Doctor is Out: A base-less drive for Obama, as Dean roils health care debate

ABC News’ Rick Klein reports: The public option died this week. We don't yet know if it's the week's biggest casualty.

Between health care reform and his sliding poll numbers, the danger for President Obama is that he's entering a base-less stage of his presidency, as he presses his top priority.

The independents who powered him to victory are fleeing; just 43 percent now approve of his job performance, in the new ABC News/Washington Post poll.

Democrats are still supportive — but the liberal base is growing anxious over health care, which has seen its favored flavor of soup watered down beyond recognition. The Senate bill (if you can call it that before it's back from the Congressional Budget Office) went from a public option to a Medicare expansion to none of the above — mostly to assuage one senator who's particularly loathed by the left.
 
Enter Howard Dean — still a force in the progressive movement. (And still not a friend of Rahm Emanuel's.)

The left now has a powerful spokesman for the argument that's been building for weeks. Even if Russ Feingold and Bernie Sanders and Roland Burris aren't with Dr. Dean, this is a tough way to pass a bill.

"Decisions are being made about the long-term future of this country for short-term political reasons, and that's never a good sign," the former DNC chief told ABC's George Stephanopoulos on "Good Morning America" Wednesday.

"This is a bigger bailout for the insurance industry than AIG," Dean added. "At this point, the bill does more harm than good. … This is an insurance company's dream."

For the record, the White House position on health care is far closer to Joe Lieberman's than Howard Dean's. Yes, only one of them gets a vote. But only one of them is a Democrat, too.

In this context, deadlines take on new significance. Allowing the skepticism and the outright opposition to build on the left — that's no recipe for happy holidays.

The backdrop — the president is down into thin air at 50, in the new ABC News/Washington Post poll: "A double punch of persistent economic discontent and growing skepticism on health care reform has knocked Barack Obama's key approval ratings to new lows, clouding his administration's prospects at least until the jobless rate eases," ABC Polling Director Gary Langer writes.

"Fifty percent of Americans in this ABC News/Washington Post poll approve of the president's work overall, down 6 points in the last month; nearly as many, 46 percent, now disapprove. On the economy, 52 percent disapprove, a majority for the first time. On the deficit, his worst score, 56 percent disapprove."

On health care, "A bad-news majority for the first time," ABC's Jake Tapper said on "Good Morning America" Wednesday, with 51 percent saying they disapprove of the health care reform efforts.

The Washington Post's Dan Balz and Jon Cohen: "After a year of exhortation by President Obama and Democratic leaders and a high-octane national debate, there is minimal public enthusiasm for the kind of comprehensive changes in health care now under consideration. There are also signs the political fight has hurt the president's general standing with the public."

"The erosion in the president's standing has been driven by continued slippage among political independents, particularly among independent men. For the first time, a majority of independents disapprove of his overall job performance, and independents' disapproval of his handling of health care and the economy tops six in 10," they write.

There's always the left — right up until the moment there isn't.

"Congressional liberals are getting kicked in the teeth repeatedly on their way out of town for the holidays," Roll Call's Steven T. Dennis and Emily Pierce report. "Are they getting a public health insurance option? No. Medicare buy-in? No. That jobs package? Not so fast. Don't even ask about cap-and-trade."

"Liberals signaled on Tuesday that they would hold their noses and vote for a version of the measure that would strip out some of their most cherished provisions, including an expansion of Medicare and the possibility of a government-run insurance plan. But the House seemed unwilling to fall in line," Sheryl Gay Stolberg and Robert Pear report in The New York Times.

"Democratic leaders focused on keeping progressives' disappointment and anger in check so the Senate could quickly pass a bill before Christmas deadline," Lisa Wangsness and Susan Milligan write in The Boston Globe.

Sen. Dick Durbin, D-Ill.: "They're not happy. I'm not happy. … We just don't want to lose the opportunity, the once-in-a-lifetime opportunity."

Realities: "Congressional and White House sources tell ABC News the Obama administration has been urging Majority Leader Harry Reid, D-Nev., and Senate Democrats to give in to moderate holdouts and to move forward with a scaled-down bill that includes no public option and no Medicare buy-in," ABC's Jonathan Karl and Devin Dwyer report. "The question is whether Senate liberals will agree, and, following that, if liberals in the House — many of whom have said they would vote ‘no' on any bill without a public option — will go along as well."

"The president firmly told Democrats: The time for bickering is over," Karl reported on "GMA" Wednesday. (And it will have to be just Democrats: Karl reports that Sen. Olympia Snowe, R-Maine, "doesn't like this latest compromise" and is "poised to vote no.")

The man in the middle — in more ways than one. "Depending on one's point of view, [Sen. Joe] Lieberman might be a turncoat who deserves to be booted from the Democratic caucus for good. Or he's a critical moderate voice who's protecting Democrats from far-left elements inside their own party," per ABC News. "On this, both sides agree: Lieberman himself couldn't be happier."

Back on the left — Rep. Anthony Weiner, D-N.Y.: "We need the president to stand up for the values our party shares. We must stop letting the tail wag the dog of this debate," Weiner told The Wall Street Journal's Greg Hitt and Janet Adamy.

Rep. George Miller, D-Calif.: "We in the House have made a beautiful souffle, but the Senate has scrambled an egg," Miller told the Los Angeles Times' Janet Hook and Noam N. Levey.

A bit broader: "House Democrats' long-simmering frustration with the slow pace of the Senate has begun to boil over, with a broad swath of Democratic representatives accusing their Sen ate colleagues of failing both their party and their country," Politico's Patrick O'Connor and Manu Raju report.

But … the towel looks tossed: "Reid does not have the votes for a public option, so in a world of alternatives you've got to focus on what you can get," said House Majority Leader Steny Hoyer, D-Md.

For those who need another excuse to be disappointed — the drug reimportation amendment failed Tuesday: "Even before the vote came, it had become clear that President Obama's aides had the votes to kill the proposal Senator Obama once co-sponsored," The Washington Post's Dana Milbank writes. "Tuesday's final clout tally wasn't even close. The drug companies won with nine votes to spare."

Not that the fight is over in the Senate: "I'm not on the bill," Sen. Ben Nelson, D-Neb., still concerned about the abortion language, told Politico's Carrie Budoff Brown. "I have spoken with the president and he knows they are not wrapped up today."

Launching in Pennsylvania: a TV ad from the Susan B. Anthony List, playing Sen. Bob Casey, D-Pa., against his late father, on abortion coverage. "Who Shall Live?" the ad asks.

And that final potential complication: "A more pivotal player could be the nonpartisan Congressional Budget Office. Its staff is in regular contact with senators, who routinely tweak and drop provisions in their legislation after CBO advises them it could be too costly," McClatchy's David Lightman reports.

Michael Gerson, in his Washington Post column: "Democratic health reform legislation promises everything to everyone while imposing a series of hidden burdens to make a massive new entitlement affordable, at least on paper. So its authors are in a game of beat the clock: Pass the legislation before those burdens are fully disclosed to the public."

Crowding: "While the decision to put off the debt fight — as well as potential clashes over highway construction, antiterrorism laws and satellite television rights — takes Congress off the hook for now, it significantly complicates the Democratic calendar for 2010," The New York Times' Carl Hulse writes. "Democrats now will have to resolve all those policy disputes while preparing for a vote on President Obama's request to add 30,000 troops in Afghanistan and, perhaps, still wrestling with health care. At the same time, the delay pushes some of the more politically delicate issues, like as an increase in the debt limit, that much closer to the November elections."

It's crowded in 2009, too: "President Barack Obama used the backdrop of a suburban Virginia Home Depot Tuesday to press his plans for job creation, the third event in four days in which the president has tried to show his concern for economic woes on Main Street," The Wall Street Journal's Jonathan Weisman and Elizabeth Williamson write.

"But political realities are clouding Mr. Obama's efforts. On Tuesday, House Democratic leaders unveiled a $75 billion job-creation package that doesn't include the two new ideas the president proposed last week: tax rebates for home energy-efficiency renovations — dubbed ‘cash for caulkers' — and tax credits for small businesses that hire new employees."

Perfect time for immigration reform: "I think it's critical," Rep. Yvette Clarke, D-N.Y., a co-sponsor of the newly introduced immigration bill, said on ABC's "Top Line" Tuesday. "It's a winner for the American people."

New title for Ben Bernanke, on the eve of the Senate Banking Committee's consideration of a second term for the Fed chief: Time's Person of the Year.

Wednesday in Copenhagen — Sen. John Kerry, chairman of the Senate Foreign Relations Committee, is in town. His speech (already delivered) takes on the Chinese, as well as his fellow senators:

"Some of my colleagues in Washington remain — like some leaders elsewhere — reluctant to grapple with a climate crisis mostly measured in future dangers and parts per million, when they're confronted every day with the present pain of hard-working people in a tough economic time," Kerry planned to say, per USA Today's Kathy Kiely.

"To pass a bill, we must be able to assure a senator from Ohio that steelworkers in his state won't lose their jobs to India and China because those countries are not participating in a way that is measureable, reportable and verifiable," he adds.

What Obama's set to arrive at, on Friday: "The possibility of failure was in the air — the UN climate chief symbolically carried a life preserver to an early afternoon press conference — because so much needs to be done," The Boston Globe's Beth Daley writes.

Sarah Palin, swinging back at Gov. Arnold Schwarzenegger, R-Calif.: "Why is Governor Schwarzenegger pushing for the same sorts of policies in Copenhagen that have helped drive his state into record deficits and unemployment?" she posts on her Facebook page. "And while I did look for practical responses to those changes, what I didn't do was hamstring Alaska's job creators with burdensome regulations so that I could act ‘greener than thou' when talking to reporters."

Wednesday marks the 2009 New Hampshire debut of Gov. Tim Pawlenty, R-Minn. (and the first-ever trip by Alex Conant).

Roiling the landscape in Florida — a poll that has Gov. Charlie Crist, R-Fla., tied with Marco Rubio in the GOP Senate primary.

Staying put: "Spokespeople for Reps. Ike Skelton (D-MO) and Tim Holden (D-PA) say the incumbents will seek another term. Rep. Rick Boucher (D-VA), another incumbent the NRCC has been pressuring to step aside, refused to confirm whether he will run again," Hotline's Reid Wilson and Erin McPike report. "Meanwhile, other potentially vulnerable incumbents have also assured the DCCC they are staying put. Reps. Ben Chandler (D-KY), Jim Matheson (D-UT) and Chet Edwards (D-TX) all told Dem leaders they would seek additional terms. A spokesperson for Rep. Lincoln Davis (D-TN) later said he will run for re-election as well."

Smart take — on why the Houston mayoral race matters: "The landmark election Saturday of America's first big-city lesbian mayor in Houston represents more than just a milestone in identity politics," Jonathan Martin and Ben Smith write for Politico. "It also signals an unmistakable evolutionary step in n ational politics, one that provides further evidence of a trend that helped make Barack Obama president: growth-oriented communities like the Texas metropolis, rather than aging big cities or nostalgia-inducing small towns, are setting the course of the country's political direction."

The Kicker:

"Why don't we all begin to have some fun? … Let's pass the bill." — President Obama, in his caucus meeting with Democrats, as quoted by The New York Times.

"We welcome the scrutiny from the press." — President Obama, not taking any questions on a health care bill that even most senators have not actually seen.

For up-to-the-minute political updates check out The Note's blog . . . all day every day:

http://blogs.abcnews.com/thenote/