Democratic strategists say the Obama administration's evolving, abstract arguments for healthcare reform are backfiring and contributing to a decline in public support for the legislation.
The strategists, many of whom saw healthcare reform fail in the Clinton administration, contend that President Obama has advanced too many rationales for his plan, leaving people confused.
For example, Obama has argued that a new healthcare system is necessary to spur an economic recovery. He also has offered up healthcare as an antidote to rising deficits. Earlier this week in a conference call with religious leaders, Obama laid out a "moral" imperative for revamping the nation's healthcare system.
At other points, Obama has portrayed "meddling" insurers as a reason for scrapping the existing system.
"One of the difficulties has been that the explanation has changed," said Howard Paster, a legislative liaison in the Clinton administration. "Originally it was keyed very much to the economy. More recently, emphasis has been placed on issues of fairness and equity. We need to have a consistent set of reasons for doing this."
Conservative opponents of the overhaul increasingly use a simple, understandable message: Government-forced cost reductions will restrict treatments, imperiling the ill and elderly.
To counter that, the case needs to be made in personal terms, some Democrats have advised. Rather than talk about healthcare's relation to fiscal policy, the White House should demonstrate how specific constituencies -- like the elderly -- stand to gain under the plan Obama has championed.
"They have not excelled in that area," said Chris Jennings, a senior healthcare advisor in the Clinton administration.
Jennings added that the Obama administration must emphasize that "the consequences of inaction are severe, and failure to act is a policy choice that will hurt real people. And the benefits of reform will help key targeted populations. You never want to get to a point in the healthcare debate where people are more comfortable doing nothing than doing something."
White House Press Secretary Robert Gibbs told reporters Friday that when Obama returns from vacation Aug. 30, he will reengage in the healthcare fight with a compelling message.
The president, Gibbs said, will "continue to tell people about why healthcare reform is important, why we can't afford to do nothing, the stakes that are involved, and to try to push back on the mistruths and misrepresentations that we all know are still out there about healthcare reform."
In a statement about the meeting, the White House said that the president and Daschle "agreed that substantive reform that lowers costs, reforms the insurance industry, and expands coverage is too important to wait another year or another administration."
Another distraction for Obama has been uncertainty over his stance on the so-called public option, a government-run program that would serve as an alternative to private health insurance.
The White House contends that its stance is unchanged: The president favors it and wants to sign it into law.
But recently, Obama and other officials also have signaled that the public option is negotiable.
On a TV talk show last weekend, Health and Human Services Secretary Kathleen Sebelius said that a public plan was not "the essential element" of Obama's healthcare proposal.
Howard Dean, former Democratic National Committee chairman, said: "They're not all saying the same thing, and that's one of the problems."
Others said the administration might be seeking maneuvering room in its dealings with Congress. Previous presidents who racked up significant legislative victories didn't always spout a consistent message, said Bob Shrum, a longtime Democratic consultant.
"A little bit of zig-zag is probably essential to a successful presidency," Shrum said.
But if Obama winds up jettisoning the public option, he risks antagonizing labor leaders and liberal supporters who helped him win the presidency.
Asked about Sebelius' comment, Andrew Stern, president of the Service Employees International Union, said in an interview: "I'll let her speak for herself. I think it's pretty essential."