Liberal Revolt on Health Care Stings White House

WASHINGTON — In the great health care debate of 2009, President Obama has cast himself as a cold-eyed pragmatist, willing to compromise in exchange for votes. Now ideology — an uprising on the Democratic left — is smacking the pragmatic president in the face.
Stung by the intense White House effort to court the votes of moderate holdouts like Senator Joseph I. Lieberman, independent of Connecticut, and Senator Ben Nelson, Democrat of Nebraska, liberals are signaling that they have compromised enough. Grass-roots groups are balking, liberal commentators are becoming more critical of the president, some unions are threatening to withhold support and Howard Dean, the former Democratic Party chief, is urging the Senate to kill its health bill.

The White House scrambled Thursday to tamp down the revolt, which has been simmering for weeks but boiled over when the Senate Democratic leadership, bowing to Mr. Lieberman, scrapped language allowing people as young as 55 to buy into Medicare.

David Axelrod, Mr. Obama’s senior adviser, began the day by calling in to MSNBC to urge the party to hold together, warning of a “tragic outcome” if Democrats failed to pass a bill that the White House says would expand health coverage while reining in costs.

“I don’t think you want this moment to pass,” Mr. Axelrod said. “It will not come back again.”

Former President Bill Clinton echoed the theme, issuing a statement in which he urged fellow Democrats to “take it from someone who knows: these chances don’t come around every day.” Mr. Clinton’s former chief of staff, John Podesta, a close Obama ally, pushed back against Mr. Dean on the Internet and on television.

The backlash is building as Mr. Obama is under increasing pressure from his party’s left flank on issues ranging from the economy to Afghanistan. This week alone, the House speaker, Nancy Pelosi, declared that she would not insist that her caucus vote to finance Mr. Obama’s troop buildup, while Senator Bernard Sanders, the Vermont independent and self-avowed democratic socialist, chastised the president for reappointing Ben S. Bernanke as chairman of the Federal Reserve.

The left’s disenchantment with Mr. Obama on health care harks back to his decision, before he became president, not to try to replace the current private insurance system with a single-payer, government-run “Medicare for all” system. Throughout the year, at town-hall-style meetings and other public appearances, he has been dogged by advocates who have complained that he has sold out.

Instead, the president proposed what he called the public option, a government-run insurance plan that would coexist with private plans on a new health insurance exchange. For many on the left who are also dissatisfied with a deal the White House cut with the pharmaceutical industry, the public option was itself a compromise.

Now that the Senate Democratic leadership has stripped the last vestige of the public option — the Medicare buy-in provision — from its bill, progressives are feeling doubly betrayed.

“It’s time for the president to get his hands dirty,” Representative Anthony Weiner, Democrat of New York, said in a statement this week. “Some of us have compromised our compromised compromise. We need the president to stand up for the values our party shares.”

The passion is most intense in the House, but it appears to be spilling over to the Senate. In an interview on Thursday, Mr. Sanders, another advocate of a single-payer system, said he was not certain how he would vote on the bill, though Democratic leaders have been assuming he would back it in the end.

“I don’t sleep well,” Mr. Sanders said. “I am struggling with this issue very hard, trying to sort out what is positive in this bill, what is negative in the bill, what it means for our country if there is no health insurance legislation, when we will come back to it.”

The senator added, “And I have to combine that with the fact that I absolutely know that the insurance companies and the drug companies will be laughing all the way to the bank the day after this is passed.”

The White House insists that is not the case. Aides to Mr. Obama argue that the bill includes a variety of consumer protections — like ending lifetime coverage caps and the practice of refusing patients with pre-existing conditions — that will make insurers unhappy.

“People need to put this in perspective,” Dan Pfeiffer, Mr. Obama’s communications director, said in an interview on Thursday. “Two years ago, the Democratic Party would have done anything for the opportunity to pass a health care reform like this. Let’s realize how far we’ve come, and how close we are to making history.