WASHINGTON -- At first it seemed plausible that President Obama had a communications problem on health care -- to which the solution was always more and more Obama. But exposure did not translate into persuasion.
Then it seemed useful to diagnose a partisan problem, blaming a small minority of congressional obstructionists and town hall crazies for frustrating the will of the majority -- until polls showed a majority opposing Democratic approaches to health reform. More Americans (according to a recent Washington Post poll) now think that health quality, costs and their own insurance coverage will get worse under Obamacare than believe these things will improve.
 In fact, Obama has a reality problem on health care, and it has begun to threaten his standing as a leader. He staked the success of his early presidency -- perhaps of his entire presidency -- on a health reform both vague and divisive, which manages to anger deficit hawks as well as liberals who believe that compromise has already gone too far. Obamacare has been the political version of the neutron bomb, vaporizing supporters while leaving every structural obstacle in place.
The political damage is already considerable. Obama has seen one of the largest drops in approval for a new president in modern times. Confidence among political independents that Obama has the ability to make the right decisions has fallen by 20 percentage points since his inauguration.
Why is the reality of comprehensive health reform so difficult? Some structural challenges have complicated this issue since the days of Harry Truman. Because there are vastly more people inside the current health care system than outside it, the majority tends to be risk-averse and suspicious of efforts that might benefit the minority at their expense. And millions of Americans associated with the health industry -- not just a few insurance company fat cats -- have a financial interest in the outcome of the health reform debate. They naturally try to calculate what changes would mean to them, and uncertainty encourages conservatism.
Obama thought -- not without reason -- that his political moment might be different. His electoral mandate was broad. An atmosphere of economic crisis, he calculated, might leave Americans open to Rooseveltian social innovation.
It was a miscalculation. Americans were neither as desperate nor as malleable as they were during the New Deal. Obama's massive spending, intended to stabilize the economy, also drained the Treasury, making it more difficult to propose major new expenditures. Deficits of $9 trillion over 10 years have raised the prospect, according to Warren Buffett, of an American "banana republic" -- endlessly printing money, weakened by inflation and abandoned by foreign bond investors.
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