President Barack Obama's No. 1 domestic project – overhauling the US health care system – still faces major obstacles in the Senate, where reform legislation could be delayed past a Christmas deadline or even die, a reflection, perhaps, of polls that increasingly show Americans opposed to the changes. Obama's struggle not only with the health care but also a high unemployment rate, an extended economic downturn and the strains of wars in Iraq and Afghanistan have dragged down his approval ratings and could mean extremely bad news for his fellow Democrats in midterm congressional elections next year. That in turn could further hamstring Obama's chances of affecting the larger changes in the way Washington does business – a key promise in his historic and successful run for the presidency. For that reason, Obama is pressing Democrats and the two independents in the Senate to move forward with a much-watered down health care reform measure, arguing that failure to achieve at least something before the year is out is far worse than abandoning the effort for another try later in his term. The overall legislation is designed to spread coverage to millions who lack it, ban insurance industry practices such as denying coverage because of pre-existing medical conditions and slow the rate of growth for medical spending nationally. After meeting in the White House with the Democratic Senate caucus on Tuesday, Obama appeared to have convinced fellow party members that the health care bill at that point met “all the criteria that I laid out” in a speech to a joint session of Congress earlier in the year. “It is deficit-neutral. It bends the cost curve. It covers 30 million Americans who don't have health insurance, and it has extraordinary insurance reforms in there to make sure that we're preventing abuse,” Obama said. But on Wednesday trouble flared again. More polling indicated that as few as 35 percent of Americans support the existing legislative effort at deep reform of the health care system. The United States is the only developed country that does not have a national plan that covers all citizens, largely paid for through taxation. Republicans unanimously oppose the reform plan, and accuse Democrats of creating a costly new benefit program that they argue gives government too large a role in the health care system. Beyond Americans' unease with altering the system – which now mainly involves private insurance coverage paid for in part by employers and the remainder by employees – Senate Republicans used rules in the upper house Wednesday to delay forward movement of the bill. Republican Sen. Tom Coburn invoked his right to require that an amendment from the Democratic side be read aloud. That sent the Senate into limbo, since the amendment by Sen. Bernie Sanders – an Independent who votes with the Democrats – was 767 pages long. It called for guaranteeing coverage to all through a public program similar to the massive federal Medicare program that covers all people over age 65. Sanders later withdrew his amendment, after 139 pages had been read, with a broadside at Republicans. Pounding the lectern on his desk, his voice rising, he accused the opposition party of trying to shut down the legislative process. “That is an outrage,” Sanders said. “People can have honest disagreements, but in this moment of crisis it is wrong to bring the United States government to a halt.” The White House also was hit Wednesday by a call from key Democrat to abandon the reform effort for now. Howard Dean, the former Democratic Party chairman and one-time Vermont governor, said the Senate bill now did more to benefit the private insurance industry than it did for the American people. That drew a sharp response from White House spokesman Robert Gibbs, who rejected Dean's claim that the current Senate bill was a “dream” for insurance companies. “If this is an insurance company's dream, I don't think the insurance companies have gotten the memo,” Gibbs said, citing heavy spending by the industry to kill reform. Beyond all that, Obama still has not convinced one Senate Democrat, Ben Nelson, who wants tougher language in the bill that would make sure no federal money can be used for insurance payments for abortions. Even if the Senate passes a reform measure by Christmas, it still much go to a conference committee of Senators and members of the House of Representatives, that has already passed a bill much more acceptable among liberals. The conference committee would have to meld the Senate and House measures into one bill that would then require passage again in both houses of Congress. The House measure contains a so-called “public option” that would establish a government-run insurance system that is intended to expand coverage to the more than 40 million Americans who don't have insurance. The Senate bill was stripped of such a provision in recent days. Subsequently removed was a replacement plan that would have allowed men and women to buy into the Medicare program at age 55.
