Huffpost Politics
Sam Stein Headshot

Barack Obama, Campaign Manager: How The 2008 Playbook Passed Health Care

Posted: Updated:

Shortly before 11 a.m. on a Sunday in mid-December, Senate Majority Leader Harry Reid was driving through Washington D.C. when he received a nervous phone call from one of his trusted deputies, Sen. Chuck Schumer.

Schumer wanted to know if Reid had seen Sen. Joseph Lieberman's comments on "Face the Nation" that morning. "Lieberman seemed to draw a line in the sand," the New York Democrat relayed. "You should check in with him. He seemed to rule out supporting the bill if it has the Medicare buy-in."

Reid immediately called a staffer to get a transcript and find out if Schumer had it right. He did.

"Alright, I'm headed to the Capitol," the Majority Leader told the aide. "See you in half an hour."

A nearly year-long effort to shepherd comprehensive health care reform legislation through Congress faced a crucial hurdle. Throughout the past week, Reid and Schumer had worked with a group of ten Democratic Senators (five progressives and five moderates) to craft a compromise proposal in place of the public option -- the government-managed insurance plan that had proved too controversial to get past a filibuster. Lieberman had been part of that group. And while in the closing days he had been sending a staffer to negotiations in his place, he had given both Reid and the White House assurances that he'd support an alternative plan that would allow people over 55 to buy into Medicare.

Now, suddenly, Lieberman was announcing on national television that he "would have a hard time voting" for the deal even though he didn't know exactly what was in it.

Making his way toward the Capitol, Reid phoned White House Chief of Staff Rahm Emanuel to discuss the news. "You need to come up here. We need to talk," he said. The hyper-energetic Emanuel, who was in a car as well (driving his son home from his bar mitzvah class) told Reid to hold steady for the time being. "I'll be over to your office soon."

By noon, Emanuel had arrived at the Capitol, dressed in blue jeans and with a cup of coffee in hand. Sitting in an office close to the Senate chamber, Emanuel, White House legislative adviser Phil Schiliro, as well as Reid and Sen. Max Baucus laid out the options (Schumer would arrive from New York City shortly). They could go back to Sen. Olympia Snowe, the one Republican who had offered support for reform. But that would require a dramatic restructuring of the bill.

"He just wasn't honest with me," Reid muttered at one point.

Also en route to the Capitol -- at the summoning of Reid -- was Lieberman, a Senator who once stood in line to be the party's vice presidential nominee but now found himself on the outskirts of his own caucus.

The Senate Majority Leader wanted to call Lieberman's bluff, bring the bill to the floor and force him to vote it down. Dare him to be the one to kill reform, the thinking went.

But before it could happen, Emanuel stepped in. "We need to get it done," he told Reid, according to multiple sources briefed on the exchange. The end game was clear: the Medicare buy-in or any other iteration of a public plan would not get in the way of legislative progress.

When Lieberman finally arrived at the office, Emanuel spoke to him just as directly. "Find a way to get to yes," he said, before insisting that if the objectionable provision was dropped, Lieberman would have to get off the fence.

A deal was reached. Health care reform survived.

* * * * *

Months removed from the debate, aides still recall those tense hours on December 13 as one of the clearer illustrations of how the Obama administration attempted to move health care reform through Congress. Over the course of a year, the president had pursued a lawmaking philosophy that was, at once, hands off and reactive, comprehensive and flexible. It was a tack unique to recent presidents. Whereas Bill Clinton viewed Congress as a house of pawns that needed to be massaged and maneuvered, often against their will, and George W. Bush saw his role as ideological compass around which lawmakers united or revolted, Obama seemingly took a hybrid approach. He provided rules of the road but avoided, at all costs, overbearance.

What exactly the president's overarching theory of governance was, however, remained largely a mystery. To this day, actually defining the Obama legislative doctrine is a difficult task, in part because different people have different interpretations. Not everyone, in fact, is sure an actual doctrine exists.

But in more than two-dozen interviews with key negotiators, lawmakers, strategists and White House officials, a common theme did emerge. For the President and his key staff -- many of whom had been with Obama as he plotted his political trajectory years earlier -- the legislative process was derived primarily from the approach they took to electoral politics. The headquarters were different (the West Wing instead of Chicago). And the campaign dealt with a massive piece of domestic policy rather than an actual candidate. But the game-plan came from the same textbook.

"It's having a long-term strategy and working backwards from that," explained Communications Director Dan Pfeiffer during an interview in his West Wing office.

Success would be premised on building blocks. Moving the health care bill through the complicated committee process would be the equivalent of winning the Iowa caucus (necessary, as both were, for at least keeping Obama's prospects alive). Persuading lawmakers to back the bill throughout 2009 would be like the delicate chase for superdelegates in 2008. The final vote, in turn, was Election Day.

The tactics, likewise, were similar. There were core messages designed to appeal to moderates and activists alike (deficit reduction and expanded coverage). There was a clear invocation of this historical nature of the effort. And when presented with a numerical value for success -- in this case, 60 votes in the Senate -- the president and his team relied more on calculated maneuvering than big sells. Instead of pushing the entire caucus behind health care reform, they worked with individual members based on their relevancy to the process. It was the difference between trying to win every primary election and prioritizing states with strategic delegate yield.

More than any other mindset borrowed from the campaign, however, was the sense that politics is a sport of transactions. Handed a political landscape of broad competing interests, the best way to navigate is to offer a broad but concrete goal and jump hurdles. The only thing not to be compromised is success itself, in part because failure would prove so crippling.

"First and foremost, passing health care defined the ability of us as a country to govern ourselves," said Neera Tanden, a domestic policy adviser for the White House throughout most of the health care battle. "People forgot that when we face an imminent disaster this country actually could act."

Over the course of a year, tension-filled negotiations, expletive-laced meetings, and stubborn lawmakers with provincial demands would put this legislative philosophy to a test. But when health care reform was signed into law -- with Vice President Joseph Biden underscoring to the president just what "a big fucking deal" it was -- the close circle of Obama advisers viewed it as a decisive affirmation of their legislative doctrine.

"There were places along the way that people would take a step back and say 'do we need to revisit our assumptions,'" former Communications Director Anita Dunn told the Huffington Post. "But the overall strategy... has basically been confirmed by events."

If a campaign mindset was what infused the White House entering the debate in the winter and spring of 2009, there were two notable folds. The first was that not everyone was sold on the campaign. Emanuel and Vice President Biden both urged Obama not to tackle health care reform in his first year, wary as they were about the sagging economy and the history of presidential failure on this front. The president overruled them both. But when he did, the second fold came into play. The administration decided to borrow, from all places, a decidedly Clintonian campaign approach with respect to health care. In order to get legislation passed, it would paint success as a forgone conclusion.

"It was 'the inevitability narrative,'" explained one White House official, borrowing a phrase used to describe Hillary Clinton's run at the White House in 2008. "The purpose was establishing an idea that everyone was on board reform."

During the early meetings, the president's inner circle outlined an elaborate effort to "defang" the opposition. Aides relayed a message to various interest groups: play a constructive role or none at all. In public, the president went out of his way to flatter traditional opponents. In private, his team was willing to play hardball with industry players to get their support. "You start badmouthing the bill and you will be cut out of the conversation," is how one industry lobbyist who dealt with the White House put it.

Early on in the process, for example, White House officials proposed cutting a deal with the drug-making lobby. If PhRMA would chip in $100 billion over ten years in reform money, the government wouldn't use its purchasing power to lower prescription drug prices. The industry bristled at the price tag. Obama's chief strategist David Axelrod thought it was a poor politics -- why not make reforming the prescription drug market a rallying point for reform? But Emanuel and his deputy, former Baucus Chief of Staff Jim Messina kept pushing the deal's virtue: a way to lower reform's cost and disarm a potential opponent. Eventually the two parties settled on an $80 billion figure, which held up until the end of the legislative process, when the president asked for (and was granted) a concession of an additional $10 billion.

For a while, arrangements like these helped fulfill the storyline of reform's pre-ordination. But as the August recess approached, confidence faded. Progress on the Hill wasn't mirroring that taking place off of it. Early talk of a landslide 70-vote victory in the Senate was replaced with an effort to get just one Republican vote. Within the president's close circle of advisers the question was posed: Should the party go it alone?

"There were some folks who said just throw the bill out there and see what happens, knowing you maybe don't have the votes secured," a top Senate aide who worked with the White House recalled. "People like [Phil] Schiliro were pushing that approach... Other folks said it was better to be careful before putting something on the floor."

Patience prevailed, but not without igniting further frustrations. In a weekly meeting with outside groups at Washington's Hilton Hotel, Emanuel barked at progressive allies for airing television advertisements against Democrats. His anger was thought to be over attacks being run against recalcitrant Senate Democrats. But Emanuel was actually steamed that the group MoveOn.org had gone after three Democratic members of the House Energy and Commerce Committee for not backing the committee's bill. His message was direct. It was "fucking stupid" to punish the home team.

It was a study in the administration's campaign mentality. MoveOn held the (hardly-radical) belief that if a historic enterprise like health care reform were to pass, it would and should be done with caucus unity; outliers should be forcibly brought into line. Emanuel, by contrast, viewed the vote through an electoral lens. Lawmakers who backed the wrong candidate in a primary could be won over during the general election. Democrats who were bucking reform now simply needed to be won over later. The last thing the president needed was allied groups alienating lawmakers months before health care's Election Day arrived.

* * * * *

A week after the histrionics that surrounded Lieberman's opposition to the Medicare buy-in provision, another fire erupted involving a conservative Democrat.

It was December 18, 2009, and Jim Messina had reserved the White House's theater so that he and college friends could watch their alma mater, the University of Montana, play Villanova in their division's college football championship game. It was a Friday and the winter's first crippling blizzard was about to hit the capital. But before he could ready himself to watch the game, Messina was called to the Hill. Nebraska Sen. Ben Nelson was worried about the bill's supposedly-lax abortion language.

The House of Representatives had earlier passed its version of reform, which contained sweeping restrictions on the ability of insurance providers to offer policies that carried abortion. Nelson, a close ally of the Catholic bishops and abortion rights foe, wanted equally tough language, even after his amendment offering a mirror image of the proposal failed. It was the last major hurdle in the Senate and both the White House and Reid had serious doubts that it could be overcome.

Negotiations, which had already started and stalled twice that day, began again in haste. Nelson was sequestered in Harry Reid's office, while one of the caucus's strongest backers of abortion rights, Sen. Barbara Boxer, was in an office down the hall belonging to Reid's chief of staff. In between was a brigade of staffers and White House aides, including Messina, White House senior adviser Pete Rouse and Jeanne Lambrew, the deputy director of the White House's Office of Health Reform. Joining them in the de-militarized zone was Schumer and, on occasion, Sen. Patty Murray.

For several hours, Reid, Rouse, Schumer and occasionally Mesina would work on Nelson, trying to hash out abortion language that could win him over. The group would then walk over to Boxer to get her feedback (which, as one source described it, could be measured best on a "rip-shit meter"). As this happened, Lambrew worked off a laptop, making changes to the language and phoning experts to run the new wording by them.

Messina grew antsy. Somehow, with the help of a Reid staffer, he found the Montana game on one of the office's small television sets. With only nuts, stale cookies and a Starbucks cheese platter to snack on, he grabbed glimpses of the game. By 8:45 p.m., Nelson -- who is friendly with Boxer but was directed not to deal with her directly on this topic -- had all but agreed to a compromise. But before he signed off on the final deal, he wanted to talk to pro-life figures in his state.

The Senator left and for nearly an hour was unreachable. "We called his office," said one person who was in the room. "No one knew where he was." When he finally reemerged it wasn't entirely clear if the deal had survived. Quizzical looks were shot between the respective staffs. Finally, the tension dissipated. The senator would support a less-restrictive proposal than the House version, but one that would still require those who received federal subsidies to purchase insurance that covered abortion with private funds.

Gathered in Reid's office, the group exchanged hugs and, in Boxer's case, tears of joy. A phone call was made to the White House to discuss the news with the president. "I've got Senators Boxer and Nelson here," Reid said, placing the call on speaker.

"Good job Harry," Obama replied. "I'm glad we got this done."

And then, awkwardness. Neither side was entirely sure if the talk was over or how, exactly, to end it. After a bit, Reid (an uneasy phone conversationalist) and Obama (apparently one himself) simply hung up their respective lines. Messina managed his way through the now-heavy snowfall back to the White House in time to catch the last minute of the game. Montana, the number one seed, lost 23-21.

That Obama was not personally involved in those negotiation sessions was by design. To have the president in the room at the time (or to host the meeting in the White House) would be to draw additional heat and attention to a meeting that, officials recognized, needed neither. More than that was concern over the heavy-handed message it would have sent to Senate leadership and the lawmakers at the heart of the dispute.

This too was an approach borrowed from the campaign trail. Throughout his run for the White House, Obama adopted an aura of being above and detached from the everyday drama that accompanied politics. When events conspired against him, he was rarely reactive (sometimes, his supporters thought, to a fault). Often, his defacto response to an individual crisis was to let it run its course.

With health care reform, this meant delegating many key responsibilities. The president would not introduce his own bill (though his staff did write an 800-page proposal that aides were ordered to keep absolutely secret -- "If this gets out, I'll fucking kill you," Emanuel told those in the know). Instead he would give the reins to congressional allies and avoid interjecting unless his help was requested. This left members feeling respected and valued, with a sense of ownership of the process.

It also created a vacuum for steady leadership. Asked to describe the experience of passing health care into law, several months after it happened, Majority Leader Reid drew the analogy of an unevenly flowing river.

"I floated the Colorado once through the Grand Canyon," he explained. "And that's what health care was kind of like. 'Oh, it's so nice,' and then BANG you hit those rapids and it throws you up in the air and 'oh man, I'm glad I'm alive.' That's kind of health care."

Still, the White House knew the pitfalls of having Obama appear heavy-handed. A group of high-ranking aides under Obama (chief among them Emanuel) had front row seats to Bill Clinton's attempt to pass health care reform during his first term in office. And if the memory of that failure had since faded (perhaps deliberately excommunicated from the mind) there were plenty of reminders once Obama decided to take up reform. Aides recalled sobering counsel they received during the early months of 2009 from Paul Begala, the longtime Clinton confidant and energetic cable news presence.

"The worst piece of advice I ever gave," Begala would say, in a pitch that became familiar to Senate staffers and White House aides alike, "was to tell President [Bill] Clinton to wave his pen at Congress in '94 and say 'If you send me legislation that doesn't guarantee universal coverage I'll veto it.' It was one of those things that doomed the Clinton bill. And I carry a great deal of responsibility for that."

For a staff already wary of tackling health care reform in the first place, Begala's confession was like a clarion call. If they were going to move legislation through congress, the president would show the utmost deference to the legislative process. "I think, being candid about it," Begala would recall more than a year later, "it opened up people's ears."

Both Nelson and Lieberman tested this approach, as did progressive allies who routinely begged administration officials to ramp-up Obama's involvement. One top-ranking Democratic operative recalled going to the White House in early June, urging them to deploy the president on hesitant lawmakers. "We are not going to waste his capital now," was the reply she received. Obama would be used to close the deal. "People think he's like Jesus up there [on the Hill]."

The administration was committed to the game plan. And if the campaign had taught the tight-knit Obama crew one lesson, it was to downplay criticism, avoid over-reaction and, above all, project confidence and rationality.

"He respects the legislative process," explained Dunn. "He understands that there are times when you can basically say to Congress 'this is it, this is what I need.' Or you get on the phone with people and say 'No, you have to vote for this.' And there are times when you have to put yourself in the other person's shoes and look at it from their perspective and think about what can make this a better vote or an easier vote for them."

* * * * *

There were notable exceptions. As in the campaign, Obama would put his thumb on the scale during moments of particularly acute crisis. He became the chief recruiter of Sen. Olympia Snowe as she emerged as the one option for a bipartisan bill. Following the contentious August recess, when a wave of town hall protests put the inevitability narrative fully to rest, it was Obama who decided to deliver a major address before a bicameral gathering of Congress. When House progressives were brimming with frustration over the state of health care in the Senate, the president held court with them in the Roosevelt Room for an hour, going through their concerns member by member

"You are going to figure out how to take yes for an answer," Obama would tell members of the Progressive, Black, Hispanic and Asian Pacific American caucuses at that October 30 meeting. "Everyone is going to have to give something up, including me."

But in entering already heated debates, even the cautious and diplomatic Obama found himself occasionally provoking additional anger. Speaker Pelosi, for one, was incensed when the president declared during that bicameral speech that health care reform should cost around $900 billion. She quickly demanded that administration officials come to her office and explain what seemed to be an arbitrary price tag and an implicit endorsement of the Senate's bill.

A more contentious moment came during a gathering of union leaders in mid-January. By that point, the president's preference for a tax on high-cost health care plans was well known. But he had done little to temper labor's protests. The friction was obvious. Not only would the tax hit negotiated union contracts, Obama himself had launched blistering attacks on the proposal when it was part of Sen. John McCain's platform in 2008. (Axelrod would tell associates it was the campaign ad that tested best with voters).

On January 11, the president brought a group of more than a half-dozen union presidents to the White House to remove any lingering doubt. "There will be an excise tax," he declared, according to one attendee.

"I'm committed to doing it," another attendee had him saying. "And I need you guys to be on board."

The crowd wasn't sold. AFL-CIO President Richard Trumka, seated across from the president, shot back that the tax was "bad policy and bad politics" pointing to the percentage of middle-class workers (even the non-unionized) who would be hit. Anna Burger, the executive director of union campaign arm, Change to Win, brought up Deb Lovell, a state worker in New Hampshire and wife of a chronic myelogenous leukemia patient, who despite earning $30,000-a-year salary would see her health care plan taxed under the proposal.

The President conceded that taxing people like Lovell was not the design and promised to look into Burger's point. But he continued pitching the tax as necessary for keeping health care costs under control. "He was persuaded to do health care, I believe, by Peter Orszag [the budget director], not Ted Kennedy [the moralist former Senator]," is how one White House ally put it.

Trumka refused to let the argument go, pushing back on Obama point by point. Several people briefed on what happened said that after the discussion ended other union leaders told Trumka that he came off as "disrespectful" to the president. To which he replied: "If telling him the truth is disrespectful, then I have to be disrespectful."

At an impasse, Obama scheduled a meeting for the next day with the same group. But in this one, his deputies would lead the conversation, and union staffers were not permitted to attend (the White House thought that staffers would expand the conservation to topics beyond the excise tax). This didn't diminish the fireworks. As Jason Furman, the White House economist and excise tax booster, continued to push the proposal, Trumka reached a tipping point.

"Don't fucking bullshit me," he demanded.

And yet, for all the drama, negotiations succeeded. Obama agreed to raise the threshold for which plans the tax would hit and delayed the date for when it would kick in. The labor leaders returned to their members comforted that they could now restructure contracts before they were taxed. But what had compelled them to cut the deal weren't just the policy concessions they'd secured, but also the president prevailing on them the importance of moving forward.

Coming, as it did, so late in the process, Obama's diplomacy was at once refreshing and persuasive. For months the president's team had largely skirted direct engagement, choosing instead to accommodate demands under the guise of advancing a bill. The infamous Cornhusker Kickback to Sen. Ben Nelson was one example. But there were countless others, including explicit messages sent to congressional leaders to give in to Sen. Evan Bayh's (D-Ind.) insistence that a tax on medical device manufacturers be scaled back.

Obama had been criticized during the campaign for a posture that -- while projecting calmness - seemed, at times, disengaged and allowed the opposition to define his candidacy. In process of passing health care reform, those criticism were shouted even louder. But in each case, the narrative changed and the skepticism diminished once the president's involvement was ratcheted up.

"The deciding factor for me was when the president decided he was going to fight like hell for this bill," explained former DNC Chair Howard Dean, a person who once called for the bill to be killed over the lack of a public plan. "The Democrat in me came out and said 'Look, if the president is willing to lead, I'm going to follow. Because this is about politics and I know which team I'm on.'"

Added Pennsylvania Governor Ed Rendell, shortly after health care was passed: "I think [the president] has learned that if things are going to move, he has got to be not only doing the broad brush but he has got to carve out with some specificity the details. They have got to be in the driver's seat, delineating that vision and saying where they want the train to go."

On the evening of Tuesday, January 19, Speaker Pelosi and Majority Leader Reid convened in the Vice President's office in the West Wing. The topic that night was an agreement to be unveiled the next day to create a bipartisan fiscal commission to look into tackling the debt -- the ceiling of which Congress was being asked to raise. But before discussions could conclude, there was an interruption. Emanuel entered the room asking the congressional leaders to come to a private meeting with the president.

As they walked to the Oval Office, the mood was grim. Polls had not yet officially closed in Massachusetts, but the White House had concluded they would lose Ted Kennedy's old Senate seat and with it, their filibuster-proof majority in the Senate.

"We're going to lose Massachusetts," Obama told the two. "I still want to get health care done. Nancy, can the House pass the Senate bill?"

For months, Pelosi had moved her caucus with dexterity. The legislation she produced was far more progressive than the Senate's. But for the past several weeks, a bicameral group of lawmakers had scrubbed portions away during negotiations to merge the Senate and House bills. Frustrations had erupted days earlier when, during a meeting at the White House, she dressed down her own ally -- Henry Waxman, chairman of the House Energy and Commerce Committee -- for suggesting he could live with even more cuts. Now the president was presenting her with the specter that she'd have to give in fully or get nothing at all.

"I don't know," the Speaker told Obama just hours before newly elected Senator Scott Brown would take the stage. "We need to see how this is all going to play out and I need you not to push me [publicly]. The House has to decide to do it on its own."

Getting legislation through the House of Representatives is a far different task than the Senate. In obvious ways it's a lighter lift: There is no filibuster. And yet, the members of the House are unwieldy and unpredictable. Since each of them run for re-election every two years, they feel particularly persuaded to go with the prevailing wind of public opinion. And, indeed, in the days following Brown's win, conservatives and liberal Democrats alike would declare reform dead, or at least too toxic to touch. Even Pelosi had her concerns. During a leadership meeting it was suggested that the House get 51 Senators to sign a letter committing themselves to revising their bill through reconciliation once it passed the House.

"It's got to be better than that," the Speaker said, according to a lawmaker present.

In the week after Massachusetts, the White House bowed to Pelosi's request for space and time. Privately, the outlook was darker than at any previous point. "The whole process had been absurd and this felt like the ultimate tragedy," recalled Pfeiffer. "Health care could die because a Republican had taken Ted Kennedy's seat."

Emanuel presented a Plan B. The president could go with a scaled down bill that -- while falling well short of the meaning of "comprehensive" reform -- would satisfy the more superficial desire for a legislative win.

During the campaign, Obama had been presented with crises that felt as existential as Scott Brown's win (notably the fiery sermons of his one-time pastor, Reverend Jeremiah Wright). And in each case he had chosen to 'go big' in response. When Pelosi dismissed Emanuel's counter-proposal as "Kiddy Care" his intuition was confirmed. Rather than back off, Obama barnstormed. He worked with progressive lawmakers to alleviate their concerns and plead for their votes. He met with the pro-life bloc to craft an executive order that met their demands. And he did his own variation of the "I feel your pain" pitch, elevating individual stories of struggles into referendums on private insurance practices.

Macro tactics were used as well. Over the course of the election, Obama had developed an astute sense of how to use public settings to contrast his position with that of the opposition. The debates he held with Sen. John McCain (R-Ariz.) had provided particularly compelling evidence that the president was the best rapid-response agent the administration had. So when the Republican caucus was set to host Obama at a retreat in Baltimore, White House aides demanded (successfully) that the cameras be let in too.

After introducing his own legislative proposal for reconciliation, the president made an even bolder gambit: proposing a lengthy bipartisan summit on health care reform at Blair House. Administration officials had actually considered unveiling the idea during the Obama's State of the Union address in late January, but ceding to Pelosi, they kept plans private. Now, with reform needing a boost in the House, the forum was pitched as the last-ditch stepping-stone -- an event that would, as one administration official put it, remove the "poison from the product."

In the end, seven hours of conversation on an unseasonably warm late February day provided congressional Democrats, and Pelosi in particular, that which they needed most: breathing room. It also proved to be a critical turning point in reform's fortunes.

"I don't think we could've passed health care without it," Pfeiffer said of the summit. "I really don't."

* * * * *

Shortly after the House voted the Senate's health care bill into law in the late hours of March 21, the president stepped before television cameras from the East Room of the White House. "Tonight," he declared, "we answered the call of history as so many generations of Americans have before us. When faced with crisis, we did not shrink from our challenge - we overcame it."

Earlier, Obama and his staff had toasted more than a year's worth of incomparable hours of work, toil and debate. On the other side of Pennsylvania Avenue, House Democrats, led by Pelosi, hailed passage of the biggest piece of domestic policy in more than forty years with hugs and cheers.

In the days that followed, however, not everyone found it easy to hide the bruises they'd endured. The party and the president had taken a deep hit in the polls. The labor community, which had elevated Obama to office in 2008, had left the process feeling slighted. Progressives felt a public option could have been passed either through reconciliation or over Lieberman's demands. Abortion rights activists, likewise, felt they had been forced to make ungodly concessions. Why, they asked, had Obama chosen the legislative path he did?

Removed from the heat of the battle, the question is easier to answer. Obama, at his core, saw and continues to see legislating as a distinctly political process: one in which goals are imparted, building blocks are set, and compromises are fair game on everything but success itself. His legislative doctrine is not static. As Dunn acknowledged, it became a "more aggressive operation" over time. But it is firmly rooted in the ethos that guided the presidential campaign -- an ethos that one administration official described as "The Art of the Possible."

"The president is not a revolutionary, he's a reformer," said Tanden, the former health care adviser to the president. "He's a person who wants to make progress. He's practical but will fight everyday to actually improve things. If you step back and look and ask: "Is it better to die trying or to get something done?" He's going to get something done."