he adds that it is a mistake for reformers to lay too much emphasis on the public option. Doing so, he says, leads many to believe that it is the entirety of health reform rather than "only one element."

The administration would sacrifice the public option if that were necessary to win major expansions in coverage and tough new rules on insurance companies. But the public option's most passionate supporters will not accept such a deal unless the administration first fights hard to get it.

The road to compromise is not paved by offering premature concessions and vagueness. Having held back, the administration now needs to lay out clear goals so that it can bargain from a position of strength. Dare one say it? That was Ted Kennedy's way.

E.J. Dionne's e-mail address is