In his health care press conference tonight, despite sounding a few optimistic notes -- "what's remarkable at this point is not how far we have to go, but how far we've come" -- the president seemed, more than ever before, on defense. Obama was clearly determined to hit back against perceptions that his health reform plan is a classic "tax and spend" proposition. Again and again, he portrayed himself as "very worried about federal spending. ... To everyone out there who's been ginned up about this idea that the Obama administration wants to spend and spend and spend, the fact of the matter is that we have inherited enormous deficits," he said. "But health care reform is not going to add to that deficit; it's designed to lower it."

Although recent polling on health care suggests the public is skeptical of the administration's reform efforts -- in part because of cost -- Obama's personal popularity remains very strong. Fifty-nine percent of Americans view him favorably. Perhaps that is why the president stated, several times, that Republican opponents of health reform are primarily concerned with scoring a political hit against him; he was asking the American people to rise to his defense by supporting his policy goals.

"I’ve heard that one Republican strategist told his party that even though they may want to compromise, it’s better politics to 'go for the kill.' Another Republican senator said that defeating health reform is about 'breaking me,'" Obama said. "So let me be clear: This isn’t about me. I have great health insurance, and so does every member of Congress." Later on, adopting the third person, he accused Republicans of opposing reform "because they think it will make Obama more vulnerable."

But after extending the deadline for health reform from August to the end of "this year," and admitting that his plan makes many Americans "queasy," there is no question that Obama is looking a bit vulnerable. When he said "Congress is still working through a few key issues" on health care, it was really the understatement of the year; the crucial Senate Finance Committee has yet to release a proposal on how to pay for reform. And in the meantime, the issue of abortion has emerged as a potential roadblock. Just yesterday, Obama rolled back his campaign promises to reproductive rights advocates, saying that excluding abortion coverage from federal health plans is a Washington "tradition" that may need to be respected when crafting a new, public insurance option.

The strongest part of Obama's remarks was his description of the crucial health insurance exchanges. He's always been good in a professorial, explanatory mode. The exchange is simply "a marketplace that promotes choice and competition," he said. "If you don’t have health insurance, or are a small business looking to cover your employees, you’ll be able to choose a quality, affordable health plan." Later on, though, he seemed to let one of Democrats' most central health reform messages slip away. Throughout this process, Democrats have been clear that people who like their employer-based insurance won't have to switch plans after reform. Yet during the question and answer session, Obama said, "Can I guarantee that there will be no changes to the health care delivery system? No."

Of course, Obama was referring here to the overall landscape of public health in America, which will indeed change -- for the better -- when insurance companies are reeled in. But his statement is likely to be widely misinterpreted and spun, not least because he simply didn't hammer home tonight the fact that employer-based insurance, as it currently exists, will remain the primary mechanism for coverage after reform. For progressives, that is a major disappointment. But since the legislation we're looking at protects our largely employer-based system, it seems politically smart to highlight that fact, for all those "queasy" upper-middle-class voters who like the status quo just fine.

--Dana Goldstein

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