He'll get some form of health care plan rammed through because it's key to permanently shifting America left.
For most of the previous presidency, the Left accused George W. Bush of using 9/11 as a pretext to attack Iraq. Since January, his successor has used the economic slump as a pretext to "reform" health care. Most voters don't buy it: They see it as Obama's "war of choice," and the more frantically he talks about it as a matter of urgency the weirder it seems. If he's having difficulty selling it, that's because it's not about "health."
As I've written before, the appeal of this issue to him and to Nancy Pelosi, Barney Frank et al is that governmentalization of health care is the fastest way to a permanent left-of-center political culture – one in which elections are always fought on the Left's issues and on the Left's terms, and in which "conservative" parties no longer talk about small government and individual liberty but find themselves retreating to one last pitiful rationale: that they can run the left-wing state more effectively than the Left can. Listen to your average British Tory or French Gaullist on the campaign trail, pledging to "deliver" government services more "efficiently."
So why can't the silver-tongued post-partisan healer seal the deal on this health care business? Surely it should be the work of moments for the greatest orator in American history to whip up a little medicinal Gettysburg, a touch of Henry V-in-the-Agincourt-casualty-tent, and put this thing away. Yet there he was the other night with the usual leaden medley of tinny grandiosity (all the this-is-the-moment, now-is-the-hour stuff), slippery reassurances (don't worry, you won't be "required" to change your present health arrangements), imputations of bad faith to anyone who takes a different view (they're playing "games"), and the copper-bottomed guarantee that you can have it all for no money down, no interest, no monthly payments, no nuthin' ("I will not sign it if it adds one dime to the deficit").
This would barely have passed muster four months back. After a summer of seething town halls and sliding approval numbers, it was a joke. Or, rather, it would be a joke if the president's intention was to persuade an increasingly skeptical, if not downright hostile, electorate. On the other hand, if the intention is to ram it down America's throat whatever the citizenry thinks, then the joke's on us.
If it was about "health care," it would be easier. It was assumed, for example, that the president's sly revision of "47 million people without health insurance" in his summer speeches to the substantially lower 30 million was a concession to those who said that his "plan" (he hasn't actually produced one, but why get hung up on details?) will cover gazillions of illegal immigrants.