Well. It’s been another tough few weeks for Obama – to say nothing of his increasingly frazzled cheer squad, watching from the sidelines, thermos untouched by their side, hand-made banner wilting from lack of use. Mired in a struggle to get a fairly modest set of health-care reforms through, the Prez was sidetracked by the messy arrest of black academic Henry Louis Gates, and a subsequent intervention therein. As a third whammy, the new front in the Afghan war is already starting to bog down — as it inevitably would — the stimulus package has not kicked in yet, and may well be vastly less than is required, and, well isn’t that enough?

Health care is the big one, the fight that Republicans think will break Obama if they can win it — just as it broke Bill Clinton’s first presidency, as the GOP took control of Congress, and launched a full-scale war against the executive branch. Hillary Clinton’s health care plan at that time was a complex system, which edged towards a dominant public option — and more importantly imposed a vast series of standard pricings and conditions on private insurance.

The aim was to stop average Americans being cheated and gouged by Big Health, but if it ever had a chance of getting through Congress (when it was still controlled by Democrats) that was killed by the Clintons’ high-handed “take it or leave it” approach — brave, and the sort of thing that sections of the left are demanding of Obama, but suicidal in the face of a Congress of members permanently running for re-election, and drip fed by Health system donations.

Obama’s model is more modest than that — but still a big ask for the American system. At the core of it he wants a “health care exchange” — a fancy-pants way of saying that a public health insurance plan would always be available to any American who wanted to purchase it (together with the Medicare system for low income earners), and that people on crap existing plans could jump out of them into the public system. Unlike Oz Medicare, the public plan is just one plan among many, paid for out of general tax revenue, rather than a universal specific levy.

The fact that Obama has got centrist “Blue Dog” Democrats even talking and negotiating about this means that he has got genuine universal health care provision closer to fruition than any President since the attempt was first made under Harry Truman. But almost jumping over a crevasse ain’t much of an achievement, and failing to get the system up would be a big blow to his Presidency. The safer option would have been to leave the US system in private hands, subsidise plans for low income earners, and mandate it in the same manner as car insurance.

But the result would be to put even more power in the hands of Big Health, with concomitant increase in service costs etc — making the most expensive, least effective major health care system in the advanced world even worse. A public option would help introduce actual competition into the system, which is why Big Health hates it so much.

Obama wanted a vote on the proposal before Congress ends its summer session in August — but that relied on getting an assent from centrist Democrats, and a couple of friendly Republicans. It’s a measure of the difficulties of getting the thing up, that even the House of Reps — where the Dems have a 70+ seat majority — is looking tough to get. The “Blue Dog” Democrats — Senators and Reps mostly in districts or states who voted for McCain in the presidential race — want a far more limited programme, using “health care co-operatives” to provide plans for those who can’t afford anything other than the most basic care.

This would be provided by private companies offering a pooled system, shouldering the burden of customers likely to cost more than they can pay over time — but still leaving provision in the hands of a private company (worse, a monopoly of private companies). They’re also baulking at the trillion dollar cost over ten years, and a host of other, smaller, concerns.

The Republicans hope — and have said, foolishly, publicly — that the health care thing will break Obama. That’s unlikely — the Democrats will come to some deal by the vote (now pushed back to December) and the White House will make whatever compromise necessary to get something passed, that they can call a major health care reform. The issue is currently the subject of a phenomenal proxy war between groups opposed to the bill at all, and those supporting it, with TV ads, mailouts, door-knocks etc covering the nation.

The GOP’s fear campaign — that overnight the US will become a health care North Korea — is undoubtedly having an effect, but so too is a no-nonsense campaign directed at the Blue Dogs, to let them know that they will be unseated in party primaries, if they simply try and kill the bill.

There’s a lot of kvetching about Obama’s leadership on the issue — an underwhelming press conference that failed to deliver the inspiring whoosh people wanted — but which was designed to not up the pressure on the Blue Dogs, such that they would feel no choice but to vote health reform down under any circumstances. But coming on top of the angst created by his comments on the false arrest of black Harvard professor Henry Louis Gates — calling the undoubtedly stupid and possibly racist white cop who arrested the man in his own home, uh stupid — which were uh, uh stupid, there was concern that Obama was not performing as well as he could under the slow shit-rain of a continuing Presidency.

He recovered as well as he could — calling the cop, asking him down to the White House for a beer — which showed a touch of the old Obama, and the NUBO rule (Never Underestimate Barack Obama) holds, but it is tough times, with the smell of blood in the water.

Worth considering as the Rudd government extends the federal system to all hospitals, that Americans are shrieking about a system that would minimise the number of their fellow citizens who are sent home to die, of easily curable conditions (about 15,000 last year). God bless America, because someone needs to.